The debate over Paul Ryan’s Medicare reform ideas has largely been healthy, even amid the liberal distortions. But why has there been so little scrutiny of President Obama’s new Medicare proposal? Anyone worrying about more individual choice and responsibility in health care might be interested to learn that the alternative is turning every one of these decisions over to a 15-member central committee.

It sounds absurd, but there the President was last week, gravely conceding Mr. Ryan’s analysis of Medicare’s balance sheet and then claiming that the solution is to give a lot more political power to an unelected board to control health costs. Democrats believe this board will play doctor and actuary and allocate health resources better than markets, so allow us to fill in some of the details of this government-planned future.

The Independent Payment Advisory Board was created in the ObamaCare statute, and the President will appoint its experts in 2012 to six-year terms. From then on, look out. Democrats cut $468 billion in Medicare spending by screwing down its price controls and gutting the private insurance options of Medicare Advantage, while also boosting taxes by about $89 billion. This money could have strung along the status quo for a few more years, but Democrats diverted it instead to their new middle-class entitlement, which is like eating all the food left in the life raft.

Under last year’s law, the board submits its recommendations to Congress on an up-or-down vote and they go into effect automatically unless Congress adopts an equivalent plan. Its decisions aren’t subject to judicial or administrative review. Now Mr. Obama wants to give the board the additional power of automatic sequester to enforce its dictates, meaning that it would have the legal authority to prevent Congress from appropriating tax dollars. In other words, Congress would be stripped of any real legislative role in favor of an unaccountable body of experts.

As a practical matter, the more likely outcome is the political rationing of care for the elderly, as now occurs in Britain, or else the board will drive prices so low that many doctors and hospitals drop out of Medicare. Either alternative would create the kind of two-tier system dividing the poor and affluent that Democrats claim is Mr. Ryan’s mortal sin.

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