Critics of the Patient Protection and Affordable Care Act have derided a central feature of the law - the Independent Payment Advisory Board - as akin to a "death panel."
Supporters of the law dismiss that as hysterical.
The truth lies somewhere in between.
Howard Dean, a former governor of Vermont and former chairman of the Democratic National Committee, is also a critic of the payment board. Since Dean also is a physician, his opinion is worth considering.
Writing in The Wall Street Journal, Dean described the board as "essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."
That leaves open the possibility that patients could be denied certain treatments because of a fiat by a distant board.
But that is not Dean's point. He says simply that the board won't work to contain costs.
Dean said rate-setting, "the essential mechanism of IPAB - has a 40-year track record of failure."
"What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients.