The nexus, so to speak, of rationing in health care starts at the bottom of page 27 and goes through page 30. That section is entitled, essential benefit package defined. This describes all those health procedures which will be deemed "essential". In the next section starting on page 30 entitled, Health Benefits Advisory Committee, this creates yet another bureaucracy that will deem which procedures are in fact "essential". in the previous part, I also mentioned page 335. On this page, there is the establishment of the "Outcome Based Measures". This will be a quantitative analysis of all procedures to measure their cost effectiveness. In other words, if there are two procedures to combat the same malady and one costs $10000 and the other costs $5000 and they both save lives at the same rate, the "Outcome Based Measures" will deem the second more cost effective. This same committee will then outlaw the first procedure. So, if a procedure is not deemed "essential" and is not deemed cost effective, it will be eliminated.
Keep in mind just how corrosive this can be. As procedures evolve they get better. Some new heart transplant might initially not see good results. Yet, as doctors perform it, study it, and trade information back and forth, it gets perfected. In the system dreamed up by the Congress, that won't happen. That's because the committee will render it obsolete before any such procedure has a chance to evolve.
The most insidious portion of this bill is found on pages 425-430. I mentioned it in the section on government control. This portion of the bill regulates the manner in which those near death will get treatment. Combine this with the "Outcome Base Measures" and this is where you will find the nightmare scenarios of the 80 year old not getting their hip replacement. Since that is likely to not be "cost effective" and "essential", it will likely be made obsolete.
Pages 272-274 deal with studying and analyzing care for cancer patients. There are several frightening parts of this section but here's the most frightening.
The Secretary shall conduct a study to determine if costs incurred by hospitals exceed costs incurred by other hospitals
The next section after this quotation is entitled, AUTHORIZATION OF ADJUSTMENT. As such, first the HHS Secretary will study if hospital patient care is cost effective and then the HHS Secretary will be given authority to adjust the cost structure of all hospital deemed not cost effective. As such, if your cancer treatment center is deemed not cost effective, the HHS Secretary will have power to adjust its cost structure and that means to decide which procedures can continue and which can't.
To understand just how intrusive this rationing gets, on page 268 the government is give authority to regulate the rental and purchase of power driven wheel chairs. In other words, even power driven wheel chairs will be rationed.
Finally, on page 241 (also mentioned in the previous part) the government sets rates that doctors can make. According to the language, there will be little difference among specialties. As such, neurosurgeons won't be able to make much more than other specialties. Because some specialties like neurosurgeons require significantly more schooling, new potential doctors will have less motivation to go into those fields. By creating a disincentive for many specialties, we'll have less of those specialists. With the power to regulate "essential" and "cost effective", the government will be forced to cut many procedures in those specialties because there will simply not be enough doctors to perform them.
Here is the previous part again. In part III, I will analyze the new tax outlays on individuals and small business owners that will be created by this plan.