Who decides? That is the most important question when it comes to Medicare savings. First, some background:
Conservatives suddenly are abuzz again with talk of an Obamacare “death panel,” and in substance they have a point: If the Independent Payment Advisory Board (IPAB) works anything like its model in Oregon… and if government health-care programs effectively crowd out private options so that the bureaucratic decision-makers in the government program are, for all intents and purposes, the ultimate arbiters of who receives which treatments… then people have serious reason to worry that their lives could be foreshortened by government fiat. Employing the phrase “death panel” has its advantages and disadvantages (the biggest of the latter is that it keeps the establishment media from giving the complaint any credence, even though the problems with IPAB are both real and acute), but the board’s potential for harm is evident in the fact that 72 Democratic House members last year joined Republicans in asking for the panel to be removed from the bill.
Meanwhile, the anti-Obamacare lawsuit which takes on IPAB directly (among other things), led by the Goldwater Institue, seems to me absolutely on target in challenging how the board is set up to be a power unto itself with no congressional oversight of any relevance or weight. That suit merits far more attention, via full columns rather than quick blog mentions, and conservatives are foolish not to rally in support of it.
With all the anti-IPAB talk bubbling up right now, though, the talk has been strangely disconnected from the budget debate that has been front and center of the American political universe for weeks. Yet with President “Don’t Interrupt Me” Obama jetting all over the country to spread demagogic scare tactics against the Medicare portion of Rep. Paul Ryan’s budget proposal, those on the right really haven’t done much to parry the specifics of his attacks on the “voucherization” or “privatization” of Medicare. Yet the fact is that the president aims to save almost as much money from Medicare as Ryan does — except that he wants to use IPAB to do it.
That’s why conservatives should take up his challenge. We should answer that it is he, not we, who is (/are) for “cutting” Medicare. He does it by giving vast powers to unelected bureaucrats almost entirely unanswerable to Congress. We achieve savings, which may not involve actual cuts in care at all, by giving power to the patients themselves. Conservatives should do a very specific poll on Medicare Part D. If, as I suspect, it is still a highly successful program, then conservatives should say that all Ryan wants to do is to make all of Medicare work the same way that Part D does — except without the doughnut hole. The idea is to allow seniors themselves to achieve savings while finding the best care they can.
We save; Obama cuts. More importantly, we give the power to the patients; he gives it to bureaucrats with a mandate to chop costs by unaccountable orders.
So the question is, Who decides: The individual patient, or the government commissars?
When phrased like that, conservatives don’t even need to say the phrase “death panel.” For most listeners, the scary implications of Obama’s approach will be clear.