Study Contradicts Claims of California’s Obamacare “Success”

Liberals have cited California as the prototypical Obamacare success story for years now, but a new study puts that assertion very much in doubt. Five years ago, even before Obamacare’s exchanges went live, The New York Times’ Paul Krugman claimed California would prove that “a program designed to help a lot of people can, strange to say, end up helping a lot of people — especially when government officials actually try to make it work.”

Reporters have chimed in with similar stories about Obamacare’s supposed success in California. During the presidential campaign in 2016, the Los Angeles Times reported that “California is emerging as a clear illustration of what the law can achieve.” The article quoted several insurers saying the state “did it right,” and had created stable insurance markets.

Emergency Rooms Are Getting More, Not Less, Use

The study, conducted by the California Health Care Foundation, examined emergency department usage over the ten years from 2006 to 2016. While the report, perhaps quite deliberately, didn’t highlight this conclusion — it mentioned Obamacare once, and only in passing — the data indicate that emergency department usage since Obamacare has not only not decreased, it has accelerated, rising at a faster rate than in prior years.

One chart tells the tale:

The study indicates that ER usage accelerated in the years immediately following Obamacare’s implementation, just as it shows Medicaid patients comprised a larger share of ER visits. From 2006 through 2016, Medicaid patients nearly doubled as a share of ER visitors, while ER visitors with private insurance and no insurance both declined:

Unfortunately, this chart does not reveal data for the years immediately before and after Obamacare implementation in 2014, making it tougher to draw direct conclusions. However, the 20 percentage point increase in ER visits by Medicaid patients (California calls its Medicaid program “Medi-Cal”) more than outweighs the 9 percentage point decline in self-pay and uninsured patients and the 4 percentage point decline in patients with other forms of coverage.

While private patients’ ER usage held relatively flat over the decade, the nearly 4 million increase in ER visits by Medicaid patients swamped the combined 863,000 fewer visits by self-pay and uninsured patients and patients with other coverage.

To put it bluntly, the raw data from the California study suggest the state has less of a problem with an overall increase in ER visits and much more of a problem with an explosion in Medicaid patient ER visits. That inconvenient truth might explain why the California Health Care Foundation didn’t highlight the impact of Medicaid, or Obamacare’s expansion of it, in the report itself.

California Study Echoes Oregon ‘Experiment’

In 2016, a group of economists released an updated analysis from Oregon, which concluded that ER usage increased, not decreased, by 40 percent for participants in the Medicaid expansion. The increased ER usage persisted for at least two years, making it unlikely that it existed solely due to “pent-up demand” — i.e., individuals using their new insurance coverage to have lingering but previously untreated problems examined.

Contrary to the conventional wisdom that giving patients a more normal source of coverage would decrease ER utilization, the Oregon study found that usage of health care services increased across-the-board, including emergency department visits.

The California study did not reveal whether access problems resulted in the 170 percent increase in ER visits by Medicaid patients. The state has notoriously stingy payment rates for Medicaid providers, which could impede patients from accessing primary care, forcing them to use the emergency room instead.

At minimum, however, the study once again demonstrates how Obamacare has failed to deliver on its promise to lower the cost of health care by providing that care in a more timely fashion and at the most efficient location. The increase in ER usage by Medicaid patients also raises questions about whether an insurance card provides access to actual health care.

Five years ago, I wrote about how Krugman’s claims of California’s Obamacare success echoed The Mamas and the Papas: little more than California Dreamin’. Last week’s study reiterates how liberal claims that the state represents an Obamacare “success story” remain nothing more than a pipe dream.

This post was originally published at The Federalist.

Does Brookings Have a “Wonk Gap?”

Yesterday two researchers at the Brookings Institution released an article claiming that “people are getting more for less” in the individual market under Obamacare.  The piece claims that people are getting “better” coverage, so I asked one of the authors on Twitter: What proof do you have that the coverage is better?  Do people like PPACA plans more than their prior coverage?  Are these new plans leading to better health outcomes for patients?

In an exchange of tweets, Brookings’ Loren Adler said that surveys show people are satisfied with their PPACA coverage — a nice point, but one that doesn’t prove people think it’s “better” than what they had before.  And he admitted that studying the trade-offs PPACA created — in which generally plans have a higher actuarial value, but smaller doctor and hospital networks — “wasn’t the focus of the research piece.”  All well and good, but if that’s the case, why go out on a limb and make an unsubstantiated claim that PPACA coverage is “better?”

