EDITORIAL: The haunting of Medicare clawbacks

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Senate Democrats on the Finance Committee ratified death panels by proxy on Wednesday night. Approval was granted even though one of their leaders worried that the provision in question might well haunt them later. Haunt them it should. The committee’s vote in favor of this deadly article was unconscionable.

The provision requires 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 federal government will force the doctor at year’s end to pay back to the government 5 percent of the Medicare fees already given to him. This provision makes no account for the results of care, its quality or even its efficiency. It just hangs a financial blunt ax over a doctor’s head, not-so-gently encouraging him to prescribe cheaper - even if less effective - care in order to avoid the penalties.

Doctors will labor knowing that far-away green-eyeshade number crunchers are doing calculations to identity from which doctors the feds will claw back fees already paid to them. Every doctor will feel at least some pressure to “race to the bottom” of allowable care in order to avoid the federal penalties. Clearly, the real losers in all this will be the Medicare patients whose care will be rationed, even unto death.

That’s why Sen. Jon Kyl, Arizona Republican, offered an amendment to eliminate this ill-considered plan. But the committee killed the amendment, with all 13 Democrats voting against it. Their stated goal was to keep the bill from adding to the deficit. Although an unusual qualm for Democrats, this would be a laudable goal if its real-world consequences weren’t so serious.

Democratic Sen. Kent Conrad of North Dakota, chairman of the Budget Committee, admitted that the provision is problematic and worried aloud: “As I try to put my feet in the shoes of a doctor, I don’t know how you separate out overutilization that is really overutilization. … There is no way of knowing when you go through the year, what you are going to do at the end of the year.” Mr. Conrad went on to acknowledge that the provision “really leaves me cold,” and that those who voted for it may well “regret” it when they “get down the road.” Yet he and his fellow Democrats all voted for it anyway.

These Democrats also gave the lie to President Obama’s promises by voting against an amendment that would have guaranteed that no public funds would pay for abortions. Result: Public money can be spent to end life before it starts but not to keep life going in old age. Yes, that’s a profoundly haunting prospect.

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