We Call It ‘Rationing,’ Obama Calls It ‘Medicare Independent Payment Advisory Board’
Suppose Congress asked Americans: which government officials should decide what foods you would be allowed to eat and what prices you had to pay at the grocery store – Congress, or an unelected board of nutritional experts appointed by the president?
Most Americans would immediately reply, “Neither!” But that’s precisely the debate between Congress and the White House regarding President Obama’s proposed Medicare Independent Payment Advisory Board.
One of President Obama’s key proposals to reduce skyrocketing Medicare costs is a so-called Independent Payment Advisory Board (IPAB). The IPAB would consist of 15 members appointed by the president (and confirmed by the Senate), empowered to decide what medical tests and procedures Medicare would cover and how much it would pay providers.
As the Wall Street Journal notes, the IPAB’s decisions wouldn’t be subject to judicial or administrative review. They would go to Congress for an up-or-down vote, and would go into effect unless Congress adopted its own plan to reduce Medicare spending by an equivalent amount.
Supporters of the IPAB liken it to the Clinton-era independent Base Realignment and Closure Commission to reduce military spending free from political pressures from influential congressmen seeking to keep their own home district military bases open.
However, giving this power to the IPAB would put tremendous medical decision-making in the hands of unelected officials with minimal accountability. We’ve already seen a foretaste of this when a federal government medical panel attempted to save money by restricting screening mammography to women over age 50, even though decades of medical research has shown clear benefits to starting annual mammograms at age 40. Although the Obama administration stated that the IPAB would not ration medical care, its power to set payments to doctors and hospitals would give it de facto rationing power.
If the IPAB sets the reimbursement rate for services below the cost of providing it, then hospitals and doctors could no longer afford to offer such services — even if the services are medically best for their patients. Life-saving medical procedures we currently take for granted, such as PET scans to detect early cancers or minimally invasive methods to safely open up blocked vital blood vessels without risky surgery, might no longer be available. Although those services might still theoretically be “covered” by Medicare, in practice doctors would no longer offer them, and their patients would no longer be able to receive them.
Interestingly enough, President Obama’s proposal has aroused strong opposition from both Congressional Democrats and Republicans. But much of this opposition is based not on a principled defense of medical freedom for patients and doctors, but rather on Congress’ desire to retain for itself the power to decide what services should (or should not) be covered under Medicare.
If Congress makes Medicare coverage decisions, these decisions will be inevitably corrupted by special interest politics. We’ve already seen this in Massachusetts, where political pressure groups have engaged in ferocious lobbying to make sure their pet benefits are included in the government-controlled insurance plans that all residents must purchase. Since 2006, special interest groups have successfully lobbied to include 16 new benefits in the mandatory insurance package (including lay midwives, orthotics, and drug-abuse treatment), and the state legislature is considering dozens more. Such special-interest lobbying would merely expand to the national level if Congress is allowed to determine Medicare coverage decisions.
The fundamental problem is that Americans are being offered a false choice: “Which government officials should control what services Medicare patients can receive: a panel of unelected, unaccountable bureaucrats or elected politicians subject to ever-shifting special interest politics?”
Of course the correct answer is: “Neither.” Medical decisions should be made by patients and doctors, not by government officials. Similarly, financial coverage decisions for tests and procedures should be left to patients, providers, and insurers to determine in a free market.
Not to government central planners.
If the health insurance market were fully free (which it currently is not), insurers would be able to offer a wide range of packages varying from low-cost “catastrophic only” plans to expensive “gold-plated” plans that covered experimental treatments for every rare disease, and everything in-between. Similarly, patients would be free to decide whether they wanted to pay higher premiums while still healthy for guaranteed access to unusual expensive treatments if they needed it later, or if they’d rather save that money for more important life priorities (such as buying a new house or saving for their children’s education) in exchange for forgoing such costly end-of-life care that might only gain them a few additional weeks of life.
In a fully free market for health insurance, everyone would be free to purchase whatever level of coverage they desired according to their best rational judgment from any willing insurer. This would allow them to join voluntary insurance risk pools with others with similar preferences without imposing their choices on others with different priorities. Individuals have the right — and the responsibility –to make these important life decisions for themselves. The government should not be making these decisions for us.
Furthermore, in a fully free market the price of advanced medical technology would quickly fall over time, just as it has with consumer technologies like cellphones and computers and with advanced medical services in the least regulated (i.e., most free) sectors of medicine such as LASIK eye surgery. This is the natural outcome of a free market, where producers survive by competing to offer consumers the best value for their money. If Americans want to guarantee long-term access to affordable life-saving medical technology, the answer is not to create government agencies like IPAB to set prices by fiat (ala the old USSR-style centrally planned economies).
