One of the most significant questions facing the country on health care policy in the wake of President Obama’s nationalized reforms is who ought to make decisions about which products are available, and for whom.

Obama’s plans involve a major bolstering of top-down rationing from Washington—particularly through the Independent Payment Advisory Board (IPAB), a group of unelected and unaccountable bureaucrats and experts whose price-focused rationing policies will go into effect unless a supermajority of Congress overrules their decisions. In the president’s recent remarks outlining his solution to deficit problems, he doubled-down on IPAB, calling for even more authority for the board, which is effectively insulated from transparency and any real challenge on the part of American citizens.