A Modest Proposal for IPAB’s Defenders
Several months ago I began experiencing problems walking on my left foot.* I was born with deformed bones in my left foot, and the pressure from walking on this abnormal foot structure for more than 30 years began to take its toll. I visited several podiatric and orthopedic specialists to evaluate my options; non-invasive methods like orthotics and therapy helped, but it became apparent to me that they weren’t really solving the problem, as opposed to delaying the inevitable. So I consulted with a surgeon, and he arrived at a plan of action – fusions, grafts, and a tendon lengthening – which should significantly alleviate my pain and improve my gait. Feeling comfortable with the surgeon’s level of expertise and with his recommended treatment plan, I scheduled surgery for a few weeks from now.
However, the recent debate over the IPAB – Obamacare’s body of unelected bureaucrats who will control Medicare spending – has prompted me to reconsider my decision. After all, who am I to decide how my own health care should be handled?
- Paul Krugman has taught me that “Patients are Not Consumers” and that “making [health care] decisions intelligently requires a vast amount of specialized knowledge”;
- The Center for American Progress, in making “The Case for Bureaucrats in Health Care,” has taught me that health care is different from buying shoes;
- Ezra Klein has taught me that “consumer-directed health care is a silly idea” because “patients are not qualified to evaluate good care”; and
- CMS Administrator Donald Berwick has taught me that “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”
These statements have left me in a serious conundrum, and forced me to reconsider my thinking. After all, I’m not an expert on health care – I’m not even close:
- I don’t have a PhD in economics, which, as Secretary Sebelius recently pointed out, qualifies individuals as “experts” in how to run a health care system;
- Neither I nor my surgeon graduated from an Ivy League school; and
- I don’t even know all the words to Fair Harvard.
I do however now recognize that I am not only clearly incapable of making my own health care choices, but also that my health – and our entire country – would be better off leaving those choices to “experts” who are my intellectual superiors. After all, President Obama promised that the stimulus would prevent unemployment from rising above 8 percent – and who thinks joblessness is still a major problem more than two years later? And just look at how Obamacare has already delivered the $2,500 reduction in premiums that candidate Obama repeatedly promised.
So all I need now is to find a suitable “expert” to tell me whether I should have the surgery or take the painkiller. Therein lies my open request to IPAB’s defenders, to provide me with the enlightened knowledge of my own medical condition that I so clearly lack:
- Peter Orszag – supporter of IPAB as a way “to improve Medicare’s cost-effectiveness” – can tell me whether my surgery will cost too much;
- Zeke Emanuel can tell me where my procedure fits on his chart for the allocation of scarce medical resources; and
- Dr. Berwick can tell me if I’m one of those cases where “Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been available for centuries.”
I do hope that one of these individuals – or indeed other political commentators who have supported IPAB in recent weeks – can tell me how I should proceed when it comes to my foot. After all, I now realize that my surgeon could be recommending an operation just for the reimbursement check – because most medical professionals base their decision-making processes on whether they will obtain a $50,000 payday (as opposed to Obamacare’s “experts,” whose decisions will be based on the fact that “the social budget is limited – we have a limited resource pool”).
There is a catch however: While I will defer my own opinion to those of the “experts,” I do expect that any individual who passes judgment on my case will assume full financial and legal liability for same. That may be a problem for some of IPAB’s defenders. After all, Section 3403 of the statute exempts the IPAB and its members from ANY legal liability associated with its decisions.
And therein lies the point of this proposal, and this story: If the IPAB’s defenders – and its so-called “experts” – aren’t willing to put their own money where their mouths are, then how good will this board of unaccountable bureaucrats be?
* And just in case you were wondering, the facts of this story are real, as is the sarcasm…