"The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here....There is going to have to be a very difficult democratic conversation that takes place."
- President Obama, interview with The New York Times
Buried within the 1,990 pages of Speaker Pelosi's health care bill are new provisions that would allow federal bureaucrats to completely re-write existing regulations in a way that could deny patients access to effective but costly health treatments:
· Sections 1159 and 1160 of the bill direct the Institute of Medicine to study ways to promote "high-value health care." The bill directs the Institute to complete a series of recommendations on changes that should be made to Medicare's reimbursement system to accomplish such ends, and further directs the Secretary to draft a plan to implement these proposed changes.
· Language on page 510 of the bill authorizes the Secretary to waive any requirements in the existing Medicare statute "in order to implement such changes." In other words, bureaucrats at the Centers for Medicare and Medicaid Services (CMS) would have blanket waiver authority to re-write existing statute and regulations unilaterally.
· While the bill does provide for a process of review by Congress of CMS' proposed changes, the federal bureaucrats' recommendations would automatically take effect unless both Houses of Congress pass a joint resolution of disapproval by May 2012. Given that President Obama will still be in office at that time and will have authority to veto such a joint resolution, the language effectively requires 2/3rds of each body of Congress to agree to override CMS' recommendations-or otherwise federal bureaucrats will have virtual carte blanche to re-write the existing statute books.
· Most disturbingly, the language does not prohibit federal bureaucrats from denying patients access to costly but effective treatments and services. Because these sections contain no anti-rationing language, many may be concerned that federal bureaucrats could decide to create a "high-value" health care system by denying access to all treatments that, while effective, are too costly in the bureaucrats' minds to warrant federal payment.
· Many may believe that the study proposals resemble a concept advocated by former Senator Tom Daschle-a board of unelected bureaucrats making health care decisions, including decisions about which therapies and treatments the federal government will cover. In his book Critical, Daschle wrote that, "We won't be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost-effective."
· Many of President Obama's key advisers have echoed his comments above questioning the need for the federal government to finance costly but effective health treatments. In addition to Sen. Daschle's long-time advocacy of a federal health board to regulate treatments' cost-effectiveness, a report released by the liberal Commonwealth Fund earlier this year argued that up to $634 billion could be saved by denying individuals access to treatments that are not "cost-effective."
"In health care, waiting lines...can reduce the average cost of health capital, even while raising patient costs in terms of time and inconvenience. Health care waiting lines represent a trade-off between patient costs and capital costs."
- Senior Obama Administration Official Sherry Glied, writing in Critical Condition: Why Health Reform Fails
Given comments by many key liberal groups-as well as the President himself-many may be concerned that the Pelosi bill's $1.3 trillion in spending on a government takeover of health care will increase federal bureaucrats' role in making patients' personal health decisions-and lead to unacceptable delays in life-saving treatments for many Americans.