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Electoral medicine

By Richard E. Ralston
web posted October 29, 2012

The authority to restore free choice in medicine is gradually being taken out of our hands. Congress and President Barack Obama are determined--without requisite legislation, no less--to have unelected boards and agencies dictate the medical care we are permitted to receive. Our only hope is that a few choices are still available in the voting booth.

The Independent Payment Advisory Board (IPAB) authorized by Obamacare has been given a dedicated source of income not appropriated by Congress--which, therefore, cannot cut it off. The board’s decisions to deny Medicare payment for any procedures or treatments may not be subjected to judicial or congressional review. And, amazingly, Obamacare requires that any proposal to repeal the creation of IPAB or amend its powers in a future Senate or House of Representatives must be ruled "out of order" by the presiding office.

Why elect lawmakers who are not allowed to change law? But then, we live in an era when the president thinks he can make a "recess appointment" to the U.S. Supreme Court if the Senate breaks for lunch. Why bother with a Congress that cannot change law or confirm appointments?

For everyone on Medicare, any decision by IPAB to disallow payment for their treatment will leave them with no alternatives. Under current law, no physician who accepts Medicare patients is allowed to receive payment directly from patients for anything not covered by Medicare.

For younger patients, no insurance company will long pay for procedures not sanctioned by IPAB.

Millions of daily decisions about the treatment of 300 million people, in a rapidly changing technological environment, with regular new advances in drugs and procedures in complex combination with each other, will be subject to the decisions of one government board.

But many politicians adore IPAB, because, as President Obama likes to say, "it is more fair," and they think medical care must be based upon the redistribution of wealth. The result: equal medicine for all--and equal misery for all.

Is that "fair"?

An additional burden for those with or without insurance will result from a new tax on medical equipment manufacturers. Although their development costs are often so high that there might not be any profit for years, Obamacare's new tax circumvents that difficulty by taxing manufacturers on all revenue from the sale of equipment, whether it is profitable or not. That will discourage new investment and add costs to all those who need the equipment to diagnose or treat their illness.

For Obamacare, higher costs and less treatment means more "fairness."

With our attention on the choices that Obamacare has eliminated, the Food and Drug Administration is rapidly expanding its role by direct interference in the practice of medicine. Countless thousands of patients have died while waiting for access to drugs and devices that were eventually approved by the FDA. Now thousands more will die while waiting for FDA approval of each use of stem cell, venous catheter or other therapies. Individual physicians and surgeons are constrained against following their judgment of the best treatment for their patients, but the authority of a vast bureaucracy is carefully preserved.

It is a tragedy that our medical choices are limited to the choices in a voting booth. But those votes are vitally important if that is all we have left. ESR

Richard E. Ralston is the executive director of Americans for Free Choice in Medicine, Newport Beach, California. Copyright © 2012 Americans for Free Choice in Medicine. All rights reserved.







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