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Deficit commission: What ObamaCare needs is … death panels

A Picture of Abby Coleman Abby Coleman
12/02/2010

(Editors Note: 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.

Hot Air Blog

by: Ed Morrissey

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 coverage 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.

Yahoo News

Deficit panel takes tough stance on health costs

RICARDO ALONSO-ZALDIVAR

Associated Press

WASHINGTON – The health care cuts proposed by leaders of President Barack Obama’s deficit commission would reach virtually every corner of society, making cost curbs in the new overhaul law look tame by comparison.

The plan tackles the unfinished business of Obama’s health care remake: how to keep it affordable. An advanced society that guarantees the latest medical technology to nearly all its citizens has to make hard choices about what to pay for and how much.

Workers with solid coverage on the job, seniors, drug companies, trial lawyers, hospitals, doctors, state governments and federal employees would all feel the pinch. For Medicare recipients, the biggest change would be an increase in cost-sharing.

The plan by commission co-chairmen Erskine Bowles and Alan Simpson is drawing criticism from groups ranging from AARP to hospitals and labor unions. Is it politically doable?

“Right now, no,” said economist Robert Reischauer, an informal adviser to policymakers of both parties on health care. “But we have a huge challenge ahead of us, and if we start by saying this proposal or that proposal is unacceptable, we are never going to get to a solution.”

The plan leaves in place Obama’s signature health care law expanding coverage to more than 30 million uninsured, but it would repeal a new long-term care program included in the legislation, calling it “financially unsound.”

It would gradually phase out the federal tax break for job-based health plans, a change that would force workers and their families to seek out cost-conscious insurance. Labor unions, which have given up wage increases to secure better coverage, are adamantly opposed.

There are even bigger changes in the proposal. Sarah Palin take note:

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.

The nonpartisan deficit commission scheduled a vote Friday on its leaders’ controversial plan. Even if it gets enough support to go to Congress, immediate prospects are dim. Yet the problem isn’t going away.

“We are going to see all of these things on the table over the next couple of years as we really struggle with the deficit,” said Christine Ferguson, a former senior Republican congressional aide and top state health official.

“Unless the economy turns around, these are the kinds of the proposals that are going to be debated,” added Ferguson, a professor at George Washington University. She called some “pretty Draconian.”

If the plan proves politically untouchable, Medicare will be a big part of the reason.

Newly elected Republicans campaigned against the Medicare cuts in the health care law, and the commission proposal would slice deeper while also making significant changes in how the program works.

Many seniors would face an increase in cost-sharing for medical services.

The deficit commission found that Medicare’s co-payments are low in most cases, encouraging overtreatment and overuse. Revamping cost-sharing would raise $110 billion through 2020. In return, seniors would get an annual cost-sharing limit of $7,500, stop-loss protection that isn’t currently offered under traditional Medicare.

The proposal would also take on so-called Medigap plans, supplemental insurance that many seniors purchase to plug holes in Medicare. Such plans would no longer be able to offer wraparound coverage that insulates beneficiaries from nearly all cost-sharing. That would raise an additional $38 billion through 2020.

“They are asking sick people to pay more in terms of cost-sharing,” said John Rother, AARP’s top health policy expert. “You are a Social Security beneficiary living on $15,000 a year, and they want you to pay up to $7,500? We are talking about bankrupting people. This doesn’t fly in the real world.”

Other Medicare changes include a new payment system for doctors that would reward quality outcomes instead of sheer numbers of visits, tests and procedures. And a board created by the new health care law to force Congress to cut questionable Medicare spending would get broader reach.

Federal workers — hit with a pay freeze by Obama — would become guinea pigs in a health insurance experiment. The federal employee plan would be replaced with a fixed payment to purchase private health insurance. The concept could later be extended to Medicare.

Validating a goal Republicans have long pursued, the commission also tackled malpractice litigation, recommending a series of limits on jury awards and the creation of specialized courts to try such cases. That’s another area that Obama’s health care law tiptoed around.

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