Rationing and Proper Authority

This morning, as I was staring at the Atlantic Ocean over the first of two cups of coffee, I stumbled upon a fantastic commentary in The Wall Street Journal on the effects that the Democrats’ health care reform will have upon seniors, medical providers (doctors), and ordinary people alike.

While I encourage everyone to read the entire piece and pass it along to family and friends, here are a few excerpts:

Like most of Europe, the various health bills stipulate that Congress will arbitrarily decide how much to spend on health care for seniors every year—and then invest an unelected board with extraordinary powers to dictate what is covered and how it will be paid for. White House budget director Peter Orszag calls this Medicare commission “critical to our fiscal future” and “one of the most potent reforms.”

As envisioned by the Senate Finance Committee, the commission—all 15 members appointed by the President—would have to meet certain budget targets each year. Starting in 2015, Medicare could not grow more rapidly on a per capita basis than by a measure of inflation. After 2019, it could only grow at the same rate as GDP, plus one percentage point.

The theory is to let technocrats set Medicare payments free from political pressure, as with the military base closing commissions. But that process presented recommendations to Congress for an up-or-down vote. Here, the commission’s decisions would go into effect automatically if Congress couldn’t agree within six months on different cuts that met the same target. The board’s decisions would not be subject to ordinary notice-and-comment rule-making, or even judicial review.

Yet if the goal really is political insulation, then the Medicare Commission is off to a bad start. To avoid a senior revolt, Finance Chairman Max Baucus decided to bar his creation from reducing benefits or raising the eligibility age, which meant that it could only cut costs by tightening Medicare price controls on doctors and hospitals. Doctors and hospitals, naturally, were furious.

But a decade from now, such limits are off—which also happens to be roughly the time when ObamaCare’s spending explodes. The hard budget cap means there is only so much money to be divvied up for care, with no account for demographic changes, such as longer life spans, or for the increasing incidence of diabetes, heart disease and other chronic conditions.

Worse, it makes little room for medical innovations. The commission is mandated to go after “sources of excess cost growth,” meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer’s in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that “Maybe you’re better off not having the surgery, but taking the painkiller,” as President Obama put it in June.

One of the examples given is a program in Washington state which is known for its rationing of care. Acknowledging the state-by-state programs which have succeeded and failed and learning from those lessons would be, in my opinion, the foundation for true reform. We see how Maine’s state-operated Dirigo Health System has failed, so we should glean from it the pitfalls of state-run systems. We see how Washington state’s system is reminiscent of the systems in Canada and Britain, so we should take from it the danger of rationing for the benefit of a global budget and consider that danger in devising our own reform.

Even such patently unconstitutional specifics as punishable-by-incarceration individual and employer mandates aside, the federal government has no business in any way, shape or form being involved in health care to begin with. The Tenth Amendment states expressly that “[t]he powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.” In other words, if it does not fall within the 17 enumerated powers found in Article I, Section 8–along with the Tenth Amendment, my favorite provision in the Constitution–then authority vests in the state or the people.

Should the federal government get involved in health care at all, it should be to harness the power of the free market through opening up the private insurance market to interstate competition and allowing small businesses and individuals to pool personnel and resources for added buying power. Anything else, any other reforms, should be within the purview of the states. That way, the power will be closer to the people, and states can learn from one another with regard to what works and what does not.



  1. Nick Cochran says:

    I agree with you wholeheartedly that our federal government does not have constitutional authority to take over the health care industry, but I am curious about what constitutional power would allow the federal government to implement the "free market" alternatives being propsed by many conservatives.

    I guess I don't understand what is preventing the "free-market" alternatives (e.g. purchasing insurance over state lines) from being in place today. If the answer is that state legislation is preventing that possibility, then what in the constitution would let the federal government to overrule the states in this matter. Isn't that the argument against the Dem's healthcare takeover as well?

    Please help me understand the legal aspect of all this.

    Thanks for all your work to intelligently represent conservative principles and cut through the liberal misinformation!


  2. Rix says:

    I expect everyone agrees that the Congress is overstepping its constitutional authority with ObamaCare. The problem, however, is that the Founders' great design could not foresee the Congress abandoning its oath to abide by and protect the Constitution, aided by a criminal President (vetted by the same Congress) and spineless Supreme Court judges (partly nominated by the same President and rubber-stamped by the same Congress). Apparently, we the people have no "standing" to oppose this scheme.

    On the other hand, why not? The Founders would shudder in their graves if they learned of income tax, Medicaid and welfare coupons. They became undisputed realities in today's America; no party, left or right, would dare placing them on the chopping block because of perceived electoral cost of repealing. ObamaCare is just another step down the Escalator to Abyss but make no mistake, we are already on that escalator and it will eventually take us all the way down unless we start running up. And running up means retracing the steps we have already passed – by whatever means necessary.

  3. Anonymous says:

    Rix is right.

  4. Anonymous says:


  5. Anonymous says:

    To Nick: The reasom that health insurance co's cannot compete across state
    lines is simple: the US Congress will not allow it!! They have allow them to operate in each state without invoking antitrust laws because the Dumbocrats long ago got in tight with them. Especially in Conn. where many of them are located-Senator Dodd for years has gotten millions from both Insurance Companies and credit card co's for his camphains.

  6. Anonymous says:


    Would you PLEASE respond to Nick's posting. I think it would help sway me (and other moderates) if you can back up what you write in your blog.
    Thank you in advance.


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