Rationing By All Means Necessary

The most instructive part of the president’s “deficit” speech last week was his insistence that he could help balance the budget through an “independent commission” with the “authority to make additional savings by further improving Medicare.” That commission is the Independent Payment Advisory Board (IPAB) and it is nothing more than another leg in ObamaCare’s rationing stool.

Writing in the Weekly Standard, Mark Hemmingway writes:

Here’s how IPAB works. It’s a panel comprised of 15 presidential appointees who are tasked with reducing Medicare spending. The panel is is given certain spending targets that kick in in 2014. At first those targets are on a sliding scale, but by 2018 the spending targets are set at the rate of GDP growth with an additional half of a percentage point tacked on. (Originally, it was GDP plus a full percentage point, but according to the “framework” released prior to the President’s speech the spending target has been reduced.)

Any recommendations IPAB makes about Medicare spending automatically become law. Congress can only override IPAB with a three-fifths majority vote, which is a very high legislative hurdle, or they can pass their own Medicare plan that meets the same spending target. There’s no administrative process for doctors or citizens to challenge the board’s decisions. There’s a school of thought that says IPAB is even more blatantly unconstitutional than the individual mandate, as its power sounds legislative in nature — its declarations would have the force of law — and therefore cannot legitimately be delegated to an executive entity.

In short, the IPAB would give power to unelected bureaucrats the make life or death decisions about Medicare – and probably private insurance – coverage without any way for patients to challenge the decision of the board. Rationing would be implemented without a vote of Congress.

Writing in the National Review, James Capretta, points out that the Administration will not only use the panel to ration care but it’s real purpose is to build a stepping stone toward a nationalized health care system.

As the years go by, if Obamacare is allowed to stand, tens of millions of American will become enrolled in publicly subsidized coverage. The costs to the Treasury will be steep — and will lead to calls for greater cost control. That’s when Democrats will push for the next step — to extend the IPAB’s authority beyond Medicare to the insurance plans subsidized by Obamacare. We will nearly be at the bottom of the slippery slope to a Canadian-style health system.

We have already seen the first iterations of rationing of care. The FDA is proposing to limit the cancer drug Avastin only to patients who can afford to pay for the drug out of pocket. 17,000 women rely on the drug to survive but the government is seeking a way to avoid paying the cost of the drug – which can be close to $80,000 a year. A hearing has been set for June to determine whether the FDA scheme will be allowed to go into effect.

On the other hand, the NIH is touting Avastin for a purpose the FDA never approved it for – injections in the eye to combat wet macular degeneration – because the existing FDA approved drug, Lucentis, is more expensive. News has leaked that the NIH study did not go well and patients seeing a huge spike in health risks. Expect the government to push more of these schemes to take decisions out of the hands of doctors and into the hands of bureaucrats whose primary care is cost not cures.

Government is leading us down the road to rationing and it is critical that Congress act quickly to turn things around. Whether through the Medicare and IPAB, the FDA or the NIH, the Obama Administration feels like they have a green light to begin to ration care in the United States. Is anyone going to do something about it?