When the Obama administration first proposed its massive overhaul of the nation's healthcare system, opponents raised concerns that government officials would be making decisions about healthcare not on the basis of a patient's needs, but based on bureaucratic spending limits and one-size-fits all political decrees.
Critics were especially alarmed over a provision in the Affordable Care Act that creates an agency called the Independent Payment Advisory Board and charges it with limiting the growth of Medicare spending. The board will set the payment rates healthcare providers will receive for treatments and services of Medicaid patients.
The board's directives automatically become law. It can't be sued; and its decisions can't be meaningfully controlled by Congress. The act even makes it nearly impossible for Congress to repeal the board's authority.
Worse still, although the board is focused on Medicare, it actually has broad powers to govern both government and private healthcare. The act gives the board power to make whatever decisions it considers "related to the Medicare program." True, the act also forbids it from "rationing care," but "rationing care" is not defined in the law. Because the board is immune from lawsuits, that's an empty promise.
The truth is, this board of 15 unelected, unaccountable administrators will decide who gets care and what care they get.
When the Act was first passed, its defenders pooh-poohed these concerns, ridiculing the idea of "death panels." But any agency that is so insulated from the democratic process and the rule of law poses a real threat to freedom — and to accessing the medical care we all need.
Unfortunately, these concerns are not just a thought experiment. A new report by the Center for American Progress calls for states to establish caps on healthcare spending growth that mimic the federal board's charter. For instance, the report urges states to set "cost growth targets" and then "enforce" them "through either existing resources — such as state health commissions — or by forming a new entity." In other words, state bureaucracies will restrict the payments hospitals receive for treating Medicaid patients — which means fewer services and less choice for low-income families who need medical care.
In another euphemistic passage, the report urges states to "set a fixed budget for each hospital each year" based on a bureaucratic formula. That way, "freed from fee-for-service incentives, these hospitals can focus on reducing avoidable admissions." In other words, if the government restricts a hospital's resources, the hospitals will discourage patients from checking in.
Imagine if bureaucrats set spending caps on everything from fast food restaurants to car washes to telecommunications to airlines. A system that puts bureaucrats in charge of how much medical care a society should receive, and how much can be spent for that care, will undoubtedly deprive patients of access to needed care — increasing centralized decision making at the expense of individual healthcare decisions.
Maybe some patients aren't interested in choosing medical care for themselves. The report's lead author, Zeke Emanuel, is the former White House healthcare advisor who famously declared that he intends to reject all medical interventions for himself, including flu shots, after age 75. He blames the Hippocratic oath — the pledge doctors take to do no harm — for the "overuse" of medical care.
But most people want to make their own decisions about medical care with their doctors — not government officials who don't answer to voters or the courts, and whose main concern is cost, not patient welfare.
The question for lawmakers and citizens is: Should choices about that service be made by individuals, legislatures, or by administrative agencies that lack oversight?
After six long years of teeth-gnashing over the ACA, voters should be asking presidential and congressional candidates' positions on one of the most concerning and far-reaching provisions in that law. Should IPAB stay on the books, or should we be moving toward putting patients and their doctors back in the driver's seat?
Naomi Lopez Bauman is the Director of Healthcare Policy and Christina Sandefur is the Executive Vice President at the Goldwater Institute and leads the Institute's legal challenge against the Independent Payment Advisory Board. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.