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Central planning a la ObamaCare

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Sunday, Sept. 2, 2012, 8:56 p.m.

Central planning is tricky. Castro decided that individualism was an obstacle to economic development — and nearly half of Cuba's 7,000 doctors fled to the United States.

The Maoists in China targeted the nation's most productive farmers as insufficiently self-sacrificing, and tens of millions of people ended up starving to death. You don't get a great harvest by killing the best farmers.

What failed in both cases was a system built on the fatal combination of arrogance, ineptitude, sanctimony and a deep-seated naivete about human nature, incentives and unintended consequences.

Here at home — again, directly dealing with matters of life and death for millions of people — the central planners of ObamaCare have established an Independent Payment Advisory Board, a panel of 15 unelected and unaccountable government officials who will call the financial shots in the U.S. health care system — no oversight or consent required by Congress, doctors, patients or the public.

The White House was supposed to name the central planners to the board and have the operation up and running by mid-September, but the Obama administration appears to be holding off on the names of the appointed bureaucrats until after the November election.

ObamaCare architect Peter Orszag, former budget director for President Obama and currently a vice chairman of bailed-out Citigroup, appears to be a likely appointee.

Orszag has stated that up to a third of the spending in the American health care system is “waste.” It's not clear if he was referring to the profit levels of insurance companies or the cost of health care for people who, under the new top-down, cheaper, one-size-fits-all system, will be tagged as too old to be permitted to have a heart valve repair or new knee.

Another top candidate for the panel is bioethicist Ezekiel Emanuel, a senior counselor on health care policy at the White House Office of Management and Budget and brother of Obama's former chief of staff, Rahm Emanuel.

Stirring up controversy and fear on the issue of “a just allocation of health care resources,” Emanuel wrote the following in The Hastings Center Report in 1996 on where to draw the line between guaranteed and non-guaranteed health care as viewed through the “civic republicanism” and “deliberative democracy” perspectives:

“Substantively, it suggests services that promote the continuation of the polity — those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations — are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed.” What's left undefined is how bureaucrats on the payment advisory board will decide if we're sufficiently “active” in being “participating citizens.” Explained Emanuel, “An obvious example is not guaranteeing health services to patients with dementia.”

In 2009, Emanuel wrote the following justification for age-based health care rationing: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.”


Ralph R. Reiland is an associate professor of economics at Robert Morris University and a local restaurateur. Email him at:

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