Obamacare, IPAB, and rationing

During the first presidential debate, Mitt Romney criticized Obamacare for creating an unelected Independent Payment Advisory Board that will effectively ration medical care. Barack Obama denied the rationing charge. Burke Balch of the Robert Powell Center for Medical Ethics explains the facts of the matter:

"A rose by any other name," Shakespeare wrote, "would smell just as sweet." Unfortunately, the same is true when the fragrance is less pleasant.

When the role of Obamacare's Independent Payment Advisory Board in rationing life-saving medical treatments is alleged, the law's apologists indignantly point out that the law specifically precludes the board from "rationing." They seem convinced this demonstrates that the charges of "rationing" are unarguably false. But are they right?

Let's review the facts. The law directs the Independent Payment Advisory Board (IPAB) to report proposals, every two years from 2015 on, "to slow the growth in national health expenditures" to significantly below the rate of medical inflation. (From 2019 on a different, but similarly constraining, target is required.)

To be clear, these recommendations are to apply to what you and I choose to spend on our health care – nongovernmental spending. They are to include recommendations that the federal Department of Health and Human Services (HHS) "can implement administratively."

What are those "administrative" means that the federal bureaucrats at HHS can use to prevent us from keeping up with medical inflation in trying to protect our loved ones stricken by illness or injury? HHS is empowered to impose so-called "quality" standards on doctors, standards they must follow under pain of losing the ability to contract with the health insurance plans that the individual mandate will require Americans to have.

To prevent "too much" private money being spent on health care, those standards could establish just which diagnostic tests and medical treatments are permitted under what circumstances – and which are not. Thus, the government could prevent people from getting particular life-saving medical treatments – even when paid for entirely by their own money. (For details and documentation, go here.)

The Obamacare law doesn't define what it means by the "rationing" it says IPAB can't use. Its apologists will claim that the "quality" standards limiting treatment are simply "cost-effective" means of assuring patients get "appropriate" care. Consequently, the "rationing" prohibition will not be an enforceable restraint courts could use to protect Americans from denial of medical care. It's not so much a shield against treatment denial as it is a rhetorical sword to ward off the law's critics.

The Britannica Concise Encyclopedia describes rationing as "Government allocation of scarce resources and consumer goods, usually adopted during wars, famines, or other national emergencies." Health care does not need be "scarce" (see here). But, when government bureaucrats tell you what treatments, paid for with your own money, you can and can't have – that is certainly "government allocation" of health care.

The Obamacare law authorizes federal bureaucrats to impose limits on what life-saving medical treatments Americans are allowed to get. It may not call this "rationing." But that doesn't mean it won't be.

Go here for more about Obamacare and rationing.