Who will be in charge of your health care?

The Washington Times Weekly - - Commentary -

In a chap­ter ti­tled “Who, Whom?” from his clas­sic book “The Road to Serf­dom,” F. A. Hayek warned of the uni­ver­sal prob­lem of a so­cial­ist so­ci­ety: “Who plans whom, who di­rects and dom­i­nates whom, who as­signs to other peo­ple their sta­tion in life, and who is to have his due al­lot­ted by oth­ers?”

The bud­get battle cur­rently un­der way in Wash­ing­ton is about much more than money and debt. It is about who we are as a peo­ple and what we are to be­come. This strug­gle is epit­o­mized in the dis­cus­sion over Medi­care.

On the one hand, Rep. Paul Ryan, Wis­con­sin Repub­li­can, has sug­gested that be­gin­ning in 2022, se­niors would re­ceive a pre­mium each year to pur­chase pri­vate health in­surance from a list of ap­proved plans. This is es­sen­tially the same health in­surance sys­tem that fed­eral em­ploy­ees re­ceive. The roughly $15,000 pre­mium that se­niors would re­ceive is the equiv­a­lent to what Medi­care is pro­jected to spend per in­di­vid­ual un­der Oba­macare. Re­cip­i­ents would be means-tested and the amount they re­ceive would be ad­justed for in­fla­tion. The dif­fer­ence in this ap­proach is that it puts pa­tients in con­trol of their own health care de­ci­sions by al­low­ing them to choose the in­surance cov­er­age that best fits their needs. The re­sult­ing competition among the pri­vate in­sur­ers is likely to lead to bet­ter cost con­trol com­pared to a gov­ern­ment-run pro­gram such as Medi­care.

Pres­i­dent Obama has cas­ti­gated the Ryan plan as a “rad­i­cal” plan that would vi­o­late our “so­cial con­tract.” And this is from a pres­i­dent who, just be­fore his elec­tion, boasted that “we are just five days away from fun­da­men­tally trans­form­ing Amer­ica.”

Oba­macare, on the other hand, cuts $468 bil­lion from Medi­care — a pro­gram that al­ready has $38 tril­lion in un­funded obli­ga­tions. The cuts come pri­mar­ily from de­creases in re­im­burse­ment to physi­cians and hos­pi­tals. Car­ing for Medi­care pa­tients al­ready is a los­ing propo­si­tion for many physi­cians and hos­pi­tals. With fur­ther cuts in re­im­burse­ments, Medi­care es­ti­mates that within 10 years, 15 per­cent of hos­pi­tals will go out of busi­ness. This will leave many se­niors with an in­surance card but no physi­cians or hos­pi­tals to care for them.

Oba­macare also puts in place a cost-cut­ting panel called the In­de­pen­dent Pay­ment Ad­vi­sory Board. Mr. Obama high­lighted the virtues of this board in his re­cent speech re­spond­ing to Mr. Ryan´s bud­get pro­posal. This is a board of 15 un­elected bu­reau­crats that is charged with lim­it­ing Medi­care spend­ing to pre­de­ter­mined lim­its. The only mech­a­nism avail­able to them is to fur­ther de­crease re­im­burse­ments or to elim­i­nate re­im­burse­ments for par­tic­u­lar pro­ce­dures or pa­tients al­to­gether. Fur­ther­more, the de­ci­sion of this un­elected panel is law; the sec­re­tary of health and hu­man ser­vices will im­ple­ment the board’s rec­om­men­da­tions. This un­doubt­edly will lead to ra­tioning of care, par­tic­u­larly for those most vul­ner­a­ble (the el­derly and the very young), much as is seen in the United King­dom to­day.

The Democrats are bank­ing heav­ily on the no­tion that most peo­ple don’t want any changes to Medi­care. What they don’t want you to know is that Oba­macare has al­ready changed Medi­care dras­ti­cally. Medi­care has been fi­nan­cially evis­cer­ated, guar­an­tee­ing that se­niors will not re­ceive the care that they have been promised. In ad­di­tion, they will be sub­jected to the dic­tates of an un­elected board of bu­reau­crats that will be man­dated to de­ter­mine what care will be al­lowed. As in­creas­ing num­bers of peo­ple reach re­tire­ment age and the re­sul­tant fi­nan­cial stresses are added to a gov­ern­ment al­ready in fi­nan­cial cri­sis, the In­de­pen­dent Pay­ment Ad­vi­sory Board will be forced un­der Oba­macare to fur­ther re­strict ser­vices in or­der to con­trol costs. This is the prob­lem of which Hayek warned us. Who will de­cide? Will it be the in­di­vid­ual who de­cides what is best for him and what is in his best in­ter­est? Or will it be a board of anointed so­cial plan­ners who de­cide what we may and may not have in or­der to de­ter­mine what is best for the col­lec­tive?

Who will we be as a peo­ple? Will we con­tinue to be a nation that supremely val­ues in­di­vid­ual lib­erty, as our Found­ing Fathers en­vi­sioned, putting per­sonal de­ci­sions into the hands of the in­di­vid­ual? Or will we sac­ri­fice our right to make our own de­ci­sions to a panel of bu­reau­crats in Wash­ing­ton?

Who, whom?

Dr. Mark G. Neer­hof is an ex­ec­u­tive board mem­ber of Docs for Pa­tient Care.

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