It didn’t take long for Jim DeMint’s outrage over highly unusual language protecting a care-rationing board to generate a response from Sarah Palin. This came just days after Politifact called her statement about “death panels” the “lie of the year,” but the attempt to rule any Congressional motion that changes the rulings of the Independent Medical Advisory Board out of order in perpetuity has highlighted once again this rationing board and its potential impact in a government-run system. And that, Palin writes at her Facebook page, was her point all along:
No one is certain of what’s in the bill, but Senator Jim DeMint spotted one shocking revelation regarding the section in the bill describing the Independent Medicare Advisory Board (now called the Independent Payment Advisory Board), which is a panel of bureaucrats charged with cutting health care costs on the backs of patients – also known as rationing. Apparently Reid and friends have changed the rules of the Senate so that the section of the bill dealing with this board can’t be repealed or amended without a 2/3 supermajority vote. Senator DeMint said:
“This is a rule change. It’s a pretty big deal. We will be passing a new law and at the same time creating a senate rule that makes it out of order to amend or even repeal the law. I’m not even sure that it’s constitutional, but if it is, it most certainly is a senate rule. I don’t see why the majority party wouldn’t put this in every bill. If you like your law, you most certainly would want it to have force for future senates. I mean, we want to bind future congresses. This goes to the fundamental purpose of senate rules: to prevent a tyrannical majority from trampling the rights of the minority or of future congresses.”
In other words, Democrats are protecting this rationing “death panel” from future change with a procedural hurdle. You have to ask why they’re so concerned about protecting this particular provision. Could it be because bureaucratic rationing is one important way Democrats want to “bend the cost curve” and keep health care spending down?
The Congressional Budget Office seems to think that such rationing has something to do with cost. In a letter to Harry Reid last week, CBO Director Douglas Elmendorf noted (with a number of caveats) that the bill’s calculations call for a reduction in Medicare’s spending rate by about 2 percent in the next two decades, but then he writes the kicker:
“It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care.”
Though Nancy Pelosi and friends have tried to call “death panels” the “lie of the year,” this type of rationing – what the CBO calls “reduc[ed] access to care” and “diminish[ed] quality of care” – is precisely what I meant when I used that metaphor.
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.
Update: I just talked to a source on Capitol Hill who wants to make sure everyone understands the mechanics of the issue. The bill sets up a supermajority threshold of 67 votes to bring accountability to IMAB decisions, and the rule on being in or out of order can get waived at 60 votes. However, as this battle shows, even getting to 60 is almost an impossibility, let alone 67. Clearly Reid wants to put accountability out of reach with these radical propositions.