Senate Committee Defeats Amendment to Stop Financial Incentive for Rationing

Bioethics   |   Steven Ertelt   |   Oct 1, 2009   |   9:00AM   |   WASHINGTON, DC

Senate Committee Defeats Amendment to Stop Financial Incentive for Rationing

by Steven Ertelt Editor
October 1
, 2009

Washington, DC ( — Members of the Senate Finance Committee on Wednesday not only turned back an amendment to stop abortion funding, but they defeated an amendment to stop rationing as well. They rejected, on a party-line vote, an amendment to eliminate the rationing components of the Baucus health care bill.

Sen. Jon Kyl, an Arizona Republican, brought the amendment out of a concern, shared by pro-life groups, that one provision of the measure penalizes Medicare doctors who provide higher levels of medical treatment to senior citizens.

Kyl and Senator Pat Roberts, a pro-life Kansas Republican, sponsored the change.

The amendment would have removed a 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.

Pro-life advocates say 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%.

“Last night’s vote in the Senate Finance Committee should put America’s senior citizens on alert," medical ethics attorney Burke Balch of National Right to Life, told today. "If death spiral provision actually becomes law, their Medicare providers will start a race to the bottom to avoid being captured in the top ten percent."

“Older Americans who rely on Medicare would be faced with fewer and less-effective treatment options. This is among the most insidious provisions for rationing in any of the health care bills before Congress," he continued.

Balch says the provision, on pages 80-81 of the "Chairman’s Mark," drives all doctors treating older people to try to order fewer and less effective tests and treatments for fear that they will be caught in that top 10%.

"It is noteworthy that this feature operates independently of any considerations of quality, efficiency, or waste – 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," Balch said.

"Moreover, it creates a moving target – by definition, there will ALWAYS be a top 10%, no matter how far down the total amount of money spent on Medicare is driven," he continued.

Although all of the Democrats on the panel voted against the amendment,
Senator Kent Conrad of North Dakota did so for budgetary reasons.

He said during the debate that he shared the concerns of pro-life groups and Senators Kyl and Roberts.

"As I try to put my feet in the shoes of a doctor, I don’t know how you separate out overutilization that is really overutilization," he said. "There is no way of knowing when you go through the year, what you are going to do at the end of the year."

He warned that the provision could come back to "haunt us" in a few years.

David O’Steen, the executive director of the National Right to Life Committee, previously warned pro-life advocates about the provision in the Baucus bill.

“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,” he said.

“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.

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.