He didn’t have a good answer.  He tweeted that the claim of “better” coverage “has nothing to do with the analysis itself of premium comparison,” and that “the wording used in the intro/conclusion has nothing to do w/ analysis itself.”

Think about those words for a second.  Is that the standard we want for research — that people can reach “conclusions” that have “nothing to do with the analysis itself?”  On that basis, I wrote an e-mail to Brookings (pasted below) requesting a retraction or clarification on the specific point that coverage is “better” and people are getting “more” under PPACA.

As I pointed out last night, the Brookings researchers MADE the nature of PPACA coverage a focal point of the analysis, by including unsubstantiated claims to fit a political talking point: “You’re getting more/better coverage for less!”  Having been called out on it, they should prove the claim, or withdraw it.

Folks on the Left complain frequently about a supposed “wonk gap” among conservatives.  I’d be VERY interested to hear from Paul Krugman, or any other observer, who would defend a researcher who makes conclusions that — by his own admission — have “nothing to do with the analysis itself.”

In California’s Health Exchange Cuts, A Preview of Other States’ Woes?

The Supreme Court is expected to rule soon on the legality of insurance subsidies in 37 states that use the federal HealthCare.gov site. Some states have discussed creating their own exchanges in the wake of the court’s decision, but those may not be fiscally sustainable.

The Los Angeles Times reported last week that Covered California, the Golden State’s exchange, “is preparing to go on a diet,” cutting its budget 15% for the fiscal year beginning July 1 because of lower-than-expected enrollment. Earlier this month, Hawaii’s state exchange prepared plans to shut down this fall amid funding shortfalls. Hawaii’s exchange had technical problems that have impeded signups since its launch, but Covered California has had relatively few computer glitches. During the HealthCare.gov rollout problems in 2013, columnist Paul Krugman held up California as a model of efficiency:

What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website? Well, your wish is granted. Ladies and gentlemen, I give you California.

Mr. Krugman called California “an especially useful test case,” saying that “it’s huge: if a system can work for 38 million people, it can work for America as a whole.”

But that model has run into financial distress. After slashing its spending, Covered California achieved a balanced budget for next year by utilizing $100 million in federally provided start-up funds. The Department of Health and Human Services’ inspector general and at least two U.S. senators have questioned whether exchanges are using start-up funds to plug holes in their budgets—a practice prohibited by law and one the senators called a “short term fix” in a letter to the Centers for Medicare and Medicaid Services. Using federal funds may help Covered California next year—but it will leave a multi-million-dollar hole in its budget the following year, leading to another round of belt-tightening.

The spending cuts—particularly a 33% reduction to marketing and outreach next year—will have an impact. As one report noted, “With enrollment growing more slowly than expected, a big cut in marketing might result in continued difficulties reaching target markets.” In other words, a spending cut next year could result in lower-than-expected enrollment—and budget crunches—in future years. Covered California could raise the $13.95 per policy monthly fee to generate more revenue—but that would also raise premiums, potentially driving away customers.

Before the exchanges opened, some worried about a disproportionate number of sick patients driving up premiums–and driving out healthy enrollees. A related phenomenon could be happening in state-run exchanges: in which few sign-ups result in a combination of cuts to outreach programs and/or higher monthly fees, discouraging enrollment and starting another round of the spiral. It’s possible that California’s experience could be a useful test case of that proposition—and a cautionary tale for those states contemplating their own exchanges.

This post was originally published at the Wall Street Journal Think Tank blog.

Paul Krugman’s California Dreamin’

Since California released its health care exchange premium rates late last week, liberals such as Paul Krugman have argued that Obamacare’s predicted “rate shock” will fail to materialize next year. At least three reasons explain why liberals’ argument falls short:

1. Dubious Assumptions About Exchange Enrollment

Some independent observers questioned whether the insurance companies in California’s exchange made favorable—and dubious—assumptions about the people who would buy insurance on the exchange next year. The Washington Post noted that “if sick people sign up en masse next year…that could dramatically increase costs for insurers, who would then have to recoup the money by increasing premiums.” One vice president at Avalere Health, a consulting firm, told the Post that a delayed premium spike could happen:

[The projected premium rates] are low enough that you have to think, are there going to be health plans in this market that are underwater…. It’s so hard to predict because you don’t know who’s going to show up on the market.

