Friday, November 18, 2011

A Rationing Advocate to Head Social Security Advisory Board?

A Rationing Advocate to Head Social Security Advisory Board?
By David Catron on 11.18.11 @ 6:09AM

If Donald Berwick was a bad dream, Henry J. Aaron is a nightmare.

When pro-life advocates list their reasons for opposing abortion-on-demand, they often cite their conviction that it is merely the first step toward even more grisly social engineering projects, including euthanasia for the old and infirm. This invariably produces sneers from soi-disant progressives, who smugly characterize these fears as hysterical nonsense. But such concerns will seem eminently reasonable to any open-minded reader who peruses the writings of Henry J. Aaron, the President's nominee for Chair of the Social Security Advisory Board. Like Obama's recess-appointed Medicare czar, Aaron is an unapologetic admirer of Great Britain's notorious socialized medical system, the National Health Service (NHS). Why? Because NHS administrators unabashedly practice the dark art of health care rationing.

Aaron, a Senior Fellow in Economics at the Brookings Institution, is unable to imagine any route to cost control that doesn't involve government coercion. In a 2005 Brookings white paper titled "Health Care Rationing: What it Means," he represents the NHS as a system that has come to grips with what he sees as the inescapable necessity for rationing. Predictably, he rejects any alternative involving the market: "The key to efficient market outcomes is that prices reflect costs of production. The market for health care does not operate that way." In other words, Aaron believes health care is a unique universe in which the market mysteriously fails to function and therefore can't be relied upon to contain costs. It never seems to have occurred to him that the market's alleged failure might be the result of government meddling.

Thus, the only realistic cost control option is government rationing. As Aaron's fellow traveler Donald Berwick famously phrased it, "the decision is not whether we will ration care; the decision is whether we will ration with our eyes open." For Aaron, this conviction manifests itself in rather disturbing ways. He is, for example, a zealous proponent of Obamacare's Independent Payment Advisory Board (IPAB). IPAB, you will recall, is the fifteen-member "death panel" to which Congress transferred the politically toxic task of imposing price controls on Medicare and thus rationing care to the elderly. In a recent column, Aaron heaped praise on Congress for abdicating its responsibilities to this unelected and largely unaccountable panel, quite literally calling it an act of "legislative statesmanship."

Aaron's only cavil with the creation of IPAB involves what he sees as Congress's failure to give it enough power to really put the hammer down on wasteful health care spending. He regrets, for example, that the panel labors under "politically motivated restrictions" that prevent it from slashing Medicare payments for such useless undertakings as hospice. Yes, hospice. In a column written for Politico last summer to counter public calls for IPAB's repeal, Aaron averred that "the provisions governing the IPAB are less than optimal. For example, recommendations regarding payments to acute and long-term care hospitals, hospices and inpatient rehabilitation and psychiatric facilities are off-limits until 2020." He goes on to say that these limitations on IPAB's reach "should be repealed as early as possible."

All of which brings us back to the concerns of the pro-life community so widely ridiculed by its pro-abortion betters. What do long-term care hospitals, inpatient rehabilitation facilities, and hospices have in common? They care for the old and infirm, of course. And what would be the effect of slashing funds for these providers? It would, in fact, amount to euthanasia for many elderly patients. But Aaron advises us not to get all worked up about this possibility because IPAB can only make "recommendations." Congress can, he tells us, undo any price controls it deems too draconian: "if Congress doesn't like what the IPAB recommends, a simple majority of both Houses of Congress can replace the IPAB's recommendations with alternative ways of meeting spending targets that Congress laid down."

Oh, is that all? Well, one can certainly see his point. Recent experience certainly suggests that getting the House and Senate to agree on important issues is mere child's play, does it not? And it goes without saying that the President would be more than happy to sign the resultant legislation into law, right? Aaron goes on to point out that, even in the unlikely event that this absurdly simple procedure somehow breaks down, "a three-fifths majority in the Senate [can] pass new targets or simply kill the IPAB." Now that is comforting. Reading this stuff, one realizes that Aaron is a man from whom it would exceptionally unwise to buy a used car. He knows perfectly well that IPAB has, for all intents and purposes, been empowered to ration health care via price controls and does not scruple to whitewash that ugly reality.

So, where does this leave us? We already have a staunch rationing advocate, Donald Berwick, running the government health care program for the elderly. Now the President has nominated Henry J. Aaron, an even more zealous rationing advocate, to chair the Social Security Advisory Board. Both of these men openly admire Britain's NHS, a socialized medical system notorious for neglect of its elderly patients. Somehow, the "slippery slope" fears of the pro-life community seem less hysterical than our progressive friends would have it. Are you comfortable submitting your aging loved ones to the tender mercies of people like Donald Berwick and Henry J. Aaron? I'm not.

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