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Tuesday, May 3, 2011

Even Critics of ObamaCare’s Independent Payment Advisory Board Miss Its Worst Rationing

Recently there has been a fair amount of press coverage of the effort to repeal a central aspect of the Obama Health Care Law—the unelected 18-member Independent Payment Advisory Board given sweeping powers to limit what people are allowed to spend for health care. Strangely, however, most critics focus only on its impact on Medicare spending, and at least one of its defenders appears ignorant of the authority it will exercise to limit Americans’ use of their own private funds.

Democratic representatives are increasingly joining Republicans in co-sponsoring H.R. 452, a bill to repeal the Independent Payment Advisory Board. As noted in an April 19 New York Times article by Robert Pear,

Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board that could make sweeping cuts in the growth of Medicare spending. Mr. Obama wants to expand the power of the 15-member [sic] panel, which was created by the new health care law, to rein in Medicare costs. But not only do Republicans and some Democrats oppose increasing the power of the board, they also want to eliminate it altogether. Opponents fear that the panel, known as the Independent Payment Advisory Board, would usurp Congressional spending power over one of the government’s most important and expensive social programs. Under the law, spending cuts recommended by the presidentially appointed panel would take effect automatically unless Congress voted to block or change them. In general, federal courts could not review actions to carry out the board’s recommendations.

In an April 21 piece defending the board, Paul Krugman, one of the paper’s op-ed columnists, wrote, “Before you start yelling about ‘rationing’ and ‘death panels,’ bear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money.”

Yet Krugman’s statement is flatly wrong.

As documented with specific quotes from the legislation at, the Obama Health Care Law specifically directs the board to make “recommendations to slow the growth in national health expenditures” for private—not just governmentally funded—dollars devoted to health care. These recommendations are supposed to limit what ordinary citizens and their health insurance coverage can pay for medical treatment to force it below the rate of medical inflation.

To implement these recommendations, the federal Department of Health and Human Services is empowered to impose so-called “quality” and “efficiency” measures on health care providers. Doctors who violate a “quality” standard by prescribing more lifesaving medical treatment than it permits will be disqualified from contracting with any of the health insurance plans that individual Americans, under the Obama Health Care Law, will be mandated to purchase. Few doctors would be able to remain in practice if subjected to that penalty.

This means that treatment that a doctor and patient deem advisable to save that patient’s life or preserve or improve the patient’s health, but which exceeds the standard imposed by the government, will be denied even if the patient is willing and able to pay for it.

“It is truly astounding that this extreme form of rationing has gone almost unremarked even by critics of the Independent Payment Advisory Board,” said National Right to Life Executive Director David N. O’Steen, Ph.D. “That means it is up to grassroots pro-lifers to make both their elected representatives and media outlets aware of the facts, and of how important it is that the Independent Payment Advisory Board be repealed.”

More details on the rationing in the Obama Health Care Law are available at


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