The government should get out of the way and leave consumers, insurers, and providers free to seek their rational self-interest in a free market.
A death panel by any other name is still a death panel.
Only when it affects them personally, in a damaging way, will these “elected officials” back off.
Demand changes that will enable people to literally sue the pants of of these “elected officials” if someone is denied proper and timely treatment for an illness, and their condition worsens, or they die as a result. That will stop this nonsense dead in its tracks, once and for all.
If we don’t, they will continue to line their pockets with our tax dollars, as they play quartermasters over life and death, and……..as we pay for their premium level health care and benefit packages.
And while we’re on the subject, why the hell are we even allowing them such benefits when the debt is so high? Make them pay for it themselves, like everyone else. Can you imagine the reduction of the debt if all government employees, including the president, were to pay for their own healthcare, disability, and retirement policies?
Anyone out there have some figures on this?
Case in point about special interest groups and the politics of politicized health care:
from yesterday’s The Hill
“The money spent on healthcare lobbying has dropped off considerably from a year ago when Congress was in the midst of the healthcare reform debate, according to disclosure records filed this week.
The main exceptions, as expected, are health insurance plans that are battling to shape an array of pending regulations that seek to overhaul their business model.”
Thank you Dr. Hsieh for keeping this issue on the front page.
Collectivized health care always requires rationing by a central body. As politicians like Gingrich try to back away from Paul Ryan’s plan, we need to make it clear that any attempts to avoid cost-cutting ignores the realities of the situation. Medicare (and our country) is heading for insolvency and realistic financial assessments of the PPACA show we are headed toward fiscal disaster.
So–bankruptcy and/or rationing or a return to personal responsibility freedom are the the true choices we face.
Agree. Most of your lifestime medical costs occur during the last 6 months of life. We have to ask ourselves whether spending $100,000 to keep a terminally ill patient alive for three more days is worth it. If so, then we have to shut up and accept massive increases in Medicare taxes and premiums.
We cannot have it both ways.
I’d like to hear a convincing argument as to how having a middleman, our vast health insurance industry, provides anywhere near benefits commensurate with its cost. In addition to profit, consider the tax deductible billions spent on delaying and denying benefits. I mean, that’s what they do – that’s their business!
And ask any health provider, who doesn’t have a financial connection or interest in the status quo vis-a-vis health insurers, about the hoops he must constantly jump through for reimbursement from health insurers. That is a real cost to providers and to consumers, meant only to further enrich health insurance companies.
One can reasonably conclude that perhaps the author of this article has just such a financial interest in maintaining the insurance cabal, undisclosed of course.
Actually, medical insurance companies have some of the lowest profit margins in the business. Some things to remember:
* The whole medical payment system (not medical care system) has systemic issues stemming from government involvement. We have confused (probably deliberately, in an effort to install a socialist health care system) “insurance” with “care”. Use to be, health insurance would only cover (in the same manner as auto and homeowners insurance) catastrophic problems. You paid for routine doctor’s visits yourself. This not only gave you a sense of how much things cost, it kept costs down by minimizing paperwork. Our current system, however, starting with HMO’s, is not really a health insurance scheme but a health payment system – essentially a commercial version of a socialist health care system, with the same problems.
* Health care companies operate under a contract. They may dicker a bit but ultimately if they don’t give you what you paid for you can haul them into court. The government, on the other hand, can’t be sued.
* Remember, doctors and hospitals are businesses. They need to charge enough to cover costs. If the government payments won’t cover the bills, somebody has to make up the difference.
* All doctors and hospitals will accept cash and – usually – credit cards. Most times they will over significant discounts if you pay yourself, since the paperwork load is far less.
I’m with Obama on this one. After 400 years of slavery and oppression, African American citizens SHOULD move to the front of every health care line and be given whatever level of health care is necessary to bring their life expectancy into line with that of white Americans. It is only fair.
NCBob get in the back of the line for the hand-outs!
Ginga’s, crossed eyed, hermaphrodites, albinos, freckle faced people, left-handers, transvestites, Icelandic dwarfs and women with small boobs and big feet unite!
We have been discriminated and oppressed for a lot longer than 400 years.
It is only fair we should be first in line.
Only if they first agree to give up all of the behaviors that drop their life expectancies in the first place. Fat chance.
NCBob, your comment disgusts me, a black man. Racial hatred and animosity do NOTHING for black people, and only serves the interest of white leftists who seek control over everybody. You dishonor our ancestors by refusing to a part of the solution. Black people *must* stop thinking in terms of getting handouts or getting our “share of the wealth” from the “white man”. Instead of going to the front of the line, we need to think in terms of becoming those who deliver the services. We are full human beings, not perpetual victims or a non-thinking mass.
