Coming soon: Medicare rationing board

Rick Moran
I have taken the position during the entire debate over health care reform that some slippery slopes that are promoted by opponents are logical fallacies; that rather than illuminate problems with the ideas in the bill, some arguments are, for the most part, fear mongering.

This is unnecessary because as we all know there is so much to criticize in the approach of the Democrats that it is entirely unnecessary to invent issues that are either a remote possibility or have no chance of becoming reality.

Case in point: The Medicare rationing board. No slippery slope to worry about here. This new board made up of 15 presidential appointees will make the most far reaching decisions about health care based not on the needs of the patient but on the needs of the budget. It is, unabashedly, a government rationing mechanism where a "global budget" will be initiated for Medicare costs and it will be the job of the commission to shoehorn procedures, surgeries, treatments, and drugs into that finite amount of money.

This Wall Street Journal piece carefully explains what this means:

As envisioned by the Senate Finance Committee, the commission-all 15 members appointed by the President-would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.

Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.

So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?

Clearly, the idea is to first, get rid of private insurance companies. They only muck up the works and prevent complete control of this commission over Medicare costs. Once their triumph is assured, the real squeeze begins:

But a decade from now, such limits are off-which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.

Yes, Medicare must be reformed. Costs must be controlled or at least the rate of increase must be drastically reduced or we will all end up paupers.

But this is not the way to go about it. The Journal article points out what is going on in Washington State with a similar board and it's not pretty:

The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.


This is the kind of coverage we can expect under the public plan - just as soon s the private insurers are out of the way and all that nasty competition is ended. Then the government will pretty much be able to decide how comfortable your life will be in your old age. Have chronic pain? Take an aspirin. Break your knee? Buy a walker from one of our political contributors. Have a lump in your abdomen? Eat an apple and call me next year.

Just today the TimesOnline is reporting that in Great Britain, health and safety "snoops" will be able to enter your home legally and investigate to see if parents are protecting their children from "household accidents."

It's not the efficacy of such investigations its the mindset that doesn't see such actions as intrusive. This is what we have to look forward to in the not too distant future under national health care.

No fear mongering necessary.

I have taken the position during the entire debate over health care reform that some slippery slopes that are promoted by opponents are logical fallacies; that rather than illuminate problems with the ideas in the bill, some arguments are, for the most part, fear mongering.

This is unnecessary because as we all know there is so much to criticize in the approach of the Democrats that it is entirely unnecessary to invent issues that are either a remote possibility or have no chance of becoming reality.

Case in point: The Medicare rationing board. No slippery slope to worry about here. This new board made up of 15 presidential appointees will make the most far reaching decisions about health care based not on the needs of the patient but on the needs of the budget. It is, unabashedly, a government rationing mechanism where a "global budget" will be initiated for Medicare costs and it will be the job of the commission to shoehorn procedures, surgeries, treatments, and drugs into that finite amount of money.

This Wall Street Journal piece carefully explains what this means:

As envisioned by the Senate Finance Committee, the commission-all 15 members appointed by the President-would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.

The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.

Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.

So the Montana Democrat bowed and carved out exemptions for such providers, along with hospices and suppliers of medical equipment. Until 2019 the commission will thus only be allowed to attack Medicare Advantage, the program that gives 10 million seniors private insurance choices, and to raise premiums for Medicare prescription drug coverage, which is run by private contractors. Notice a political pattern?

Clearly, the idea is to first, get rid of private insurance companies. They only muck up the works and prevent complete control of this commission over Medicare costs. Once their triumph is assured, the real squeeze begins:

But a decade from now, such limits are off-which also happens to be roughly the time when ObamaCare's spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.

Yes, Medicare must be reformed. Costs must be controlled or at least the rate of increase must be drastically reduced or we will all end up paupers.

But this is not the way to go about it. The Journal article points out what is going on in Washington State with a similar board and it's not pretty:

The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a "naturopath" who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn't worth the money, then Olympia won't cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a "high" efficacy but also a "high" cost.


This is the kind of coverage we can expect under the public plan - just as soon s the private insurers are out of the way and all that nasty competition is ended. Then the government will pretty much be able to decide how comfortable your life will be in your old age. Have chronic pain? Take an aspirin. Break your knee? Buy a walker from one of our political contributors. Have a lump in your abdomen? Eat an apple and call me next year.

Just today the TimesOnline is reporting that in Great Britain, health and safety "snoops" will be able to enter your home legally and investigate to see if parents are protecting their children from "household accidents."

It's not the efficacy of such investigations its the mindset that doesn't see such actions as intrusive. This is what we have to look forward to in the not too distant future under national health care.

No fear mongering necessary.