Saturday, September 26, 2009

Pages 80-81 Of The Baucus Bill: Death Panels

Via Memeorandum:

From a Washington Times editorial-Death Panels by Proxy:
Yes, there are death panels. Its members won't even know whose deaths they
are causing. But under the health care bill sponsored by Senate Finance
Committee Chairman Max Baucus, Montana Democrat, death panels will indeed exist - oh so cleverly disguised as accountants.

The offending provision is on Pages 80-81 of the unamended Baucus bill,
hidden amid a lot of similar legislative mumbo-jumbo about Medicare payments to
doctors. The key sentence: "Beginning in 2015, payment would be reduced by five
percent if an aggregation of the physician's resource use is at or above the
90th percentile of national utilization." Translated into plain English, it
means that in any year in which a particular doctor's average per-patient
Medicare costs are in the top 10 percent in the nation, the feds will cut the
doctor's payments by 5 percent.

If I understand this provision, the more care a physician gives, the less they will be paid. Doctors are already paid less for treating the elderly through Medicare so the bill would cut reimbursement even more if a doctor exceeds a threshold set by bureaucrats. This creates a disincentive for doctors to provide for their patients as they see fit. And because doctors won't know when they are about to cross the threshold, it means that they will be forced to cut treatment for all seniors.

This will lead to rationing and as we've seen in Canada and particularly Great Britain, rationing leads to premature death.

Forget results. This provision makes no account for the results of care,
its quality or even its efficiency. It just says that if a doctor authorizes
expensive care, no matter how successfully, the government will punish him by
scrimping on what already is a low reimbursement rate for treating Medicare
patients. The incentive, therefore, is for the doctor always to provide less
care for his patients for fear of having his payments docked. And because no
doctor will know who falls in the top 10 percent until year's end, or what total
average costs will break the 10 percent threshold, the pressure will be intense
to withhold care, and withhold care again, and then withhold it some more. Or at
least to prescribe cheaper care, no matter how much less effective, in order to
avoid the penalties.

The National Right to Life Committee concludes that this provision will
cause a "death spiral" by "ensur[ing] that doctors are forced to ration care for
their senior citizen patients." Every 10th doctor in the country will fall
victim to it. Libertarian columnist Nat Hentoff calls the provision "insidious"
and writes that "the nature of our final exit" will be very much at risk.

The cynic in me wonders if provisions like this might be the reason that Baucus is fighting the full release of the bill prior to it being voted on. Baucus claims that it would delay the bill but when spending a trillion dollars a two week delay is not only reasonable but full disclosure is necessary. The only logical reason for not putting the bill online is to prevent the public from knowing what is in it until it is too late.
Chairman Max Baucus, D-Mont., himself admitted that “This probably sounds a
little crazy to some people that we are voting on something before we have seen
legislative language.” Indeed.

Crazy and sneaky.