The Problem with Technocracy
Recently the Wall Street Journal ran an editorial, entitled “The Trouble with MedPAC,” regarding the Medicare Payment Advisory Commission. The opinion piece pointed out the bias of the MedPAC commissioners against Medicare Advantage, specifically the allegation that the program receives billions of dollars per year in “overpayments” compared to traditional Medicare.
Indeed, MedPAC’s analysis of Medicare Advantage spending vis-a-vis traditional Medicare omits one important factor. When they sign up for the program, seniors aren’t placed into the most efficient plan available to them, or the one with the best clinical outcomes, or the one that their doctors participate in.
No—seniors are automatically placed into the government program, and private insurers have to entice seniors to take some action to opt out of traditional Medicare and switch over to Medicare Advantage. That creates a significant inertial bias in favor of the government, one that MedPAC and the Left always ignore when comparing the two systems’ finances.
But the Journal editorial’s last sentence mentions only in passing a larger issue: Why do bodies like MedPAC even exist? The idea that a group of technocrats can get in a room and plan out a trillion-dollar program covering nearly one in four Americans is absurd on its face. It smacks of Ronald Reagan’s famous quote in his 1964 A Time for Choosing speech about “a little intellectual elite in a far-distant capital” who think they “can plan our lives for us better than we can plan them ourselves.”
Yet the Left truly believes in this approach. Oregon, for instance, for decades has had a “commission of appointed experts that has overseen what types of care and services are paid for by the Medicaid-funded Oregon Health Plan for lower-income people.” You read that right: A rationing body that decides which treatments get covered, which supporters defend for “provid[ing] needed transparency for the kinds of decisions most states make politically and behind closed doors.” (Or, as Donald Berwick would say, “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”)
The next time the Left tries to argue that Republicans are a “threat to democracy,” feel free to point out all the ways in which they support government by “experts,” as opposed to government by the people. MedPAC is a typical example, but far from the only one.