Well, then, 0bama shouldn’t be putting an extra ‘tax’ on tanning booths since black people cannot make adequate vitamin D from the little sun they get in many parts of the USA and tanning booths would actually boost their vitamin D levels. Lack of vitamin D can cause many chronic health problems.
NCBob,
The importance of color of one’s skin, during any debate or activity, is about as important as the color of one’s eyes. Neither the color of one’s skin nor the color of one’s eyes has anything resembling importance. Instead, the offer of such a red-herring is akin to claiming that one’s race or nationality should play a more important role in everyday, government solutions. Nothing could be further from the truth.
I do not profess to know you, certainly not by the short message which you deposited here on this doorstep, but I can begin to believe what you think. Since I don’t have any idea the color of your skin, I only ask for you to guess the color of my eyes in order to lend any credibility into your statement.
Now, those were pretty ridiculous statements, correct? Both on your part and mine?
Zivjax, you would be welcome in my home, anytime. (salute)
NCBob;
Their life expectancies are lower because black men have a higher than average tendency to kill each other, which gets factored into the mortality statistics. If black lifespans are to be brought into line with lifespans of other groups, then a change in personal values is required.
What we really need, is growth in the supply of medical schools and doctors. We have a doctor shortage, and a medical school shortage. The business of training doctors should grow freely, so the doctor supply can increase, and bring down costs. And how many more do we need? A lot more, ten times more at least.
Solving these economic problems is fairly straightforward. Usually there is a supply problem, and so the obvious solution is unfettered economic growth.
One addition: Doctors need to be paid more so that more smart people will want to go the the additional medical schools. Government price controls are distorting this market.
With more medical schools, and more doctors graduating each year, the average doctor’s salary may go down. However, with more medical schools competing for students, tuition would also go down. According to Wikipedia, there are only 161 accredited medical schools. Something is not right. I bet the market, unrestrained, could support at least 500 medical schools, no problem.
As long as people expect others to pay for their medical treatment, there will be some form of rationing. It doesn’t matter if you’re talking about private health insurance or some government plan, there will come a point where people will refuse to pay for specific treatments or above a specified amount. To do otherwise is to guarantee bankrupsy.
Some people say you can’t put a price on a human life but society does it all of the time. If you asked whether the government should pay for a million dollars worth of medical treatment to save an individual’s life, most people might agree. OK, what about $10 million, $100 million, $1 billion? At some point, people are going to say that it isn’t worth spending any more money to save an individual life. At that point, they’ve made their decision on what that life is worth.
My mother has been in the medical field for over 25 years. I’ll never forget a true story she told me that still goes on and will only get worse with Obamacare. A patient came to the office and saw the doctor. The doctor determined the patient needed a test and procedure immediately. My mother called to get the referral authorization from the insurance company, and was told by a nurse that it had to go before the nursing review board before they could authorize it. Being the quick thinker my mother is she said “since when does a nurse or a group of nurses get to decide what a doctor does or orders?” Needless to say, she got the referral. It made me wonder how many others go through the cracks and wait and possibly die because someone other than a doctor decides the medical care one receives.
This is the norm. RN’s make these decisions all of the time. I have been in the field since the early 90′s. The advent of HMO’s made this a cost effective,profit inducing measure for health insurers. Now with Obamacare, a government panel will take over and decide whether the patient needs the test/procedure/surgery.
Unless Obamacare and/or Obama is repealed/impeached a single-payer government run system is inevitable. Berwick is not going anywhere, even if his second in command (and third, etc)passes muster and survives the nomination process he will be implementing socialized medicine-and the CMS already in charge of the two government run programs, Medicare and Medicaid, will be that mighty federally run death panel.
Anyone who believes that there is still such a thing as a “doctor patient” relationship still believes in the tooth fairy. Lets face it doctors and their profession have consired for years to limit the number of doctors. So they have contributed to the lack of broad supply that we should have in that regard. However the free market can solve this problem and consumers need to pay their bills directly. Just like you get car service without knowing how to build a car from scratch. Third party payor is another problem. Finally where is all the state action to de-regulate the market for insurance to permit purchasing across state lines? Once again vested interests are dragging their feet but that would increase competition in the health care market. We do not need big government to set up a team of 15 ideologues who will dictate when we die. We do need more competition and we do need doctors to start deregulating and opening up the market for more competition. Otherwise the medical profession and our lives will be flushed down the crapper in the biggest, dumbest medical buracracy of all time run by the radical obama care drones and nitwits. Take your choice. I choose liberty!
