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Death Panels Are Real

October 1, 2013

Okay, they’re sort of real.

Every year, the Big Death Panel, aka the U. S. Congress, after being advised by any number of Little Death Panels, decides how much doctors should get paid for doing this or that procedure on Medicare patients.

Here’s how it works. The AMA has a subcommittee called the RUC which does an analysis and then tells the CMS how much doctors would like to be paid. The CMS typically accepts most of the doctors’ requests and reports to the MPAC which then reports to Congress. Finally, Congress passes a law setting Medicare reimbursement rates.

Got all that? Don’t worry, there’s no need to know what all the letters stand for. Basically, the doctors say, “Pay us this,” and Congress says, “No, we’ll pay you that.”

This happens every year.

In 1997, the Republicans created a Death Mandate called SGR and it was signed into law. SGR tells Congress to hold down the rise in Medicare costs by paying doctors less, or, more precisely, paying them more but not as much more as the doctors would like. Unfortunately, SGR turned out to be too drastic, so every year Congress passes a temporary measure to ignore SGR. The annual ignore the old law law is known as the “doc fix.”

The doc fix is still broken. Obamacare didn’t touch it.

Instead, Obamacare added a Little Death Panel called IPAB that will advise Congress in the event that the RUC, CMS, and MPAC are unable to provide a recommendation that keeps Medicare costs under control. Congress will have to either accept the IPAB recommendations or pass a law ignoring IPAB the way they’ve been passing laws ignoring SGR.

For years, the Big Death Panel, even though it can’t stomach SGR, has been holding down costs a little bit. Congress sets Medicare reimbursement rates below what private insurance pays and thereby saves those precious tax dollars.

So guess what happened? Now some doctors don’t want to treat Medicare patients. Private insurance pays better.

I know what you’re going to say: “What about Medicaid?” Don’t ask. Just forget about it. Don’t go on Medicaid. Bad idea.

So Obamacare, like SGR, says we need to control Medicare costs. It’s a Death Mandate and it has its own Death Panel called the IPAB. If Medicare reimbursements only rise modestly while private insurance costs keep skyrocketing, then Medicare patients might have a harder time finding doctors willing to treat them.

If you can’t find a doctor to treat you or you have to wait longer to see a doctor, you could, in theory, die. This is why traditional cost control measures are now called Death Mandates and Death Panels. It has nothing to do with politics.

Want to control costs? Say hello to your friendly neighborhood Death Panel. Don’t like Death Panels? No problem, just  raise Medicare taxes. But wait! That would hurt the economy. Okay so no Death Panels and no tax increase. I know! We’ll just borrow the money. Oh, but that would increase the national debt. Get rid of Medicare entirely? Can you say political suicide?

No wonder the politicians spend so much time making up fun names for cost control measures.

Let’s recap. The Republican Death Mandate known as SGR, which replaced the Reagan-era Death Mandate known as MVPS, has been ignored by Congress for 15 years but left on the books to make the looming problems with Medicare seem a little less looming. Obamacare and IPAB are up to bat next.

Obamacare supporters say everything will be great. Cost savings will come from cutting waste, fraud, and abuse and broadening the insurance base by insisting that everyone participate. That’s the ticket. Cut fat, not meat; create a fiscally healthy health care system. The days of medical care being the leading cause of bankruptcy will soon be over. Yay!

Or not. Lots of people aren’t quite so idealistic about the government’s ability to pull off this particular trick.

Tea Party Republicans want to save money more simply: insist that retirees make big contributions to their health care in addition to the taxes they’ve already paid. Under their voucher system, private insurance companies would be the Death Panels and the free market would keep costs down automatically.

But, as you know, voucherizing medicare is extremely unpopular.

Libertarians say this mess is what we get for letting Lyndon Johnson create Medicare in the first place.

Liberals don’t like Obamacare either. They want a single-payer universal system like Canada’s. But that’s not going to fare any better politically than the vouchers.

So Obama split the difference by setting up a government system based on private insurance companies and lots of rules like, “you have to sign up” and “you have to cover your employees” and “you can’t drop people when their illness became too expensive.” In general, people don’t like Obamacare but do like the individual provisions when they are presented separately. These people are often portrayed as irrational, but maybe all they are saying is, “We like the ideas, we just don’t think the government can pull it off.”

Obamacare, complete with Death Panels is lurching itself into place complete with disastrous computer programs. On the bright side, there are new “Accountable Care Organizations” that are supposed to leverage American ingenuity by letting people make money by keeping sick people healthy through basic preventative care thereby putting an end to horrid I-need-a-new-car-so-let’s-order-another-procedure doctoring.

The sad truth is, most of us don’t know enough about the very expensive train wreck that is the U. S. health care system to have any idea whether Obamacare is a step forward or a step back. Splitting of the difference between socialized and private solutions worries me. I’m afraid it might be a devil’s compromise where we get the worst of both worlds.

Even more concerning is that fact that elected officials and journalists play games like renaming old-fashioned cost control mechanisms as “Death Panels” and then waste all their time engaging in partisan posturing.

On the other hand, lurid discussions about Death Panels are entertaining.  If you can’t beat ’em, join ’em, that’s what I say.

Death Panels are real.

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