Death Panels

From the Wall Street Journal comes word of Death Panels in the ObamaCare legislation. Death Panels. They don't call them that - of course - but that's what they are.
As usual, the most dangerous parts of ObamaCare aren't receiving the scrutiny they deserve—and one of the least examined is a new commission to tell Congress how to control health spending. Democrats are quietly attempting to impose a "global budget" on Medicare, with radical implications for U.S. medicine.
Of course, there are different types of Death Panels. These aren't personal - 'you can't have that treatment because you're too old and it's not cost effective' type decisions. This is about the generalized, impersonal, bureaucratic slashing of coverage areas in Medicare in order to make it meet its budget.
Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission "critical to our fiscal future" and "one of the most potent reforms."
Which, actually, isn't an unreasonable thing to do to Medicare. The program is $37 trillion dollars in the hole - something has to be done. But if this is to be the solution, shouldn't there be a public conversation? Shouldn't seniors know?
Prominent health economist Alain Enthoven has likened a global budget to "bombing from 35,000 feet, where you don't see the faces of the people you kill."
[                    oj_rove0521                ] AP
As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.
Just as the Democrats have admitted, through subsequent actions, that the President was not telling the truth about illegal immigration and abortion in the health care bill, we now know that panels in Washington will decide who lives and who dies.
The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission's decisions would go into effect automatically if Congress couldn't agree within six months on different cuts that met the same target. The board's decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.
Worse than the fact that the bill will make denying care the method of cost containment for Medicare is the fact that it will also attack the development of new treatments - medical innovation.
The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions. Worse, it makes little room for medical innovations. The commission is mandated to go after "sources of excess cost growth," meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer's in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that "Maybe you're better off not having the surgery, but taking the painkiller," as President Obama put it in June.
Death Panels. As the political genius behind that phrase, Sarah Palin, is rolled out in her own package for the first time this week, we have to wonder if the Obama Administration isn't working on her payroll.
In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn't pretty.
The board in Washington state, the Health Technology Assessment, decides what treatments are kosher and which ones aren't.
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he's covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don't, Washington will not reimburse them for "inappropriate care."
This is appealing for Democrats because budgets will be cut automatically. They'll be able to offer legislation to fight the harsh restrictions imposed by the government bureaucrats, and continue to posture as the party of compassion and empathy - even as they fight against the dirty work they created.