Five Steps to Rationing Health Care

by John Goodman

This is Scott Gottlieb on the Senate health bill:

Step One	The Centers for Medicare and Medicaid Services…will be given the authority to unilaterally write new rules on when medical devices and drugs can be used, and how they should be priced…when a cheaper medical option will suffice for a given problem and, in turn, when Medicare only has to pay for the least costly alternative.
Step Two	The Senate health-care bill also exempts Medicare’s actions from judicial review, taking away the right of patients to sue the government.

Step Three	Primary-care doctors who refer patients to specialists will face financial penalties under the plan. Doctors will see 5% of their Medicare pay cut when their “aggregated” use of resources is “at or above the 90th percentile of national utilization.”
Step Four	[The plan] imposes new costs on doctors who remain solo, mostly by increasing their overhead requirements [and] the plan offers doctors financial carrots if they give up their small practices and consolidate into larger medical groups, or become salaried employees of large institutions such as hospitals or “staff model” medical plans like Kaiser Permanente… The idea here is that Medicare can more easily apply its regulations to institutions that manage large groups of doctors than it can to individual physicians.
Step Five	The impact of these provisions won’t be confined to Medicare. Private insurance sold in the federally regulated “exchanges” will take cues from Medicare, since they’re both managed from the same bureaucracy.