And lest anyone thinks Obamacare mitigates that reality, think again. Obamacare authorizes the creation of an Independent Payment Advisory Board (IPAB) consisting of 15 unelected “experts” tasked with keeping Medicare spending under control. If Medicare spending exceeds predetermined targets, the IPAB is required to propose legislation aimed at reducing future spending. It also requires the Secretary of Health and Human Services to implement those reductions, unless Congress intervenes. Yet Congressional intervention is decidedly lopsided. If they introduce cuts to spending, all well and good. On the other hand, if they introduce spending in excess of the IPAB’s recommendations, overturning those recommendations requires a simple majority in the House — but a three-fifths majority in the Senate, plus the president’s signature. In the Senate, that’s a higher threshold than it takes to pass a Constitutional amendment.
Obamacare ostensibly prohibits the IPAB from raising taxes or rationing care. But the board itself gets to define “rationing” completely insulated from administrative or judicial review. The prohibition on raising taxes is equally meaningless. Adding insult to injury, the editors at National Review have discovered that Congress is forbidden to repeal the IPAB unless it does so within a brief time-frame in 2017. If it doesn’t, then the IPAB becomes a permanent fixture by 2020 — even if Congress repeals the healthcare act. This is a blatant attempt by Democrats to bind future Congresses to the current statute. That effort is completely illegal. Yet barring a Republicans sweep in the 2012 elections, or at the latest, the 2016 elections, the IPAB will become a permanent feature of American healthcare.
How does this bode for the doctor-patient relationship? Dr. Jill Vecchio illuminated that reality at an anti-Obamacare rally hosted by Americans For Prosperity on June 29, 2012:
According to the government, I can only recommend a screening mammogram for women over 50 every other year until 74, then never again. That violates the American Cancer Society guidelines…The American Cancer Society says every year after the age of 40 until the woman no longer wants to have a mammogram.
Screening mammography has been proven to decrease the number of women who die by breast cancer by 30-40 percent–just screening mammography. These government rules that I will have to abide by will cause me to violate my Hippocratic Oath. And I won’t do it. I will violate their guidelines every day, many times a day. As a result of that..I will be fined, I won’t be paid[.]
In other words, many doctors will face a nightmarish choice: do I incur the wrath of government bureaucrats and practice medicine in the best interests of my patients–or succumb to a system where bureaucratically determined cost considerations override patient necessities? A third option is obvious: many doctors will quit practicing medicine altogether. As for the doctors willing to remain in such a system, Americans might ask themselves how eager they are to be treated by someone willing to betray a patient’s best interests in favor of government-mandated rationing and collectivism.
Under Obamacare the doctor-patient relationship will inevitably become the government-doctor-patient relationship — in precisely that order of priority. Thus, assumption number two is a fraudulent as assumption number one.
Both assumptions, like so many other issues, reveal the bankruptcy of progressivism. It is an ideology that assumes most human behavior is static rather than dynamic. Only a progressive could believe that the vast majority of doctors will continue to practice their craft under increasingly onerous conditions, or that equal numbers of would-be doctors will continue to pursue a career path underscored by ever-increasing amounts of medical school debt, coupled with fewer opportunities for remuneration and autonomy. Only a progressive could fail to see how an American public infused with greater and greater levels of self-entitlement won’t overwhelm the system when healthcare becomes “free.” Only a progressive could fail to see that yet another massive entitlement program will contain precisely the same “unforeseen” cost explosions that have plagued every entitlement program ever enacted, thereby hastening our rendezvous with national insolvency.
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