Sarah Palin popped up again today on the Wall Street Journal’s Op-Ed page to renew her accusation that President Obama was advocating “death panels.” Never mind that lawmakers have already abandoned the proposal that gave rise to the original “death panel” hysteria, namely, a provision allowing Medicare to pay doctors no more than once every five years to counsel patients about their options for “end of life” care. (Some top geriatricians think such counseling would actually give the elderly more control by encouraging them to declare their preferences while they’re still capable of doing so. But I digress.) This time, Palin attacked Obama’s proposal to beef up MedPAC — the Medicare Payment Advisory Commission. The 17-member MedPAC makes recommendations to Congress about how much doctors and hospitals should be paid for the services they provide. To insulate these decisions from political pressure, Obama has proposed giving a new version of MedPAC the power to set reimbursement levels, with Congress retaining the power to veto those decisions before they take effect. To Palin, though, this amounted to giving “an unelected, largely unaccountable group of experts” the power to make life-and-death decisions about care.
As much as I appreciate the former governor’s concern for her elders, myself included, her argument smacks of pandering to those who don’t want the federal government to rein in Medicare costs. The program’s trust fund for hospital care is going bankrupt; with no change in policy, it will be insolvent in eight years. In addition, the program’s rising costs are consuming an ever-growing percentage of the U.S. economy. The ship is sinking, and Palin’s solution is to cap malpractice awards and give Medicare recipients “vouchers that allow them to purchase their own coverage.” That’s just an invitation to a more vicious form of rationing than anything a beefed up MedPAC might do.
Think about it for a minute. The cost of private health insurance is rising faster than Medicare expenses (in part because private insurers pick up part of the tab for the uninsured and underinsured, such as Medicaid patients). If the government increased the value of the vouchers over time to keep pace with that growth, the program would cause a bigger financial headache than Medicare does today. But if Congress held down the value of the vouchers below the rate of medical inflation — an idea that former House Speaker Newt Gingrich and President George W. Bush both backed — the program would force seniors to pick up an increasing share of the tab or sign up for more restricted (i.e., more heavily rationed) coverage. Unless, of course, some meaningful changes were made in Medicare to limit the increases in healthcare costs — like, say, Obama’s MedPAC proposal.
It’s dishonest to suggest we can bend the curve on Medicare spending without sacrificing something. It’s past time for politicians to own up to the people who receive subsidized healthcare — to wit, anybody with Medicare, Medicaid or a group plan from their employer — that the system is unsustainable. Done right, the changes made to control costs will come mainly at the expense of those profiting from the inefficiencies of the system. Those inefficiencies, however, often translate into services that are desired but not really needed — for example, having an MRI to make absolutely sure your orthopedist correctly diagnosed your joint pain as tendonitis. That’s the part of the healthcare reform debate that neither Palin nor Obama seem willing to acknowledge.
The Los Angeles Times