The Wall Street Journal editorializes on a little-covered aspect of Obamacare that’s in both the House and Senate bills: a “global budget” for Medicare– to be enforced by the unelected (and thus effectively answerable to no one) Commission on Comparative Effectiveness Research–that will kick in by 2019:
The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.
Worse, it makes little room for medical innovations. The commission is mandated to go after “sources of excess cost growth,” meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer’s in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that “Maybe you’re better off not having the surgery, but taking the painkiller,” as President Obama put it in June.
Here’s how the state of Washington, which already has such a commission in place, doles out medical treatment for old folks and the poor:
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a “high” efficacy but also a “high” cost.
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he’s covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don’t, Washington will not reimburse them for “inappropriate care.”
And you thought death panels were just a figment of the imagination of the moose-murdering mama from Wasilla.