2. A Pre-Existing Preview

While no one knows who will sign up for exchange coverage next year, an Obamacare program already up and running—one established for individuals with pre-existing conditions—has attracted far sicker enrollees than first anticipated. As The New York Times reported last week:

The administration had predicted that up to 400,000 people would enroll in the program, created by the 2010 health care law. In fact, about 135,000 have enrolled, but the cost of their claims has far exceeded White House estimates, exhausting most of the $5 billion provided by Congress….

When the federal program for people with pre-existing conditions ends on Jan. 1, 2014, many of them are expected to go into private health plans offered through new insurance markets being established in every state. Federal and state officials worry that an influx of people with serious illnesses could destabilize these markets, leading to higher premiums for other subscribers.

People in the pre-existing condition program have been much sicker than actuaries predicted at the time the law passed. If that phenomenon repeats itself in the exchanges—either because only sick individuals enroll, or because employers struggling with high health costs dump their workers into the exchanges—premiums will rise significantly in future years.

3. Bait and Switch

As a column in Bloomberg notes, for all the press around California’s supposedly low exchange premiums, officials generated such spin only by comparing apples to oranges:

Covered California, the state-run health insurance exchange, yesterday heralded a conclusion that individual health insurance premiums in 2014 may be less than they are today. Covered California predicted that rates for individuals in 2014 will range from 2 percent above to 29 percent below average small employer premiums this year.

Does anything about that sound strange to you? It should. The only way Covered California’s experts arrive at their conclusion is to compare apples to oranges—that is, comparing next year’s individual premiums to this year’s small employer premiums. (Emphasis added.)

Therein lies one of Obamacare’s many flaws. Liberals now argue that while some may pay more for coverage, they will get “better” benefits in return. However, when campaigning in 2008, then-Senator Barack Obama didn’t say he would raise premiums; he said he would give Americans better coverage: He promised repeatedly that he would cut premiums by an average of $2,500 per family. That gap between Obamacare’s rhetoric and its reality makes arguments such as Krugman’s seem fanciful by comparison.

This post was originally published at The Daily Signal.

On Liberal Elites and “Dumb” Patients

Just before the Memorial Day recess, liberal blogger Ezra Klein published an interview with Sen. Coburn regarding health care.  Dr. Coburn’s responses can be found here, but in many respects Klein’s “questions” are themselves more interesting.  Two in particular speak volumes to the liberal mindset on health care:

EK:  Well, if you presuppose “properly regulated [markets],” then I doubt there are many examples.  But IPAB seems like an effort to deal with something you’re worried about: The inability of Congress to act to reform Medicare.  It’s an effort to more properly regulate the Medicare market….

EK:  The question is how do you define excess?  In the market version of this, it’s not clear that people know the care that’s best for them.  When you say how many primary care physicians we need, it may just be that Americans like a lot of specialty care.

There, in a nutshell, lies the liberal philosophy: That patients are unable to make their own choices, and that government – in this case, the IPAB bureaucracy created by Obamacare – should do so instead.  It’s worth examining each premise more closely.

The idea that patients cannot be intelligent consumers of health care permeates the left.  Former CMS Administrator Donald Berwick perpetuated the belief, as have writers like Paul Krugman and Klein himself.  At least at the most basic level, one can’t argue with the logic: It would be highly irregular – not to mention dangerous – for an accident victim riding in an ambulance to quibble about hospital choice.  But a significant part of the health spending problem in the United States focuses not on acute episodes like heart attacks or car crashes, but on chronic diseases like diabetes and emphysema, which comprise three-quarters of all health spending.  In these cases, patients certainly have the ability – and often the desire – to take better control of their health care, if only they were given the tools to do so.

The left argues in response that not every diabetic patient will want to spend time poring over “Consumer Reports”-esque ratings guides to find the most effective clinic or program that will work best for them.  But as Harvard’s Regina Herzlinger has written, markets don’t assume – and don’t need – every consumer to be fully informed in order to spark innovation; they only require a leading vanguard of educated “early adopters” to spark change and competition.

