Tuesday, May 24, 2011

Thoughts on Rationing

Today I've been seeing some articles about how Republicans are planning to filibuster the confirmations of Obama's appointments to the Independent Payment Advisory Board, the Medicare board which will determine which treatments are most effective and which are unnecessary. This board is one of the "Death Panels" which Republicans lied about during the healthcare debate, and what most opponents of the ACA point to when claiming the law will ration healthcare.

This board is actually one of the most important aspects of the law, as this is the Democrats' first salvo in the war on healthcare costs. The Democrats think that there's a lot of waste in the medical system right now and the best way to trim the fat is to have a government agency perform detailed studies to determine which treatments work and which don't. This agency can then make recommendations to Medicare about which treatments to pay for. In this way spending can be kept down without affecting seniors' overall health. If not for the scary name (Death Panels) I doubt this provision of the bill would be particularly controversial to the public. In fact, I wouldn't be surprised to learn plenty of people think that Medicare already does this, or something like this. After all, it makes a lot of sense. Why should our tax dollars go to procedures which have no real benefits?

So why are Republicans attacking this board? Simple. If it works, it makes them look bad and it makes Democrats look good. Anything that makes Medicare work better is a problem for Republicans. Also, it's the part of the ACA that looks most like rationing, and that's the part of their argument that I find most ridiculous.

Republicans claim that by cutting Medicare or by trying to determine which procedures the system will or won't pay for is rationing. They say that people and their doctors should be able to decide which treatments are right for them. That the government has no business telling people what treatments they can or can't have. And they're right! The problem for them is that this board doesn't actually get between a person and their doctor. What this board is doing is determining where best to spend government money. If the board determines a treatment is useless there's nothing in the law saying a person can't spend their own private money on the treatment. If the board decided tomorrow that the only thing Medicare should pay for is visits to the doctor's office then that still wouldn't be rationing.

Rationing is when a government forces a person to consume less of something. In World War 2 people were issued coupons  which they needed to use to buy food. If they ran out of coupons it was illegal for them to buy more food. They had to make do with what they got, because much of the food was needed for the war effort.

The fact of the matter is that Republicans can't win this debate without resorting to emotionally charged words like "Rationing" and "Death Panels", so that's exactly what they do. They imply that some soulless bureaucrat will stand between you and your doctor, but nothing of the kind will happen here. The IPAB is a common sense solution to the problem of the rising cost of Medicare, and I think the reason the Republicans are opposing it so strenuously is because they're afraid it might work. After all, if we can control Medicare costs without reducing the effectiveness of the program then what excuse could Republicans use to destroy it?

Related: For more on why the Republican reasoning behind killing Medicare to control healthcare costs is absurd I'd recommend this excellent post by Jared Bernstein.

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