Obamacare’s Monster and the Rationing Future

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Obamacare’s Independent Payment Advisory Board is authoritarian. It does not “advise,” it imposes on cost cutting for Medicare—even over a presidential veto.  Moreover, it’s imposed “advice” is also immune from judicial review.  Frankly, I think it is blatantly unconstitutional because it tells Congress what to do instead of the other way around. But with the courts we have these days, nothing is certain.

As currently existing, the IPAB cannot ration care. But that is precisely the destination toward which the monster is lurching. It isn’t even up and running yet, and already President Obama and the New England Journal of Medicine have called for expanding its powers—and in the NEJM’s case, urged that it be allowed to impose rationing.  And now a big voice in Obamacare circles, Christina Romer has dittoed the call in the NYT.  From, “Only the First Step in Containing Health Care Costs:”

Once the payment advisory board has a track record, for example, perhaps it could be empowered to suggest changes in benefits or in how Medicare services are provided — say, along the lines of successful demonstration projects.

Suggest?  IPAB doesn’t suggest: It dictates and its fiats are all but removed from democratic checks and balances.

If we want to remain free, IPAB must die, or at least be defanged into a truly advisory panel without the power to tell Congress what to do. Otherwise it will reproduce and we will have IPAB-like authoritarian boards scattered throughout the depth and breadth of government, unaccountable to “we the people,” who at least theoretically, are supposed to be in charge of the country.