Got to agree with tommy. Doctors (as do lawyers) maintain a guild with high barriers to entry for alternative provision of services. Surely we could have first line caregivers that could handle much of the routine needs at a much lower cost.
The massive burden created by a doctor who borrowed to pay for a medical degree is caused by the same dysfunction that prevents competition for health care services — third party payment – primarily government. I have no incentive to price shop for health care. Multiply that by 150 million other people and a huge purchasing influence is removed from the system — no need for providers of care to compete.
If incentives to compete for patients existed, it would help lower the cost of providing a healthcare safety net for the truly needy.
I still don’t get what is fundamentally different in this board, than what an insurance company does when it decides what it will, and will not cover. Please, someone explain.
If you don’t like what coverage an insurance company offers, you are free to purchase insurance elsewhere. If you don’t like what the government offers, tough luck.
You can sue an Insurance Company but not the Federal Govt. You also have to think about the services that will be offered and available. Under the New Obamacare we really have no idea if many of the services will be available to anyone except Govt. and Union workers.
I remeber the days when there was such a thing as a Hospitilization Policy. The permiums were affordable and Doctors visits were inexpensive and Doctors still made house calls. Then Unions got really expensive Medical Insurance packages as benifits which caused an over use of the system and the costs went up. All employers had to start offering these policies which also caused more over utilization and the costs skyrocketed.
You do not need to go to the doctor for every scrape, sniffle, pain, or other malady. For the most part as the old saying goes take an asprin and call me in the morning is still good advice. The over utilization of the healthcare system has directly caused the advance of these superbugs from overuse of antibiotics caused by way too many people demanding them and way too many doctors using them when they were not needed.
Between government interference, a sue happy public the costs keep going up. It just isn’t malpractice insurance but every item used in a hospital or doctors office costs 3 to 4 times what it should to cover product liability. Most claims are not for bad or deficient products but because someone used it in a manner the maker never intended.
In the end, I blame the lawyers who only protect themselves and make sure that the laws advance thier pocket books.
I’d be for it if Obama were standing in the same line as I was to see a doctor. He isn’t and will never be. By some strange coincidence, that’s my stance on Obamacare. I’m not for it and will never be.
What? You folks don’t appreciate the kinetic institutionalized sorting system, medically yielding attrition, statist-style?
Or for you aging, white, Republicans…the acronym will do.
Sincerely,
Your betters
The ultimate problem that infuriates leftists and liberals alike is that money will always buy better healthcare. If it becomes illegal in this country, we will simply engage in medical-tourism.
Ladies, if you want that breast augmentation, you may have to visit a doctor in another country, ’cause the taxpayers aren’t footing that bill. Gentlemen, if you’d like that Sildenafil prescription and the medication, you may need to visit another country as well. I can see that taxpayers aren’t going to foot that bill either. Next thing you know, orthodontia will be heavily taxed. Vision correction surgery may be deferred in favor of glasses because it keeps more people paying taxes making expensive eye-wear.
You can see where this is going. Ladies and Gentlemen, No government can recommend anything. Recommendations have the force of law when things go wrong. The lawyer’s question of Why Didn’t You Follow The Recommended Practice will trump all else.
Once again, the poor will receive mediocre care, and those with the means and income will receive the best care they can pay for.
Silly leftists: the more things you change, the more things stay the same. That’s why Mr. Obama’s poll numbers in the left are falling: Where’s My Change, Mr. President?
Before retiring, I was a teacher. There were times that I wanted to quit teaching for a higher paying job; but, my wife would explain to me that the health insurance which I had was worth $6000 per year. Alas, I stayed with it until I retired. In the twenty some years that I’ve had health care, I watched it deteriorate until its value is really questionable. When I first got the insurance, I could go anywhere to any doctor with a low co-pay. Over the years my co-pay has increased and I’ve been forced into a HMO set up. Now finding a doctor that will take my “insurance” is getting impossible. Plus, if I need a specialist or a special procedure, I have to wait for approval. Persons making decisions about my life, death, or health have no medical degree; just, a list of procedures which they ration out. I will soon be able to use Medicare. However, Medicare is cutting the amount they pay the health providers. The same rumblings have started in the Medical community about Medicare that I heard of about my previous insurance. I saw what happened there and it turned ugly. In our State we have a program called MediCal. Hardly any doctor will take it. My insurance, hardly any doctor will take it also. Now the same will be true for Medicare. The more somebody screws with these program, usually for our own good, the worse they get. Obama may get what he wants, universal health care insurance; finding a doctor who will take it will be impossible.
