Wednesday, June 1, 2011

Who should ration health care?

“Racer,” you may have already said, “why resort to false, emotional words like ‘ration’ when what we need is a serious discussion about health care reform?”

Easy. Rationing is an essential element of the ACA way. 

Fifteen commissioners, each earning $165,000 a year, will do the rationing. They are called the Independent Payment Advisory Board, and are foundational to how ObamaCare will function.

President Obama and the Democratic members of Congress, in passing the misnamed Affordable Care Act of 2010 (ACA), took $500 billion away from future Medicare payments. They did this knowing that more than 78 million Americans are beginning to qualify to enroll in Medicare. What happens when less money is available for more people? You choose your favorite term: I use the appropriate one: It’s called rationing.

Make no mistake about it. Rationing will happen as  revenue fails to keep up with cost of care. 

Medicare Revenue is directly linked to the expansion (or retraction) of the economy, except that President Obama does not believe this. Instead, he believe there is a finite amount of money, and the role of politicians is to divide it up.

The way to divide up a finite amount of money in Medicare is to ration care. The instrument to accomplish this is the Independent Payment Advisory Board (IPAB). This 15-member board, set up under the ACA, will decide what care will be allowed to be provided to Medicare enrollees, and what will be denied. Denial of care is called rationing.

It is true that there are other forms of rationing. If a person has no money, and there are not medical providers willing to care for that person, it is called rationing. But the Affordable Care Act will create more of this type of rationing, not less. Why? Because the ACA discourages individuals from becoming physicians. If there are no doctors, there is no health care – well, professional health care.

If a person has prepaid health coverage (some call it insurance), and the insurance company or Health Maintenance Organization (HMO) is in charge of deciding who gets what coverage, that is a form of rationing. But it is far different from the way the IPAB functions. There is at least some competition among health care insurance companies to provide coverage for individuals. If there would be only one insurance company, it could dictate – yes, dictate – who will get what care, when, where, and under what conditions. This is precisely what the IPAB will be able to do, because Medicare is single payer, government-run health care – it has no competitor. 

Repeat it. Tell the truth. ObamaCare, the ACA, is the process to ration health care. First, to senior citizens on Medicare, and then to the rest of society (as Exchanges give way to single payer systems, and as Accountable Care Organizations submit to the federal paymaster).

We start to fix this by repealing the IPAB. And the requirement for Exchanges. And the individual mandates. We fix it by expanding access to consumer-directed health care, Health Savings Accounts, and medical entrepreneurism. 

We cannot, absolutely cannot waste our time trying to fix the ACA. It cannot be fixed. It must be rationed out of existence.

Health care  decisions are the realm of patients, their families, and doctors. Communities join this process voluntarily. This is the way to pursue rational decisions about health care.


  1. You mean when Andy Griffith promised that our seniors would have "guaranteed Medicare benefits" this is not what he meant?

    I for one, searched and searched to find out the EXACT definition of "guaranteed Medicare benefits", and could not find one.

    Today, we received our monthly Medicare/Medicaid benefit changes from CMS. Medicaid will no longer cover circumcisions. They also cut the benefit for diabetic supplies in half.

    Rationing. Its already happening and they havent even begun "reform".

  2. Dave, you are right. The only way a free society can work is to allow individuals to make their own rationing decisions by controlling the dollars directly rather than through government or private "insurance" (really pre-paid medical care). Health insurance should emulate homeowners insurance in that it is in place to cover large unexpected financial losses and not routine medical care.

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