“Waste, fraud and abuse”, that favorite old refrain, will probably not suffice to cut Medicare costs. Fears of “death panels” are way overblown. Fears of “Are second knee replacements worth it?” panels are not. And the infamous “overpayments to insurers” are actually paying for extra services, which the seniors in Medicare Advantage will probably lose, possibly along with Medicare Advantage, since providers may pull out. You may think that these are wasteful and seniors will end up just as happy back in traditional Medicare. But revealed preference seems to indicate that they prefer what they have.
What looks unnecessary to one bureaucrat will turn out to be a critical procedure to someone’s grandmother. Top-down decision making — which the administration wants more of in Medicare — can’t avoid this conundrum.