January 11, 2009 11:00AM

Would Daschle’s Federal Health Board Ration Medical Care?

Matthew Holt implausibly says no.

Tom Daschle is a former majority leader of the U.S. Senate, and president‐​elect Barack Obama’s pick to head the Department of Health and Human Services. Daschle will also head up the Obama administration’s health care reform efforts.

Which is why Daschle’s proposal for a Federal Health Board has received so much attention. Holt reports:

the main role of the Federal Health Board would be as a cost‐​effectiveness review organization with teeth—in that Medicare, Medicaid & FEHBP would all be bound to follow its guidelines.

Holt continues:

Critics on the loony right … will call this rationing.

What’s interesting about that comment is that Holt merely associates the “rationing” claim with people who are loony. He doesn’t actually say they’re wrong. In fact, Holt himself writes:

we need to make cardiologists in Miami behave like cardiologists in Minnesota with a consequent impact on the incomes of doctors, hospitals and stent & speedboat salesman in high cost areas … If the Federal Health Board has teeth, that’s what it’ll do, and the AMA, AHA, AdvaMed, PhRMA et al know it. Which is why the PhRMA front organizations have been railing against cost‐​effectiveness for so long.

So Holt acknowledges that the point of comparative‐ and cost‐​effectiveness research — and Daschle’s Federal Health Board — is to do something that would reduce the incomes of doctors, hospitals, and drug/​device manufacturers. That something would be so dramatic that it has the providers and manufacturers up in arms and funding front organizations. If that something is not refusing to pay for some medical services — i.e., rationing — then what is it?

Rationing medical care is not just essential, it’s unavoidable. And the way we ration medical care today is unconscionable. But so too would be having the government ration medical care. Which is probably why proponents of government rationing don’t want to call it that.