Democrat Proposals to Create a Federal Health Board
Plans Would Empower Bureaucrats to Ration Care by Setting Payment Levels
“The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here….There is going to have to be a very difficult democratic conversation that takes place.”
— President Obama, interview with The New York Times
Last week the Administration sent to Congress draft legislation creating an “Independent Medicare Advisory Council” (IMAC), which would create a new, Presidentially-appointed board empowered to make recommendations on cost savings proposals. These cost-saving proposals could include denying care to the elderly because an unelected board of bureaucrats determines the treatment recommended by physicians is too expensive. In transmitting the legislation, the White House endorsed its bill, along with similar legislation (S. 1110; H.R. 2718) first introduced by Sen. Jay Rockefeller (D-WV), as two potential ways to slow the growth of health costs. However, a close examination of the bills’ provisions finds that each would give significant power to federal bureaucrats, with few controls on their ability to impose reimbursement cuts and deny access to life-saving but costly medical treatments:
- Both bills would empower boards to make recommendations on reductions in Medicare payment levels—the White House bill through its new Council, and the Rockefeller bill through a revamped Medicare Payment Advisory Commission (MedPAC).
- Both bills would give the President the power to appoint board members, subject to Senate confirmation; MedPAC members are currently appointed by the Comptroller General, but S. 1110 would make the Commission an independent executive branch agency, with its members subject to Presidential appointment.
- Both bills would make the boards’ recommendations binding absent external action. The Rockefeller bill would permit Congress to overrule recommendations made by the Commission—but only if 3/5 of Members in each chamber agreed to consider such legislation. The White House proposal would require the President to give his up-or-down approval of the Council’s recommendations en bloc, and if the President approves, Congress would have 30 legislative days to pass a joint resolution expressing its disapproval—otherwise the proposals would be implemented.
- Both bills would give the respective commissions the power to set reimbursement rates for providers in Medicare. Some Members may be concerned that these provisions could result in the federal government refusing to reimburse doctors and hospitals for providing treatments to seniors that, while effective, are too costly.
- While press reports indicate that some Democrat Members are insisting on higher Medicare reimbursements for rural areas to expand physician access in those locales, there is nothing in either proposal that would prohibit the respective councils from reducing—or even eliminating entirely—these payment increases for rural providers.
- The White House bill would go further than the Rockefeller proposal, empowering the new IMAC to impose “delivery system reforms” on health care providers. Page 11 of the bill notes that such reforms must “either improve the quality of medical care received by the beneficiaries of the Medicare program or improve the efficiency of the Medicare program’s operation.” Some Members may be concerned that this provision, by allowing the enactment of “reforms” that EITHER improve beneficiary care OR save the program money could result in this new board of bureaucrats denying access to life-saving treatments on cost grounds.
- Both pieces of legislation would also place significant restrictions on judicial review that would effectively prohibit individuals harmed by the boards’ recommendations—including any seniors denied access to care because of a bureaucratic prohibition on covering costly treatments.
“In health care, waiting lines…can reduce the average cost of health capital, even while raising patient costs in terms of time and inconvenience. Health care waiting lines represent a trade-off between patient costs and capital costs.”
— Senior Obama Administration Official Sherry Glied,
writing in Critical Condition: Why Health Reform Fails
- Because both pieces of legislation would give the President veto power over any disapproval resolution, overriding the recommendations of the respective Commissions could effectively require the support of 2/3 of Congress—which would give the bureaucratic boards significant leverage to make binding decisions on millions of doctors and other health care professionals.
- Some Members may believe that both proposals resemble a concept advocated by former Senator Tom Daschle—a board of unelected bureaucrats making health care decisions, including decisions about which therapies and treatments the federal government will cover. In his book Critical, Daschle wrote that, “We won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost-effective.”
Given the various proposals for a “MedPAC on steroids,” some Members may be concerned by the implications of these potential changes—which would give unelected and unaccountable bureaucrats power to micro-manage the doctor-patient relationship and deny life-saving treatments to millions of American seniors. Moreover, some Members may view the many new bureaucracies the bill establishes—and the significant powers given to them—as emblematic of the many problems associated with the Democrat-proposed government takeover of the health care system.