WASHINGTON — Last week, U.S. Rep. Phil Gingrey (R-Ga.), an obstetrician, trotted out a well-worn canard about the Affordable Care Act: It will kill old people. Gingrey had trained his overheated rhetoric on one portion of the new law — the Independent Payment Advisory Board.
“Democrats like to picture us as pushing grandmother over the cliff or throwing someone under the bus. In either one of those scenarios, at least the senior has a chance to survive. But under this IPAB, where a bunch of bureaucrats decide whether you get care. . .I guarantee you . . .that the patient is going to die,” Gingrey declared.
Gingrey’s gambit was a bit desperate. He managed to remind voters that the plan he favors — a proposal to turn Medicare into a voucher program — has its own considerable political liabilities.
He also put the spotlight on what is arguably the smartest innovation in the new health care law — an independent panel of experts who will make decisions about cutting Medicare costs. President Barack Obama hasn’t gotten much credit from deficit hawks, who insist that he hasn’t been serious about cutting the federal budget. In fact, the IPAB is a smart plan to keep future health care costs from sinking the entire government.
So, fiscal conservatives love it, right? Not so much. National Review editor Rich Lowry denounced the president’s “obnoxious faith in the surpassing wisdom of unelected experts.” Others have seen in the panel the unmistakable outlines of a hammer and sickle stamped on a bright red flag.
Even some Democrats have turned against the planned panel, complaining that it would take away too much Congressional authority over Medicare spending.
But the most widespread criticism is that the panel will lead to “rationing,” as Gingrey charged. In fact, the Affordable Care Act specifically states that the IPAB may not make any proposals to ration care.
Besides, that’s a specious argument for House Republicans to make, since the vast majority of them endorsed the plan presented by House Budget Committee Chairman Paul Ryan. By 2030, according to the Congressional Budget Office, the vouchers it creates would buy a policy that covers only a third of the care that Medicare currently delivers. That’s not rationing?
For all the scary talk about killing grandma, here’s a simple fact every American consumer of health care surely understands: you only get the health care that you or your insurance company will pay for. In other words, health care is already “rationed.”
Take organ transplants, among the most heavily regulated (and “rationed”) medical procedures. When Arizona cut its Medicaid budget a few months ago, transplant patients who had waited months or years for surgery were suddenly no longer eligible because they didn’t have the money for needed procedures.
Patients must also be able to show the resources to pay for a lifetime of pharmaceuticals. Hospitals regularly reject patients who cannot show that they have the means to pay for the anti-rejection drugs they will need. Isn’t that rationing?
So the big question isn’t, should we ration? We already do. The question is, who decides? I know “experts” are the new enemy, but I’d rather have a panel of physicians, surgeons and health care economists making those decisions than members of Congress. Whether they are physicians or bankers, Democrats or Republicans, they are prone to pander to the special interests who give them money: pharmaceutical companies, medical equipment manufacturers and hospital companies, among others.
By contrast, the IPAB is expected to be guided by comparative-effectiveness studies that show which procedures are both less costly and effective. Quiet as it’s kept, some medical procedures don’t make patients any better, but they do make doctors and hospitals richer. Why should Medicare pay for those?
The United States spends more per capita on health care than any other country in the world, without producing measurably better outcomes. And costs are continuing to soar. Bring on the experts.