House Obamacare repeal vote just the start in struggle to prevent health care rationing.

At press time, the U.S. House of Representatives was expected to vote January 12 to repeal the Obama Healthcare Law. While the Senate leadership, still controlled by the law's supporters, is unlikely to vote on repeal during 2011 or 2012, the House vote will be an important step in laying the groundwork for repeal, depending on who is in power in Washington in 2013.

As the story on page 15 details, late last year the Obama Administration used its executive power to impose by regulation a strengthened version of a provision that had provoked great public outcry in summer 2009--then abruptly reversed itself January 4. Section 1233 in the then-proposed House bill would have reimbursed doctors for discussing with their Medicare patients advance directives that might include authorization to withhold lifesaving medical treatment, food, and fluids--a discussion that would generally take place only every five years.

Many feared that these counseling sessions would in practice be used to cut down on health care costs by convincing elderly people to forego expensive treatment. The provision was omitted in the law finally passed--but the Obama Administration quietly issued a regulation ensuring that doctors would be paid to talk about advance directives with their Medicare patients not just every five years but as part of their annual checkups. After a New York Times story brought the regulation to public attention, the Administration beat a hasty retreat.

However, much less attention has been paid to a different provision in the Obama Healthcare Law likely to be used to persuade patients that they will be just as well off, or better, if they forego life-preserving treatment. The law's "Shared Decisionmaking" program provides funding to nongovernmental organizations to develop "patient decision aids" that are supposed to help "patients, caregivers or authorized representatives ... to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences." These organizations will also receive funding to establish "Shared Decisionmaking Resource Centers ... to provide technical assistance to providers and to develop and disseminate best practices ...."

One of the organizations likely to receive funding for these "patient decision aids" is the Foundation for Informed Medical Decisionmaking. Its web site features a box titled "Did You Know" which contains a rotating set of messages, including, "About 25% of Medicare dollars are spent on people in their last 60 days of life"; "Whether or not they receive active treatment, most men diagnosed with early stage prostate cancer will die of something else"; "Back patients in Idaho Falls, Idaho are 20 times more likely to have lumbar fusion surgery than those in Bangor, Maine, with no clear difference in ... quality of life"; "For at least 70% of people who have heart bypass surgery, the survival rate is no better than if they had chosen to take medication alone"; "More care does not equal better outcomes"; and "In many people with stable heart disease, medications are just as good as stents or bypass surgery."

Notice a pattern? Clearly, this is a group that wants to discourage patients from choosing treatment that may be extensive or costly.

But the provisions of the Obama Healthcare Law that try to persuade Americans we are better off without expensive lifesaving treatment are not its most dangerous features. Those are the ones that will prevent our doctors and other health care providers from giving us such care even when they agree it is needed and we're willing to spend our own money to get it.

Under the Obama Healthcare Law, an "Independent Payment Advisory Board" is required to come up with recommendations to the federal Department of Health and Human Services (HHS) to force nongovernmental health care spending below the rate of medical inflation. In turn, HHS is empowered to impose "quality" and "efficiency" measures on health care providers.

A doctor who gives her patients more treatment than authorized by HHS guidelines may not contract with qualified health insurance plans. (Once the insurance mandate kicks in, Americans will be required by law to participate in a "qualified" health insurance plan.) This will be the coercive--as distinct from the merely persuasive--means used to impose rationing.

For documentation and more details about the rationing in the Obama Healthcare Law, visit www.nrlc.org/HealthCareRationing/Index.html.

BY Burke J. Balch, J.D.