The Independent Medicare Advisory Committee: death panel or smart governing?

AuthorColeman, Robert

ABSTRACT: This comment explores whether health care reform legislation establishes an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." IMAC's recommendations would be implemented nationally, subject to a Congressional vote. Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations.

Part I is an introduction. Part II of this article covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE).

Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms. For convenience, an index of these acronyms is provided in an appendix following the article.

  1. Introduction

    In 2009, lawmakers presented the American people with a serious dilemma: Is it right that a government "death panel" (1) should be charged with the decision of "pull[ing] the plug on grandma," (2) or would it be preferable that a "holocaust" (3) be perpetuated? Should we ask Americans to "die quickly?" (4)

    Indeed, after the health care debate of 2009, no one will ever accuse national lawmakers of soaring with the angels during their recent intellectual discourse. Instead, rhetoric seems to have overshadowed what might have been a fruitful public dialogue on the topic of health care in America. Health care expenditures have spiraled out of control for consumers, employers, and the federal government. (5) Moreover, the number of uninsured Americans stands as a persistent scandal to many. (6) To solve these matters, some have advocated a national (federally-managed) health care system that would cover all Americans. (7) Yet, others have suggested that a national health care system would lead to the rationing of health care. (8)

    Economic rationing consists of controlling the distribution of scarce resources and services among a population. (9) This comment explores whether the health care legislation currently making its way through the United States Congress is establishing an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). (10) IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." (11) IMAC's recommendations would be implemented nationally, subject to a Congressional vote. (12) Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. (13)

    Critics of health care rationing cite examples of waiting lists and long lines in Canada and elsewhere as proof that government-managed health care leads to rationing. (14) Some proponents of national health care go so far as to advocate rationing as the best way to curtail skyrocketing health care expenditures. (15) Still, for the most part, proponents of national health care (whether consisting of single-payer reform or managed competition reform(16)) have suggested that the political rhetoric about health care rationing is just that-rhetoric. (17)

    Former Alaska Governor Sarah Palin famously accused proponents of the current federal legislation of instituting "death panels" in order to ration health care. (18) Rhetoric aside, advocates of non-governmental, free-market health care reform argue that rationing will be an inseparable component of a national health care system. (19) They submit that rationing finite health care resources is the logical result of government-administered health policy. (20) These reformists further assert that free-market health care reform could bring costs down without government intervention and without rationing. (21)

    Part II of this comment covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE).

    Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Part VI briefly concludes this comment. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms to assist in the readability of this article. For convenience, an index of these acronyms can be found in an appendix following this comment. (22)

  2. History

    1. What is 'Health Care'; What is 'Medicine'?

      "Medicine's role," the philosopher Voltaire once quipped, "is to entertain us while Nature takes its course. " (23) Today, some two hundred years later, some consider access to health care to be a constitutional and moral right, as still others say neither right exists. (24) Indeed, nature's course notwithstanding, a lot has changed since the eighteenth century. Most assuredly, little if anything has changed in human physiology since humans first walked the Earth: bones still break and cancer is still deadly. But Dr. David Gratzer, a Canadian psychiatrist and proponent of free-market health care reform, prefers to separate the practice of medicine into pre- and post-twentieth century paradigms. (25) Gratzer asserts that in the decades leading up to the twentieth century, medical practitioners developed new treatments at an increasing rate. (26) But in the twentieth century, cures to ancient illnesses began to develop. (27)

      At the dawn of the twentieth century, polio was crippling, old age meant painful degeneration and immobility, while schizophrenia meant institutionalization or, worse, a lobotomy. (28) Among children, ailments such as measles, whooping cough and leukemia were often death sentences. (29) In 1924, President Calvin Coolidge's sixteen-year-old son succumbed to an infected blister he developed playing tennis at the White House. (30) The son of the President of the United States died because antibiotics did not exist. In 1941, a British police officer, Albert Alexander, scratched his face on a rose bush and nearly succumbed to an infection. (31) Albert's wound became septic, his face was covered with abscesses and he lost his left eye. (32) Albert's doctor, Charles Fletcher, decided to administer a new treatment, which would prove to be a medical breakthrough. (33) On February 12th, 1941, Albert became the first human recipient of penicillin. (34) His temperature dropped within four days. (35)

      Since the introduction of penicillin, our understanding and expectations of health care have dramatically changed. (36) Childhood leukemia is survivable in nearly every case. (37) Schizophrenia is routinely treated with anti-psychotics. (38) The first open heart surgery was performed in 1955, and in 1963 the first kidney transplant was performed. (39) Strokes can be prevented and hips can be replaced even in old age, while chemotherapy prolongs the life of cancer patients and the first test-tube baby solved infertility. (40) Yet, in 1787, no one could have claimed that access to such life-saving health care was a moral right to be enshrined in the Constitution: the knowledge and technology for such care did not exist.

    2. A Federal Health Care Policy Prior to World War I: Slippery Slope or Governmental Prerogative?

      1. Franklin Pierre's Veto of Federal Subsidies for the Mentally Disabled

        In 1854, President Franklin Pierce vetoed a bill that would have mandated each of the several states to set up permanent funds to provide social support for the mentally disabled. (41) Pierce surmised that if the federal government took up the task of caring for "all the poor in all the States," such "public philanthropy" would serve as an initial misstep down a slippery slope of federally subsidized welfare. (42) Pierce declared that the General Welfare Clause is not a "substantive general power to provide for the welfare of the United States." (43)

      2. The Progressive Era

        In the five decades after the Pierce administration, the Industrial Revolution drastically...

To continue reading

Request your trial