About the president’s National Commission on Fiscal Responsibility and Reform Sarah Palin writes,
It also implicitly endorses the use of “death panel”-like rationing by way of the new Independent Payments [sic] Advisory Board—making bureaucrats, not medical professionals, the ultimate arbiters of what types of treatment will (and especially will not) be reimbursed under Medicare.
Sigh. I’ll restrain myself and simply ask, would Palin accept IPAB recommendations if they were endorsed by medical professionals? Let me also note that a low Medicare reimbursement for a proven less-effective treatment need not mean the inability to receive it. It just means that the patient has to pay a greater marginal cost. It’s a consumer-directed and value-based design.*
About the Ryan Roadmap, she writes,
On health care, it would replace ObamaCare with a new system in which people are given greater control over their own health-care spending. It achieves this partly through creating medical savings accounts and a new health-care tax credit—the only tax credit that would be left in a radically simplified new income tax system that people can opt into if they wish. [Emphasis mine.]
This is not a terrible idea, and I have no doubt that more enrollment into consumer-directed (higher deductible) plans with medical savings accounts is in our future. So long as there are protections for low-income individuals and a movement toward value-based cost sharing, it’s worth a try.
But recognize the disconnect between support of consumer-directed concepts in the Ryan Roadmap and rejection of what could be essentially the same thing under the IPAB. Either way, it’s about individuals paying more of their own way, and particularly for therapies with lower effectiveness. Why does Palin prefer taxpayers foot the bill for less effective care?
If Palin is going to call spending more of one’s own money and less of someone else’s (taxpayers’) on health services “death panel-like rationing” then she has effectively rejected and endorsed doing so in the same column. That presupposes that “death panel-like rationing” has a precise definition and that Palin knows what it is. I wish she’d tell us and explain why the term doesn’t apply to what insurance companies do every day, what they’d do under Rep. Ryan’s plan.
I have another theory that fits the facts. “Death panel-like rationing” actually doesn’t mean anything and doesn’t apply to anything that would ever happen in the U.S. It’s just another euphemistic bit of nonsense, full of fear and loathing, signifying nothing.
*This would require a change in the balance-billing rules. Follow the links to learn more (post 0, post 1, post 2, post 3).