Andy,
Since you are retired, as per your admission, your current health insurance program is Medicare, correct? That’s a government run health plan.
My Medicare kicks in this June.
Why don’t people get it? Health care is NOT NOT NOT NOT a right! Just like education is not a right, clothing is not a right, housing is not a right, food is not a right, helping yourself to what I have earned is not a right. Get the government out of the private sector and let us freely trade with each other.
Various State Constitutions have written the right of an education, of all citizenry, as one of our citizen’s rights. For example, the State of Vermont Constitution (the first to outlaw slavery, also) claims education as a legal right of all citizens. However, health care was not one of them. Simple solution? Amend the Constitution to include this as a right.
NOW WHAT DO WE DO to address this problem?
I prefer to call them “Joseph Mengele Panels” because it fits better with
their mission and Bill Ayres’ dream of killing 25 million people. Isn’t
that what Communists do? Remember, Dr. Joseph Mengele was a National
Socialist.
Why does the Government turn its promises into Ponzi schemes?
It is because the initial partakers of social security paid more into it than was needed immediately and the greedy politicians saw this big pot of money that they could use to buy reelection, so they stole the money using it for more promises. Too many politicians have been doing the same since. Then when Paul Ryan and others before him propose fixing the situation to make it solvent, they are attacked for trying to destroy the system.
The people who tolerate the greedy politicians are too blame!
Just look at the list of those Americans exempt from having to pay into the new, health care scheme.
All employees and families of a fire department
All employees and families of a police department
All employees and families of an EMT squad
All employees and families of the military
All employees and families of the Internal Revenue Service
All employees and families of U.S. Senators
All employees and families of U.S. House members
All employees and families of our federal and state judicial systems
All employees and families of our respective municipal governments
All employees and families of the T.S.A.
All employees and families of the F.B.I.
All employees and families of the N.S.A.
All employees and families of the State Department
All employees and families of the Interior Department
All employees and families of many federal contractors
All employees and families of most unions
All families on welfare and other government subsidized programs
etc …
What’s wrong with this picture?
What’s wrong with this picture?
We’re in it.
Obamacare? It helps with Leftist propaganda when you can give hard-working taxpayer dollars to mainstream media.
The DAILY CALLER
Washington Post and CBS receiving money from Obamacare ’slush fund’
Two mainstream news organizations are receiving hundreds of thousands of taxpayer dollars from Obamacare’s Early Retiree Reinsurance Program (ERRP) — a $5 billion grant program that’s doling out cash to companies, states and labor unions in what the Obama administration considers an effort to pay for health insurance for early retirees. The Washington Post Company raked in $573,217 in taxpayer subsidies and CBS Corporation secured $722,388 worth of Americans’ money.
http://dailycaller.com/2011/04/06/washington-post-and-cbs-receiving-money-from-obamacare-slush-fund/
Here’s a question to consider.
Which PRIVATE CITIZENS should control what patient/medical services ELECTED OFFICIALS can receive: a panel of unelected, unaccountable TAX-PAYING INDIVIDUALS struggling to make their mortgage payment or a group of TAX-PAYING CHRISTIAN SCIENTISTS?
Either one works for me. What do you think?
here we go again Obama is bound & determined to ram this Obamacare down our throats it is bad enough that insurance companies called the shots in medical treatments now we have 15 hand chosen left wing green sucking slobs by Ovommit himself to rule the roost over medicare what a bunch of hogwash now congress is apparently powerless to get some sanity back back in the white house & the federal government I guess impeachment is also out of the question because nobody in congress is willing to investigate this clown his alliances & his actions
lets see: cover more people + reduce health care cost + no change in the quality of services = B.S.
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I was talking about Medicare to a group of financial advisors recently and had some questions on the so called “death-panels.” I was surprised to find one man there who actually questioned me quite a bit on whether it was really realistic to keep allowing people to rack up huge Medicare bills in their last few months of life. He was the first person I’ve encountered who actually seemed to think this end-of-life care was a good thing. I wondered how he would feel if this were his own parent who was struggling to defeat cancer or some other dread disease. Who is to say which people are at the end of life or not? We live in an age of advanced medical techology where people have turn-arounds all tthe time. Let the free market compete to provide this technology and the laws of supply and demand will kick in and function as they always do to bring prices down.
I agree with the author that any attempt at price-setting will absolutely result in death panels becoming a reality. Take a look at the realities of the system in Britain and Canada. If you are in the U.K., you don’t qualify for dialysis after the age of 55. If that’s not a death panel, then I don’t know what is.