The Independent Medicare Advisory Committee: death panel or smart governing?

ABSTRACT: This comment explores whether health care reform legislation establishes an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." IMAC's recommendations would be implemented nationally, subject to a Congressional vote. Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. Part I is an introduction. Part II of this article covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE). Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms. For convenience, an index of these acronyms is provided in an appendix following the article. I. Introduction In 2009, lawmakers presented the American people with a serious dilemma: Is it right that a government "death panel" (1) should be charged with the decision of "pull[ing] the plug on grandma," (2) or would it be preferable that a "holocaust" (3) be perpetuated? Should we ask Americans to "die quickly?" (4) Indeed, after the health care debate of 2009, no one will ever accuse national lawmakers of soaring with the angels during their recent intellectual discourse. Instead, rhetoric seems to have overshadowed what might have been a fruitful public dialogue on the topic of health care in America. Health care expenditures have spiraled out of control for consumers, employers, and the federal government. (5) Moreover, the number of uninsured Americans stands as a persistent scandal to many. (6) To solve these matters, some have advocated a national (federally-managed) health care system that would cover all Americans. (7) Yet, others have suggested that a national health care system would lead to the rationing of health care. (8) Economic rationing consists of controlling the distribution of scarce resources and services among a population. (9) This comment explores whether the health care legislation currently making its way through the United States Congress is establishing an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). (10) IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." (11) IMAC's recommendations would be implemented nationally, subject to a Congressional vote. (12) Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. (13) Critics of health care rationing cite examples of waiting lists and long lines in Canada and elsewhere as proof that government-managed health care leads to rationing. …