More than 5,000 cancer patients in the United Kingdom recently learned that their government healthcare program will no longer pay for many of the most-effective life-extending drug treatments. Many of these patients must live with the knowledge that they may now die much sooner than they would have if they had access to these vital treatments.
While this news involves overseas cancer patients, the reality is that America’s seniors could soon face a similar fate under the Medicare program.
Since the start of the year, the United Kingdom’s publicly funded National Health Service has ceased funding two-thirds of the drug treatments that were recently available to patients under the Cancer Drugs Fund. The fund was established to allow cancer patients in England to apply for treatments deemed not effective or economical enough for the government’s liking, despite the fact that these drug treatments are standard in many other European countries and the United States.
Here in the U.S., the Independent Payment Advisory Board could soon be responsible for rationing healthcare for our nation’s seniors. The board was established under the Affordable Care Act and is charged with controlling Medicare costs. IPAB’s so-called “recommendations” automatically become law and cannot be reviewed by the courts or rejected by Congress, although Congress could present a competing cost-savings plan.
Under the ACA, IPAB flexes its muscles when Medicare per capita spending growth exceeds the target growth rate. This is expected to take place as early as 2017, according to the most-recent annual Medicare Hospital Insurance Trustees’ report.
IPAB’s authority is unprecedented. The 15-member board is unelected and unaccountable to the President, Congress, the courts or the American people. The ACA even insulates the board from repeal.
IPAB is the most extreme example of consolidated, unchecked government power in American history. Under the U.S. Constitution, no agency can be rendered exempt from democratic processes and the rule of law.
That’s why the Goldwater Institute challenged the Board’s dangerous and unconstitutional powers in court to defend the principles of democracy and checks and balances. Unfortunately, the Ninth Circuit Court of Appeals refused to hear the case until the president appoints members to the board, and the Supreme Court declined to reconsider.
But the ACA says that so long as IPAB remains unstaffed, the secretary of health and human services wields the board’s vast powers alone. And the recent Medicare Trustees’ report suggests those decisions — which will likely reduce healthcare options — could be right around the corner.
The tragic situation for England’s cancer patients too clearly illustrates the dire consequences of relinquishing control over healthcare to unelected and unaccountable bureaucrats. But patients in the U.S. face a worse fate, because IPAB has much broader powers to make law governing both government and private healthcare — whatever the board considers to be “related to the Medicare program.” And those decisions are free of any meaningful checks or balances.
IPAB is free to deny care based on cost alone, without regard for individual patients’ health circumstances or their doctors’ recommendations. While IPAB defenders claim that the board is not allowed to ration care, the ACA doesn’t define what it means to ration care. Interpretation and discretion is left to the board. And because IPAB’s actions can’t be reviewed by courts, doctors and patients can’t sue to protect themselves if the board does ration care.
Indeed, there is little doubt that care will be rationed in one way or another. The question is whether those decisions should be guided by individuals, by the political process or by an administrative agency immune from accountability and oversight.
Fortunately, the courts will have another opportunity to put an end to this unconstitutional consolidation of power when IPAB makes its first law. But in the meantime, countless patients will be left without recourse when the Board starts rationing their care.
Americans should think twice about whether they are willing to put these important healthcare decisions in the hands of unelected and unaccountable administrators. Imagine the thousands of British cancer patients who are learning that, because of a bureaucrat’s decision, they might have significantly fewer years, months or days with their families and loved ones. They might warn us against it.
Naomi Lopez Bauman is the Director of Healthcare Policy and Christina Sandefur is the Vice President of Policy at the Goldwater Institute.Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
