NCPA - National Center for Policy Analysis


November 17, 2009

Under ObamaCare, Democrats will control health care spending by imposing a "global budget" on Medicare.  This will have radical implications for U.S. medicine, says the Wall Street Journal.

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:

  • 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 gross domestic product (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.

If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care, explains the Journal.  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.

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, says the Journal.

Source: Editorial, "The Rationing Commission: Meet the unelected body that will dictate future medical decisions," Wall Street Journal, November 15, 2009.

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