Monday, October 8, 2012

Will on IPAB and Rationing

In the aftermath of last week's debate, the issue of the ObamaCare IPAB board for Medicare rationing has resurfaced.

Supporters of IPAB are again claiming that the IPAB won't ration care. But in his 10/4/2012 column, George Will debunks this claim:
Beginning in 2014, IPAB would consist of 15 unelected technocrats whose recommendations for reducing Medicare costs must be enacted by Congress by Aug. 15 of each year. If Congress does not enact them, or other measures achieving the same level of cost containment, IPAB’s proposals automatically are transformed from recommendations into law. Without being approved by Congress. Without being signed by the president.

These facts refute Obama’s Denver assurance that IPAB “can’t make decisions about what treatments are given.” It can and will by controlling payments to doctors and hospitals. Hence the emptiness of Obamacare’s language that IPAB’s proposals “shall not include any recommendation to ration health care.”

By Obamacare’s terms, Congress can repeal IPAB only during a seven-month window in 2017, and then only by three-fifths majorities in both chambers. After that, the law precludes Congress from ever altering IPAB proposals.

Because IPAB effectively makes law, thereby traducing the separation of powers, and entrenches IPAB in a manner that derogates the powers of future Congresses, it has been well described by a Cato Institute study as “the most anti-constitutional measure ever to pass Congress.”
I'm glad George Will is emphasizing this point.

It's true that the IPAB won't directly tell individual doctors and individual patients what specific treatments they can or cannot receive. But it can set the prices so that a hospital can no longer afford to offer a specific service. For instance, if they say "Yes you can offer a PET-CT scan for detecting metastatic ovarian cancer, but you can only charge $100" (instead of $1000), then no one will offer that service and no patient would receive it.

It would be like the government telling grocers, "We won't ration food and we won't restrict what food consumers can purchase. But you must now all sell steaks for $1." 

Pretty soon, no one would sell steak at a loss and no one would be able to buy steaks either.