Why Obamacare won't work: Reason #4,566

The crisis in health care is manageable - without the radical, extreme measures passed in the Affordable Care Act.

USA Today reports that just 5% of patients account for 50% of health care spending. And just 1% account for 22% of the spending.

That's about $90,000 per person, according to the Agency for Healthcare Research and Quality. U.S. residents spent $1.26 trillion that year on health care.

Five percent accounted for 50% of health care costs, about $36,000 each, the report said.

The report's findings can be used to predict which consumers are most likely to drive up health care costs and determine the best ways to save money, said Steven Cohen, the report's lead author.

While the report showed how a tiny segment of the population can drive health care spending, the findings included good news. In 1996, the top 1% of the population accounted for 28% of health care spending.

"The actual concentration has dropped," Cohen said. "That's a big change."

About one in five health care consumers remained in the top 1% of spenders for at least two consecutive years, the report showed. They tended to be white, non-Hispanic women in poor health; the elderly; and users of publicly funded health care.

Other studies have shown that most of this spending is on "end of life" care - that is, patients who have very little chance of recovery but who have numerous hospital stays and even surgeries that don't extend life, but deal with unrelated symptoms to their primary disease. Someone dying of heart disease getting a kidney transplant, for instance.

The question is how to manage our eventual demise in a compassionate, but reasonable manner? One thing for sure - government doesn't have the answer to that. Only families and their physicians should be involved in those decision.

Of course, insusrance companies will get involved and are likely to balk at paying for more and more treatments at this stage of life. But we can sue insurance companies if they refuse to pay for a necessary procedure. We can't sue the government.

In fact, the decisions of the government when it comes to Medicare spending will be above and beyond any legal review. Mona Charen:

All decisions about controlling Medicare costs will be decided by the Independent Payment Advisory Board (IPAB).

IPAB is a new thing in American government. Unlike most other boards and commissions, the panel's 15 members (appointed by the president and approved by the Senate) need not be bipartisan. Also unlike other boards, commissions, and federal agencies, the IPAB's decisions are virtually unreviewable. IPAB doesn't have to adhere to the notice and comment rules of federal agencies, which permit citizens to respond to proposed rule-makings. IPAB dictates automatically become law unless Congress itself intervenes. Ah, but they've thought of that and made it virtually impossible. The law prescribes that Congress has a limited period of time in which it can modify IPAB rulings and then it must do so by a three-fifths majority. Even ratifying treaties and proposing amendments to the Constitution require only two-thirds majorities. As for the courts, forget it. The judiciary is forbidden to review IPAB decisions.

The really bizarre part, reminiscent of the "I wouldn't do that, Dave" scene in 2001: A Space Odyssey, is that Congress can only repeal IPAB itself under strict conditions. Clint Bolick of the Goldwater Institute explains:

"Under the statute, any bill to repeal IPAB must be introduced within the one-month period between January 1 and February 1, 2017. If introduced, it must be enacted by a three-fifths super-majority no later than August 15, 2017. If passed, the IPAB repeal will not become effective until 2020 - leaving an out-of-control agency in operation for three years after Congress votes to abolish it."

A trillion dollar piece of legislation to deal with a problem that mostly affects 5% of health care users? Call it overkill. And call the IPAB a dagger aimed at the heart of our health care system.

Hat Tip: Ed Lasky