- The Washington Times - Tuesday, May 24, 2011

In a chapter titled “Who, Whom?” from his classic book “The Road to Serfdom,” F. A. Hayek warned of the universal problem of a socialist society: “Who plans whom, who directs and dominates whom, who assigns to other people their station in life, and who is to have his due allotted by others?”

The budget battle currently under way in Washington is about much more than money and debt. It is about who we are as a people and what we are to become. This struggle is epitomized in the discussion over Medicare.

On the one hand, Rep. Paul Ryan, Wisconsin Republican, has suggested that beginning in 2022, seniors would receive a premium each year to purchase private health insurance from a list of approved plans. This is essentially the same health insurance system that federal employees receive. The roughly $15,000 premium that seniors would receive is the equivalent to what Medicare is projected to spend per individual under Obamacare. Recipients would be means-tested and the amount they receive would be adjusted for inflation. The difference in this approach is that it puts patients in control of their own health care decisions by allowing them to choose the insurance coverage that best fits their needs. The resulting competition among the private insurers is likely to lead to better cost control compared to a government-run program such as Medicare.

President Obama has castigated the Ryan plan as a “radical” plan that would violate our “social contract.” And this is from a president who, just before his election, boasted that “we are just five days away from fundamentally transforming America.”

Obamacare, on the other hand, cuts $468 billion from Medicare - a program that already has $38 trillion in unfunded obligations. The cuts come primarily from decreases in reimbursement to physicians and hospitals. Caring for Medicare patients already is a losing proposition for many physicians and hospitals. With further cuts in reimbursements, Medicare estimates that within 10 years, 15 percent of hospitals will go out of business. This will leave many seniors with an insurance card but no physicians or hospitals to care for them.

Obamacare also puts in place a cost-cutting panel called the Independent Payment Advisory Board. Mr. Obama highlighted the virtues of this board in his recent speech responding to Mr. Ryans budget proposal. This is a board of 15 unelected bureaucrats that is charged with limiting Medicare spending to predetermined limits. The only mechanism available to them is to further decrease reimbursements or to eliminate reimbursements for particular procedures or patients altogether. Furthermore, the decision of this unelected panel is law; the secretary of health and human services will implement the board’s recommendations. This undoubtedly will lead to rationing of care, particularly for those most vulnerable (the elderly and the very young), much as is seen in the United Kingdom today.

The Democrats are banking heavily on the notion that most people don’t want any changes to Medicare. What they don’t want you to know is that Obamacare has already changed Medicare drastically. Medicare has been financially eviscerated, guaranteeing that seniors will not receive the care that they have been promised. In addition, they will be subjected to the dictates of an unelected board of bureaucrats that will be mandated to determine what care will be allowed. As increasing numbers of people reach retirement age and the resultant financial stresses are added to a government already in financial crisis, the Independent Payment Advisory Board will be forced under Obamacare to further restrict services in order to control costs.

This is the problem of which Hayek warned us. Who will decide? Will it be the individual who decides what is best for him and what is in his best interest? Or will it be a board of anointed social planners who decide what we may and may not have in order to determine what is best for the collective?

Who will we be as a people? Will we continue to be a nation that supremely values individual liberty, as our Founding Fathers envisioned, putting personal decisions into the hands of the individual? Or will we sacrifice our right to make our own decisions to a panel of bureaucrats in Washington?

Who, whom?

Dr. Mark G. Neerhof is an executive board member of Docs for Patient Care.