Saturday, September 26, 2009

"Death panels by proxy"

Some fascinating news from a Washington Times editorial:
on Pages 80-81 of the unamended Baucus bill, hidden amid a lot of similar legislative mumbo-jumbo about Medicare payments to doctors. The key sentence: "Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician's resource use is at or above the 90th percentile of national utilization." Translated into plain English, it means that in any year in which a particular doctor's average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor's payments by 5 percent.

What was it I was saying yesterday about details? Oh yeah, the devil is in the details. Well, that seems like a pretty significant detail. As the Times correctly notes,
The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year's end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties.

Anyone want to guess as to whether that might make care better or worse?

Anyone want to argue that a committee or panel that decided on that policy doesn't qualify as a "death panel?"

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