After all, how many automobile purchasers know the intricacies of their cars’ ignition systems, braking devices, etc.?  A car can be just as deadly an instrument as a surgeon’s scalpel – yet we don’t need a federally-created board like IPAB to “properly regulate” the automobile market.

Liberals Should “Cut” Out Their Medicaid Nonsense

Paul Krugman’s Monday New York Times column featured a typical rant – typical not least because it’s just plain wrong.  He talks about the “savage cuts” associated with conservative proposals to block grant Medicaid – except the “cuts” don’t actually exist.

Don’t believe me?  Well, take a look at this chart from the Kaiser Family Foundation’s study on Medicaid, issued last week.  The red line below illustrates the supposed “cuts” associated with block grant proposals – and shows that such “cuts” don’t actually exist, because Medicaid spending will increase each and every year under a block grant:

What’s particularly striking about the above chart is that the Kaiser study modeled a block grant proposal that was less generous than Governor Romney’s plan – the House-passed budget linked the growth of the block grant to inflation, whereas Governor Romney’s plan links the growth of Medicaid to inflation plus one percent.  So the Kaiser researchers, even as they claimed that their modeling was based on a plan “similar to Governor Romney’s,” cherry-picked (false) assumptions in order to portray block grants in the worst possible light.  This partisan hackery also explains why the Kaiser study uses the term “cut” no fewer than 60 times in one 22-page paper – even though both the House-passed budget and Governor Romney’s proposal do NOT reduce Medicaid spending in absolute terms.

Appearing before Congress last year, Secretary Sebelius testified that the Administration believes Obamacare did not “cut” Medicare – it merely slowed the program’s growth rate.  If that’s the case, the Secretary, the Administration, and their liberal allies should adopt a truly novel concept – consistency – and not argue that a slowdown in Medicare’s growth rate under Obamacare is not a “cut,” while a slowdown in Medicaid’s growth rate is a “cut.”

Paul Krugman’s Typical Trifecta

Writing in the New York Times this morning, Paul Krugman’s column hits the usual Krugman-esque notes.  The column, entitled “The Medicare Killers,” is liberal.  As you can tell from its title, the column is hyperbolically over-the-top.  And it’s also flat-out WRONG.  The most obviously false statement is his unequivocal declaration that not a shred of evidence exists that private plans can deliver Medicare benefits more efficiently than the federal government:

Wouldn’t private insurers reduce costs through the magic of the marketplace?  No.  All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs.

As Bill Clinton might say, the accuracy of that statement depends solely upon what the meaning of the word “all” is.  Because a new study published in the Journal of the American Medical Association just this month found that private plans would “bid an average of 9% below traditional Medicare costs” under a premium support model.  Which might explain why other liberals at the Center for American Progress are now – disingenuously – advancing the exact opposite of Krugman’s argument: that seniors would have to pay more to stay in government-run Medicare.

So either Paul Krugman doesn’t know his facts, or he doesn’t want to know his facts – because he would rather keep making claims about government-run Medicare’s “efficiency” that he knows to be wrong.  Either way, it’s a sad statement that Krugman and his allies would have to stoop so low to defend the indefensible – and unsustainable – status quo.

The Myth of “Market Power”

The Center for Budget and Policy Priorities released a preliminary analysis of the Ryan-Wyden Medicare proposal late last week, and (unsurprisingly) outlined reasons to oppose it.  But included in their brief was an interesting line: “Ryan-Wyden would deny Medicare much of its ability to serve as a leader in controlling costs by depriving it of the considerable market power it secures from its large enrollment.”  The “market power” argument is one liberals toss around frequently, claiming Medicare can use its power to get “better bargains.”

But there’s one easy question that exposes the fallacy of this liberal argument.  If anyone tries to talk about preserving or expanding Medicare’s “market power,” ask them this: Would you have any objections if drug companies, or major hospitals, decided to drop out of the Medicare program, or all government-run programs?  Recent experience suggests that Democrats will NOT allow providers to drop out of government-run programs – in Massachusetts, Gov. Deval Patrick proposed “solving” the problem of physician access by forcing doctors to participate in government-organized insurance plans as a condition of licensure.  That’s NOT a market – that’s government coercion.  And “leveraging market power” is just a euphemism by the left for the government dictating prices to medical providers.

