The Rationing Commission - WSJ Article

[Whrlwnd13]

From the Wall Street Journal - Nov 15, 2009
The Rationing Commission
Meet the unelected body that will dictate future medical decisions.

As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.

Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."

On that last score, he's right. Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."

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?

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.

In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't 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.

Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."

If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington's cost-minded judgments—is at the core of medicine is that usually there are no "right" answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.

It's possible this global budget could become an accounting fiction, like the automatic Medicare cuts Congress currently pretends it will impose on doctors. But health care's fiscal pressures will be even stronger than they are today if ObamaCare passes in anything like its current form. And that is when politicians will want this remote, impersonal and unaccountable central committee to do the inevitable dirty work of denying care.

The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn't make decisions in the best interests of patients, but in the best interests of government.

Original article here

[Whrlwnd13]

I really thought this article would get at least a few comments. If the healthcare bill gets signed into law we'll see lots more rationing. I find it very suspicious that days before the cloture vote that suddenly there are new guidelines for mamograms and pap smears. Is it a coincidence that after years of them telling us they should be done so often, suddenly they change their tune and say they should be done less frequently?? And to say that women shouldn't preform self exams???!?!?!? WTF are they afraid that they'll find something and then have to see a doctor?

this is just the tip of the iceberg folks... brace for impact!!

[SpringerRider]

Great read. I did not see this article but had heard it talked about on Beck. Anything the government manages gets rationed since there is no incentive or proper information to meet the public need.

If I make bread and sell it, I price it based on supply and demand. When the demand is high, my supply of bread goes down and I raise my price. When demand decreases, my inventory increases so I lower my price. It is an ebb and flow, and I often don't know the reasons why nor do I have to. Wheat prices can affect my price just as whether kids are in school or a social trend where the public is reluctant to eat bread. All I have to follow is the supply and demand principle and I will always meet the need of the customers.

Now the government steps in and takes over the bread industry. I am told that I must provide a quota of bread daily. I am not sure what this quota is based on-maybe last years output but some government hack has dictated how much bread I must provide. My price is fixed by the government based on some schedule they provide. My profit is fixed and guaranteed. I make the same if I see 10 loaves or 1000. What incentive is there for me to meet market needs? More bread is more work but not more profit. In the eyes of the government, profit is vulgar and greed.

The information of the market is never returned to DC. If there is a blight and wheat prices go up, my bread price remains the same since my pay is not based upon profit. I am now selling wheat at a loss to the tax-payer. If there is a bumper crop yield of wheat, I still sell at the same price. In a free market, I might take advantage of a lower wheat price and lower my price and try to capture more of the market. But why bother?

One week my bread shelves might be empty with people in line. They complain to the ministry of Food Production and I am ordered to increase my production 10 fold. Next week the shelves are overflowing with bread and their is moldy bread in the back because school has left out but I still must deliver my quota. The gov. worker in DC who adjusts my quota knows nothing about the market or food production.

Sound outlandish? Join the military. I did 20 years there and that is how the supply system works. One can be forgiving for the military. Their job is to defend our way of life, including free markets. Since the inception of this country, we have understood that we would have to tolerate the contradiction of a government and military.

And that is what government health care will look like.