If you’re an oncologist with a heavy load of breast cancer patients requiring expensive tests and treatments, the cost of what you are authorizing could far exceed what the average general practitioner authorized for his healthier Medicare patient caseload. If what you prescribe is in the upper 10 percentile of per capita Medicare costs, you’ll automatically lose 5 percent of your Medicare reimbursements.
Notice, there’s no consideration made for quality of care or results. You may be prescribing the most effective and efficient care, but that doesn’t count. Notice also that, since some physicians always will end up in the top 10 percentile (it’s like teachers who grade on the curve, thus ensuring that someone always fails) the pressure on doctors to reduce costs would be constant. Thus, the death spiral.
David N. O’Steen, executive director of National Right to Life Committee, which opposes the provision, said it shifts the bad guy role from government bureaucrats to physicians. “Instead of bureaucrats directly specifying the treatment denials that will mean death and poorer health for older people, it compels individual doctors to do the dirty work.”