Liberals’ incoherence on “market power” is actually quite stunning:

  • Zeke Emanuel wrote a New York Times opinion piece yesterday on premium support (about which more soon) stating that when it comes to Medicare, “We Must Cut Costs, Not Shift Them.”  The only problem with his logic is that one 2008 study found that Medicare and other government-run programs ALREADY shift costs from the public sector to the private sector – to the tune of nearly $1,800 per family per year.
  • Ezra Klein last week alleged that Medicare Advantage compete against government-run Medicare, apparently unaware that the structure of the Medicare Advantage program means plans actually compete against themselves, and have ZERO incentive to compete against government-run Medicare on price.
  • Then there’s Paul Krugman, who says that “Patients Are Not Consumers.”  Well, if patients are not consumers, then how can there be a “market” for Medicare to exercise its “power” over?  The only other potential “buyers” under Krugman’s logic are government bureaucrats – and does anyone think some government officials sitting in Washington offices constitute a “market” in any realistic sense of the word?

The fact of the matter is, many conservatives believe that there is certainly NOT a market in health care – or not enough of one anyway – and that comprehensive entitlement reform should look to change that fact.  And their rhetoric notwithstanding, the policy positions of most liberals prove that their talk about increasing “market power” is really just an excuse for government to increase its dominance over everything in its path.

A Modest Proposal for IPAB’s Defenders

Several months ago I began experiencing problems walking on my left foot.*  I was born with deformed bones in my left foot, and the pressure from walking on this abnormal foot structure for more than 30 years began to take its toll.  I visited several podiatric and orthopedic specialists to evaluate my options; non-invasive methods like orthotics and therapy helped, but it became apparent to me that they weren’t really solving the problem, as opposed to delaying the inevitable.  So I consulted with a surgeon, and he arrived at a plan of action – fusions, grafts, and a tendon lengthening – which should significantly alleviate my pain and improve my gait.  Feeling comfortable with the surgeon’s level of expertise and with his recommended treatment plan, I scheduled surgery for a few weeks from now.

However, the recent debate over the IPAB – Obamacare’s body of unelected bureaucrats who will control Medicare spending – has prompted me to reconsider my decision.  After all, who am I to decide how my own health care should be handled?

  • Paul Krugman has taught me that “Patients are Not Consumers” and that “making [health care] decisions intelligently requires a vast amount of specialized knowledge”;
  • The Center for American Progress, in making “The Case for Bureaucrats in Health Care,” has taught me that health care is different from buying shoes;
  • Ezra Klein has taught me that “consumer-directed health care is a silly idea” because “patients are not qualified to evaluate good care”; and
  • CMS Administrator Donald Berwick has taught me that “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care.  That is for leaders to do.”

These statements have left me in a serious conundrum, and forced me to reconsider my thinking.  After all, I’m not an expert on health care – I’m not even close:

  • I don’t have a PhD in economics, which, as Secretary Sebelius recently pointed out, qualifies individuals as “experts” in how to run a health care system;
  • Neither I nor my surgeon graduated from an Ivy League school; and
  • I don’t even know all the words to Fair Harvard.

I do however now recognize that I am not only clearly incapable of making my own health care choices, but also that my health – and our entire country – would be better off leaving those choices to “experts” who are my intellectual superiors.  After all, President Obama promised that the stimulus would prevent unemployment from rising above 8 percent – and who thinks joblessness is still a major problem more than two years later?  And just look at how Obamacare has already delivered the $2,500 reduction in premiums that candidate Obama repeatedly promised.

So all I need now is to find a suitable “expert” to tell me whether I should have the surgery or take the painkiller.  Therein lies my open request to IPAB’s defenders, to provide me with the enlightened knowledge of my own medical condition that I so clearly lack:

  • Peter Orszag – supporter of IPAB as a way “to improve Medicare’s cost-effectiveness” – can tell me whether my surgery will cost too much;
  • Zeke Emanuel can tell me where my procedure fits on his chart for the allocation of scarce medical resources; and
  • Dr. Berwick can tell me if I’m one of those cases where “Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been available for centuries.”

I do hope that one of these individuals – or indeed other political commentators who have supported IPAB in recent weeks – can tell me how I should proceed when it comes to my foot.  After all, I now realize that my surgeon could be recommending an operation just for the reimbursement check – because most medical professionals base their decision-making processes on whether they will obtain a $50,000 payday (as opposed to Obamacare’s “experts,” whose decisions will be based on the fact that “the social budget is limited – we have a limited resource pool”).

