Medicare and Rationing

As of this writing, it is impossible to know what is in the new National Health Insurance Act. The text has not been released, and even if it were, it will take months to fully analyze all of its provisions.

We have been told that the bill creates a Medical Review Board within the Medicare system. That Board has been instructed to reduce Medicare spending by half a trillion dollars. In theory, its job is to reduce "fraud and abuse" in the system. How will it really accomplish this feat? Not by reducing fraud and abuse, as we point out in our book, they will always be a part of any governmental program

It appears that this Medical Review Board will look at all 7,500 accepted diagnoses of sickness. It will then specify the treatment protocol for each diagnosis which Medicare will reimburse, (thereby limited "abuse"). In other words, you are not limited to the authorized treatment. However, neither Medicare nor your Medicare supplement policy will pay for treatment not specified in the treatment protocol. If you want further treatment, or an "experimental" drug, you will have to pay for it out of your own pocket.

The underlying premise of this protocol is likely to be "quality life years." The procedures or drugs covered will vary depending on how many "quality life years" you have remaining. It is certainly safe to say that if the intent is to reduce health care spending, the effect will be to limit access to care and drugs. Those with the fewest "quality life years"--the frail elderly--will be disproportionately affected.

How ever you look at it, it all comes back to rationing. For a practical discussion of rationing based on "quality life years" read To Tax or To Ration. An entire chapter is devoted to the pros and cons of rationing on this basis.

I wish to emphasize that, as of this writing, the actual details of the bill are yet to be revealed. However, we've been told, repeatedly, that one of the goals of the bill will be to reduce Medicare spending. If so, rationing of care is inevitable.