Pro-Life Amendments to Baucus Bill Would Remove Financial Incentive for Rationing

Bioethics   |   Steven Ertelt   |   Sep 24, 2009   |   9:00AM   |   WASHINGTON, DC

Pro-Life Amendments to Baucus Bill Would Remove Financial Incentive for Rationing

by Steven Ertelt Editor
September 24
, 2009

Washington, DC ( — Pro-life members of the Senate Finance Committee have offered two amendments designed to eliminate the rationing components of the Baucus health care bill. The concern revolves around one provision that penalizes Medicare doctors who provide higher levels of medical treatment to senior citizens.

“This provision creates a cruel death spiral. By financially penalizing Medicare providers, the Baucus bill sets up the cruelest and most effective way to ensure that doctors are forced to ration care for their senior citizen patients,” says David O’Steen, the executive director of the National Right to Life Committee.

“Instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health care for older people, it compels individual doctors to do the dirty work," he said.

Senator Jon Kyl, a pro-life Arizona Republican and Senator Pat Roberts, a pro-life Kansas Republican, are behind amendments.

They would remove the provision that establishes that, for at least five years, Medicare physicians who authorize treatments for their patients that wind up in the top 10% of per capita cost for a year will lose 5% of their total Medicare reimbursements for that year.

NRLC says the provision means that all doctors treating older people will constantly be driven to try to order the least expensive tests and treatments for fear that they will be caught in that top 10%.

The pro-life group says this feature operates independently of any considerations of quality, efficiency, or waste and that, "if you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year."

The provision creates a "moving target," the pro-life group explains, because by definition, there will always be a top 10%, no matter how far down the total amount of money spent on Medicare is driven.

“It’s like a game of musical chairs, in which there is always one chair less than the number of players – so no matter how fast the contestants run, someone will always be the loser when the music stops,” O’Steen added.

O’Steen says the incentive the provision creates is purely cost-driven, without any balancing of benefit and that it will create a constant sense of uncertainty in doctors, since none can know in advance precisely what the cutoff for a given year will be — resulting in still more pressure to limit treatment and diagnostic tests to the bare minimum.

Burke Balch, an attorney who is the director of NRLC’s Powell Center for Medical Ethics, said the bill is "creating a financial penalty for doctors who seek to provide their patients with the best, and therefore more costly, treatment available, is a scary way to cut costs."

The Kyl Amendment #D2 is amendment 125 and the Roberts Amendment #D1 is amendment 137 in the Senate Finance Committee’s markup of the Baucus bill.

National Right to Life has also been concerned about a comparative effectiveness provision.

In the Kennedy health care plan that has already been approved by another Senate committee, a measure is employed that calls for a system similar to the “quality of life years” system, or QALY, in England where payment for treatment is only authorized if it extends the quality of life not the length of life.

Under such a system someone in a wheelchair is determined to have a lower quality of life compared with an able-bodied person.

National Right to Life asked lawmakers to support the Enzi amendment, which would have said the government can’t use that system to deny treatment to people on the basis of a disability or degree of medical dependency or quality of life, but the HELP committee defeated it.

O’Steen says the Baucus bill "does contain language to prevent the use of comparative effectiveness analysis in a manner that would discriminatorily deny treatment because of age, disability, or terminal illness.

"However, this language would not affect the financial incentive to ration care" as he earlier described.

Related web sites:
National Right to Life –

Sign Up for Free Pro-Life News From

Daily Pro-Life News Report Twice-Weekly Pro-Life
News Report
Receive a free daily email report from with the latest pro-life news stories on abortion, euthanasia and stem cell research. Sign up here. Receive a free twice-weekly email report with the latest pro-life news headlines on abortion, euthanasia and stem cell research. Sign up here.