Dr. Orwell Will See You Now

George Orwell may have invented “Newspeak” for his novel, 1984. But in their discussions of health care, the Obama administration and their political allies have elevated the deceptive use of language to new heights.

Consider the very title of the ObamaCare law, “The Patient Protection and Affordable Care Act.”

New estimates from the Congressional Budget Office show that ObamaCare will cost $1.76 trillion over 10 years, nearly double the earlier estimated $940 billion. Rather than being “affordable,” ObamaCare will worsen our massive budget deficit.

Nor does ObamaCare provide much “protection” for patients, especially senior citizens. Rather, one of the biggest dangers to seniors’ health care will be the new Independent Payment Advisory Board (IPAB). The IPAB would consist of 15 unelected members appointed by the president empowered to determine what medical procedures Medicare would cover and how much it would pay providers. IPAB decisions would not be subject to judicial review and could not be overturned unless overridden by a nearly-impossible two-thirds majority of both houses of Congress.

Although the law states that IPAB will not be used for rationing, its authority to set prices will give it de facto rationing power. If the IPAB sets the reimbursement rates for services below the costs of providing them, doctors would no longer offer them and patients would no longer be able to receive them.

ObamaCare supporters are also selling a version of Orwell’s slogan, “Slavery is freedom,” by claiming that greater government controls over doctors will enhance their freedom to practice.

In the Journal of the American Medical Association, former White House health policy advisor Dr. Ezekiel Emanuel advocates replacing standard fee-for-service payments with “bundled payments” where hospitals and physicians receive a fixed fee to take care of Medicare patients’ conditions (e.g., a stroke or a heart attack) regardless of how much the care actually costs.

Emanuel argues that bundled payments will give doctors more “autonomy” because it will allow “physicians to develop and deliver new approaches to care without being concerned about whether Medicare will pay for a specific service.” But in reality, bundled payments will pressure doctors and hospitals to skimp on care, just as patients experienced with “managed care” and HMOs in the 1980s.

Suppose the government outlawed restaurants from charging for each separate menu item. Instead, it only allowed restaurants to charge a single “bundled payment” of $10 for meals that had to include an entree, vegetable, dessert, and drink. Would the quality and quantity of food go up or down as the government set ever-stricter limits on what restaurants could charge?

In a recent New York Times interview, Stanford health economist Victor Fuchs similarly compared government-imposed bundled payments to “the emancipation of slaves.” This is the ObamaCare version of “Slavery is freedom.”