There is a catch however:  While I will defer my own opinion to those of the “experts,” I do expect that any individual who passes judgment on my case will assume full financial and legal liability for same.  That may be a problem for some of IPAB’s defenders.  After all, Section 3403 of the statute exempts the IPAB and its members from ANY legal liability associated with its decisions.

And therein lies the point of this proposal, and this story:  If the IPAB’s defenders – and its so-called “experts” – aren’t willing to put their own money where their mouths are, then how good will this board of unaccountable bureaucrats be?

 

* And just in case you were wondering, the facts of this story are real, as is the sarcasm…

Who Am I To Decide How My Own Health Care Should Be Handled?

Several months ago I began experiencing problems walking. I was born with deformed bones in my left foot, and the pressure from walking on this abnormal foot structure for more than 30 years has begun to take its toll. I visited several podiatric and orthopedic specialists to evaluate my options. Non-invasive methods like orthotics and therapy helped, but it became apparent to me that they weren’t really solving the problem; they were just delaying the inevitable. So I consulted with a surgeon, and he arrived at a plan of action — fusions, grafts and a tendon lengthening — which should significantly alleviate my pain and improve my gait. Feeling comfortable with the surgeon’s level of expertise and with his recommended treatment plan, I scheduled surgery for a few weeks from now.

However, the recent debate over the Independent Payment Advisory Board (IPAB) — Obamacare’s body of unelected bureaucrats who will control Medicare spending — has prompted me to reconsider my decision. After all, who am I to decide how my own health care should be handled?

  • Paul Krugman has taught me that “patients are not consumers” and that “making [health care] decisions intelligently requires a vast amount of specialized knowledge”;
  • The Center for American Progress, in making “The Case for Bureaucrats in Health Care,” has taught me that health care is different from buying shoes;
  • Ezra Klein has taught me that “consumer-directed health care is a silly idea” because “patients are not qualified to evaluate good care”; and
  • CMS Administrator Donald Berwick has taught me that “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”

These statements have left me in a serious conundrum, and forced me to reconsider my thinking. After all, I’m not an expert on health care — I’m not even close:

  • I don’t have a PhD in economics, which, as Health and Human Services Secretary Kathleen Sebelius recently pointed out, qualifies individuals as “experts” in how to run a health care system;
  • Neither I nor my surgeon graduated from an Ivy League school; and

I do, however, now recognize that I am not only clearly incapable of making my own health care choices, but also that my health — and our entire country — would be better off leaving those choices to “experts” who are my intellectual superiors. After all, President Obama promised that the stimulus would prevent unemployment from rising above 8 percent, and who thinks joblessness is still a major problem more than two years later? And just look at how Obamacare has already delivered the $2,500 reduction in premiums that candidate Obama repeatedly promised.

So all I need now is to find a suitable “expert” to tell me whether I should have the surgery or take the painkiller. Therein lies my open request to IPAB’s defenders, to provide me with the enlightened knowledge of my own medical condition that I so clearly lack:

  • Peter Orszag, who supports IPAB as a way “to improve Medicare’s cost-effectiveness,” can tell me whether my surgery will cost too much;
  • Dr. Berwick can tell me if I’m one of those cases where “Most people who have serious pain do not need advanced methods; they just need the morphine and counseling that have been available for centuries.”

I do hope that one of these individuals — or indeed other political commentators who have supported IPAB in recent weeks — can tell me how I should proceed when it comes to my foot. After all, I now realize that my surgeon could be recommending an operation just for the reimbursement check, because most medical professionals base their decision-making processes on whether they will obtain a $50,000 payday (as opposed to Obamacare’s “experts,” whose decisions will be based on the fact that “the social budget is limited — we have a limited resource pool”).

There is a catch, however: While I will defer my own opinion to those of the “experts,” I do expect that any individual who passes judgment on my case will assume full financial and legal liability for same. That may be a problem for some of IPAB’s defenders. After all, Section 3403 of the statute exempts the IPAB and its members from ANY legal liability associated with its decisions.

And therein lies the point of this proposal, and this story: If the IPAB’s defenders — and its so-called “experts” — aren’t willing to put their own money where their mouths are, then how good will this board of unaccountable bureaucrats be?

This post was originally published at The Daily Caller.