What you will hear from Democrats trying to “sell you” on what they already did:
The “Medicare Advisory Board” is established by this bill to ‘directly control payments for Medicare benefits’ to help lower medical costs for people in this program. This is a perfect example of how government works when it is trying to control costs. It should be a good thing that they are “independent” from the functioning of Congress (once the members are approved by Congress, that is), because Congress is terrible at controlling costs. However, by definition they will be looking at “the good of the whole” and making the overall Medicare budget work better. What they won’t do because they can’t, is look out for each individual patient, nor will they pay much attention to the effect on health care providers and organizations. Thus it turns into either ‘hard’ or ‘soft’ direct rationing of health care by committee.
Here’s an example to make it more understandable: a few months back, you may recall that the government-funded group called “U.S. Preventive Services Task Force” (USPSTF) reviewed the data they have available about mammograms - their cost, risk vs. benefit analysis, etc. They recommended against women getting mammograms in their 40’s, primarily because it was not found to be cost effective. Women and women’s groups around the country were immediately up in arms about this. The head of the Center for Disease Control quickly called a press conference to assure us all that ‘hey, it’s ok everyone because this is just a recommendation from this group - it will not change your insurance coverage and mammograms are still covered like before - so just talk to your doctor about what’s right for you to do.’
Very nice. This sort of worked because the USPSTF does not have real power to change coverage or reimbursement for the tests it evaluates. The new Medicare Advisory Board, however, would indeed have such power. So the next time the USPSTF says something is unnecessary or not cost effective, that can and will become in fact what you are allowed to get. Medicare already plays this game with any number of tests and services or treatments - if it has deemed that only certain groups at certain ages can get text X, then that’s just the way it is. You’re 49 years and 9 months old and want to get your screening colonoscopy? Sorry, but if you do get it, you either get the bill sent to you personally or the doctor and facility that did it are forced to ‘eat’ the cost themselves. Now you’re 50? OK, now it’s covered.
Does private insurance do things like this? Yes and no. They do set up ‘rules of coverage’ and we have to deal with those. However, it is usually more like a negotiation...depending on how strict an insurance company wants to be with a particular test or treatment, it may be an easy or difficult negotiation, but if the doctor and patient both feel some test or treatment is important and needed, we can push and give reasons and get those approved in most cases. When we work with Medicare, however, it’s just a done deal, and although I’m sure in theory there exists some way to appeal, I’ve not seen it work that way in practice.
So point one from this bill is the creation of a committee that will determine what tests and treatments you can and can’t get. Theoretically this will apply initially only to government funded plans, but I guarantee it will become the ‘de facto’ standard across the board for private plans as well the way the system will now be structured.
SO, welcome to one example of new government rationing of your health care options!
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