Controlling health-care costs, not just in government programs but throughout the American economy, is essential to a prosperous future. As the chart above illustrates, we already spend considerably more on health care as a percentage of our GDP than any other industrialized nation, and with the Baby Boom generation about to retire, those numbers are almost certain to climb.
The health-care debate, then, is not merely a debate over who will pay for it and how. It is also a debate over who will control costs and how.
U.S. Rep. Paul Ryan and his GOP colleagues prefer to use economic scarcity as their rationing agent. And the truth is, a purely capitalistic system, driven solely by profit considerations, perhaps could control costs to a degree. But it would do so only by ignoring issues of humanity, morality, justice and fairness — considerations that pure capitalism is not equipped to handle, but that are inherent in matters that are literally life and death.
Under the GOP approach, health insurance and the health care it provides would be available only to those who can afford to buy it, with private insurance companies making the necessary decisions to deny coverage of certain patients or procedures. Government efforts to inject humanity and justice into that for-profit system, either through laws or regulation, would be barred on the grounds that they would also inject inefficiency, which they undoubtedly would.
They also propose to dismantle Medicare, replacing it with a system in which senior citizens would be provided with a voucher to allow them to purchase that private insurance.
Over time, that voucher by design would cover less and less of their insurance costs, making them more and more vulnerable to economic pressures, which is how Ryan “bends the curve” of Medicare expenditures.
In his recent speech on the deficit, President Obama proposed the alternative of relying on the Independent Payment Advisory Board, a panel of 15 experts created under ObamaCare to recommend ways to control Medicare costs. By law, the panel is prohibited from recommending health-care rationing; its role is simply to find the most cost-effective approaches to health care, with Congress given the power to override its decisions.
Inevitably, that proposal revived talk of “death panels.” It’s an emotionally powerful phrase, but only because it strips things down to uncomfortable truth: Death panels exist, they will exist in any conceivable system of health-care delivery, and we all know they are necessary but prefer to ignore it.
Somebody has to say no to the terminal patient who refuses to acknowledge that he or she is terminal and demands hopeless if expensive treatment. Somebody has to have the power to rule that Procedure A or Drug A is more cost-effective than Procedure B or Drug B, despite the fact that Procedure B or Drug B has a strong lobby. Even Heaven has a gatekeeper.
But it’s too easy to try to deny that reality. As the New York Times reports, Ryan is now complaining that under Obama’s proposal, the panel would have the power to “impose more price controls and more limitations on providers, which will end up cutting services to seniors.” That’s pretty rich, considering what Ryan’s own plan has in mind for seniors.
But some Democrats are no better on the issue. The Times also quotes Rep. Allyson Y. Schwartz, D-Pa., who like Ryan wants to legislate the payment advisory panel out of existence but for very different reasons:
“It’s our constitutional duty, as members of Congress, to take responsibility for Medicare and not turn decisions over to a board. Abdicating this responsibility, whether to insurance companies or to an unelected commission, undermines our ability to represent our constituents, including seniors and the disabled.”
Great. Congress sitting as the death panel. I wonder how that one’s going to work out?
Hospitals, doctors and other industry interest groups also oppose the IPAC, which itself tells you something about its potential impact. They see it as a threat to their bottom line, which of course it must be if it’s to be effective. For example, the head of the American Health Care Association, representing nursing homes, said that his group opposes the panel because it would allow Congress and the president to “subcontract out difficult decisions.”
In other words, the panel couldn’t be lobbied as effectively as Congress, which is exactly the point in creating it.
Again, somebody has to be the gatekeeper. Patients lack the knowledge to do so and confronted by death or illness are not capable of self-rationing. The medical industry won’t do it; it has a considerable economic incentive to keep throwing treatment at a patient as long as the bills are being paid.
Private industry will do it, but only if we are willing to submit ourselves and our loved ones to its not-so-tender and arbitrary mercies. And Congress? Please no.
In the end, while a panel of experts has problems and drawbacks of its own, it is also the approach most likely to find that difficult balance between efficiency and humanity.
– Jay Bookman