SENATE AMENDMENT WITH MORE EXTREME RATIONING COMING?

The Reid Substitute now being debated and amended on the Senate floor contains significant provisions that, unless corrected, will lead to rationing of lifesaving medical care. However, it may be that a still greater danger of rationing looms.

According to both the Washington Post and InsideHealthPolicy.com (a subscription-only service) this morning (December 2, 2009), a group of "centrist" Democratic Senators are fashioning new provisions "to strengthen the bill’s existing cost-containment measures," and are doing so in private consultation with committee and Senate leaders.

Among the most dangerous possibilities reportedly under discussion is a proposal to extend the authority of the Medicare Commission, which in the Reid Substitute has the duty to cut Medicare growth below the rate of medical inflation, to cover nongovernmental health insurance as well. If a government commission is given authority to limit what private insurance plans are able to charge and the treatment they are allowed to provide, this would track proposals to create a "Federal Health Board" first put forth by former Senate Majority Leader Tom Daschle, whose original nomination to be Obama’s Secretary of Health and Human Services was withdrawn because of concerns over back taxes and financial conflicts of interest. It has been reported that despite his lack of a formal position, Daschle has been heavily involved in strategizing with White House and Senate leadership about how to guide the Senate bill to the finish line. An analogue to such a board exists as the National Institute for Clinical Excellence (N.I.C.E.) in Great Britain.

Opponents of rationing are put into a bind by the reports. On the one hand, until an actual "cost-containment" proposal is made public, it is impossible to determine whether it will compel rationing and, if so, mobilize to oppose it. On the other hand, by the time it is made public, it may already have the support of the majority caucus negotiated behind the scenes, making it very difficult to stop.

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