The good news for Barack Obama: the Associated Press reports today that Obama’s deficit commission wants to keep most of ObamaCare in place.  The bad news: they pronounce it unsustainable — unless it includes hard caps on c0verage and decisions made to stop care.  Doesn’t this sound a little familiar?

For the first time, the government would set — and enforce — an overall budget for Medicare, Medicaid and other federal programs that cover more than 100 million people, from Alzheimer’s patients in nursing homes to premature babies in hospital intensive care.

Palin attracted wide attention by denouncing nonexistent “death panels” in Obama’s overhaul, but a fixed budget as the commissioners propose could lead to denial of payment for medical care in some circumstances.

Overall, the nation will spend about $2.6 trillion this year on health care, and there’s evidence that a significant share of that is for procedures and tests that are of little benefit to patients. There seems to be room enough to cut, but no consensus on what should go.

Also, ObamaCare stripped resources from Medicare Advantage to fund coverage for the uninsured under Medicaid.  The deficit commission would go even further, forcing an end to Medigap plans that help seniors and the disabled pay for better coverage.  That would save $38 billion, but the move would force people on limited incomes to foot a large part of their medical bills out of pocket while living on fixed incomes.  That choice would make sense if the government hadn’t drained their pockets for decades to pay for Medicare and other entitlement programs.

Sarah Palin aroused the ire of critics for mentioning “death panels” as part of ObamaCare, but that is the end stage of health-care rationing.  The IPAB created by ObamaCare has a specific mission to reduce per capita spending in Medicare, using either explicit end-of-care decisions or indirectly influencing those by denying reimbursements, as I explained in December (when IPAB was IMAB):

All health care gets rationed in one manner or another, as does every commodity (except air, although with cap-and-trade, that would change).  Insurers ration, and so do consumers in a fully free-market system such as the Lasik or cosmetic-surgery industries.  The difference is that those systems involve free choice, especially the latter.  With insurers as third-party payers, there is less free choice, but the solution to that is more competition and better ability to be completely portable — or better yet, the removal of third-party payers for normal health care services.

When government rations commodities, it does so with the force of law.  Considering the power it would have had in a completely government-run system to make the kind of decisions now left to insurers in a competitive market, people are correct to be worried about how exactly IMAB would bend the cost curve.  Their mission in the ObamaCare bill is to “reduce the per capita rate of growth in Medicare spending.”  The way ObamaCare is structured, the only way to hold down costs would be to start denying more treatments, or to cut compensation to the point where long wait times take care of the rationing by discouraging access to a dwindling number of providers. Will that prevent more deaths and make Americans healthier?

With insurers, consumers have the option to find another insurer or self insure.  Those options won’t exist in a government-run system, and are seriously limited in ObamaCare, even in the latest incarnation.  Without those options, the IMAB’s decisions will be inescapable — and thanks to Harry Reid’s language, citizens won’t even have the opportunity to challenge IMAB actions in Congress.  It’s an abomination.

In fact, that’s the very process the deficit commission says will be needed to make ObamaCare viable.  Peter Orszag made it clear how IPAB would become one of the most powerful agencies in the federal government, and how its decisions would mainly be out of reach of Congress as part of its design.  That was clear early in the process, as was how that power would be used.  Now the deficit commission has not only recognized it but argues that without a “death panel,” ObamaCare simply won’t work.

Which is what Sarah Palin argued all along.