Are the ideas banned?

In an interview with the New York Times in April 2009, President Obama said that it “is a very difficult question” whether it is “a sustainable model” to give hip replacements to the terminally ill. He went further, explaining how to cut the cost of caring for “the chronically ill and those toward the end of their lives”:

It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

That, and other remarks, led people to worry about an “independent group” that would be responsible for rationing care to the elderly and chronically ill. And, sure enough, the health care nationalization bill creates an Independent Medicare Advisory Board to cut Medicare spending.

A month ago, the White House told us not to worry about the board rationing care because:

To make sure that America’s seniors on Medicare are protected, all ideas that ration care . . . will be banned.

The ideas will be banned! I was skeptical, to put it mildly. But now that the bill is law, let’s see what it says. Are the ideas banned?

Section 3403 says in regards to the board’s proposals (which take effect automatically):

The proposal shall not include any recommendation to ration health care.

Sounds like a good start, but the strength of the prohibition depends on how “ration health care” is defined. So what’s the definition?

There isn’t one. The word “ration” appears nowhere else in the entire bill. As a result, it’s hard to see that this prohibition could ever be enforced. It’s just there for the White House to point to.

But, in the very next paragraph, the bill specifically authorizes cuts in “payment rates for items and services furnished” beginning in 2020. So while the board isn’t supposed to “ration health care”, it has the power to limit payment rates for health care, which will have exactly that effect.

In short, the board is empowered to ration care, but prohibited from calling it that.

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