Suppose Congress asked Americans: which government officials should decide what foods you would be allowed to eat and what prices you had to pay at the grocery store – Congress, or an unelected board of nutritional experts appointed by the president?

Most Americans would immediately reply, “Neither!” But that’s precisely the debate between Congress and the White House regarding President Obama’s proposed Medicare Independent Payment Advisory Board.

One of President Obama’s key proposals to reduce skyrocketing Medicare costs is a so-calledIndependent Payment Advisory Board (IPAB). The IPAB would consist of 15 members appointed by the president (and confirmed by the Senate), empowered to decide what medical tests and procedures Medicare would cover and how much it would pay providers.

Giving this power to the IPAB would put tremendous medical decision-making in the hands of unelected officials with minimal accountability. We’ve already seen a foretaste of this when a federal government medical panel attempted to save money by restricting screening mammography to women over age 50, even though decades of medical research has shown clear benefits to starting annual mammograms at age 40. Although the Obama administration stated that the IPAB would not ration medical care, its power to set payments to doctors and hospitals would give it de facto rationing power.

If the health insurance market were fully free (which it currently is not), insurers would be able to offer a wide range of packages varying from low-cost “catastrophic only” plans to expensive “gold-plated” plans that covered experimental treatments for every rare disease, and everything in-between. Similarly, patients would be free to decide whether they wanted to pay higher premiums while still healthy for guaranteed access to unusual expensive treatments if they needed it later, or if they’d rather save that money for more important life priorities (such as buying a new house or saving for their children’s education) in exchange for forgoing such costly end-of-life care that might only gain them a few additional weeks of life.

In a fully free market for health insurance, everyone would be free to purchase whatever level of coverage they desired according to their best rational judgment from any willing insurer. This would allow them to join voluntary insurance risk pools with others with similar preferences without imposing their choices on others with different priorities. Individuals have the right — and the responsibility –to make these important life decisions for themselves. The government should not be making these decisions for us.

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