Max Baucus Requires Health Care Rationing

The Washington Times recently took a look at the forced health care rationing in Chairman Max Baucus’s health care overhaul legislation:

The offending provision is on Pages 80-81 of the unamended Baucus bill, hidden amid a lot of similar legislative mumbo-jumbo about Medicare payments to doctors. The key sentence: “Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician’s resource use is at or above the 90th percentile of national utilization.” Translated into plain English, it means that in any year in which a particular doctor’s average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor’s payments by 5 percent.

Forget results. This provision makes no account for the results of care, its quality or even its efficiency. It just says that if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year’s end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties.

This is a highly arbitrary and pernicious way to cut medical care for seniors. The Baucus approach penalizes the top ten percent every year. There is no target level of spending, after which the penalties sunset. Further, no provider ever knows if he or she is likely to end the year in the top ten percent. For that reason there is an incentive to cut costs on every patient, every procedure, every expenditure, on every day of the year. And if a doctor finishes the year in the bottom 90 percent, the average level of spending will have been reduced, and there will be a new contest to cut further, to remain in the bottom 90 percent the next year.

In practical terms, there’s probably some point at which further rationing becomes politically impossible. Once Medicare expenditures and reimbursements are sufficiently reduced, once the federal government has adopted Oregon-style death panels to deny expensive care to the aged and infirm, Congress will likely have to step in to stop the ‘death spiral.’

Another likely effect of this change would be to encourage doctors to shift more costs from Medicare to private plans. If there is an ongoing incentive to reduce spending on Medicare patients, caregivers will try to cost-shift to those on private plans. That will have the added effect of driving up health insurance costs.

Every Democrat on the Finance Committee voted to preserve the Medicare death spiral. Kent Conrad voted for it even as he recognized why it’s a bad idea:

As National Right to Life Executive Director David N. O’Steen, Ph.D., has previously noted, “It’s like a game of musical chairs, in which there is always one chair less than the number of players – so no matter how fast the contestants run, someone will always be the loser when the music stops.”

Although Senator Kent Conrad (D-ND) voted against the Kyl Amendment because he disagreed with its budget offsets (required under the committee’s rules), he earlier said, “As I try to put my feet in the shoes of a doctor, I don’t know how you separate out overutilization that is really overutilization. There is no way of knowing when you go through the year, what you are going to do at the end of the year.” He warned that the provision could come back to “haunt us” in a few years.

The Senators who voted to keep this provision are:

Max Baucus, MT

Jay Rockefeller IV, WV
Kent Conrad, ND
Jeff Bingaman, NM
John Kerry, MA
Blanche Lincoln, AR
Ron Wyden, OR
Charles Schumer, NY
Debbie Stabenow, MI
Maria Cantwell, WA
Bill Nelson, FL
Robert Menendez, NJ
Tom Carper, DE

If you’re a constituent, you might want to ask why.

Via Protein Wisdom

Cross-posted to theconservatives