Recently the debate about “death panels” has been heating up as Republican Congressional leaders express their opposition to implementing the Independent Payment Advisory Board (IPAB) by refusing to appoint members to serve on it. The IPAB, which was referred to as a death panel by Republicans during the 2010 Congressional elections, is a committee that was to be created as part of health care reform and consists of 15 full-time members appointed for staggered six-year terms. The IPAB must provide a report to Congress about how to hold Medicare spending within legislated limits. Congress is given a strict timetable within which it must consider the board’s recommendations and either vote to accept them or come up with alternatives that achieve comparable savings. Although the IPAB might not be the best way to do it, as long as the government pays for health care, someone must have the responsibility of making decisions about which health care will not be paid for even in cases where the care might prolong the person’s life.

Although intended to be a pejorative term, the term “death panel” accurately reflects decisions that have to be made about whom to save when resources are scarce. We simply do not have the resources to provide as much health care as people might desire for prolonging their lives or the lives of their loved ones. If government pays for health care, as it does for Medicare and Medicaid beneficiaries, limited funds necessitate that sometimes people will be denied access to care. If the decision of who does and who does not get care is not made explicitly by an appointed committee, it will be made by default as scarcity necessitates that some must wait in line for health care.

It is not hard to find tragic stories of Medicaid or Medicare beneficiaries who died because they could not get the care they needed. In some cases, this is due to the fact that reimbursement rates are so low that those with urgent health problems may have to wait too long to get an appointment. In others, an explicit decision may have been made to deny coverage to someone. When government or an insurance company pays the bill, scarcity necessitates that people cannot get all the health care they might want or need. It might be better for an appointed board to decide the rules that determine when care gets paid for and when it does not, than for people to be told they are entitled to whatever care they need, but then end up waiting for treatment until it no longer does them any good.

In our market economy, if a board such as the IPAB decides that a certain treatment will not be covered by Medicare, that does not mean that a patient who desperately needs the treatment cannot get it. If something is not covered by Medicare, those who are willing and able to do so may pay out of their own pockets so they or their loved ones can get the health care they need.

Republicans, or anyone else opposed to the idea of death panels, should be consistent. They should either support elimination of health care entitlements, particularly Medicare and Medicaid, or support changing them into defined contribution plans, where government contributes money toward health insurance premiums and lets insurance companies decide what is covered and what is not. This way, those covered by Medicare and Medicaid would at least be able to have some choice about who makes those decisions and how they are made. As long as they are counting on a third party to pay for their health care, Americans should not expect to be able to get as much care as they want or need regardless of cost.

If government is going to continue to pay for health care entitlements, the question is not whether some people will be denied health care; it is about who makes the decision and how the decision is made. Rather than pretending that it is possible for the government to spend whatever it takes to provide unlimited health care for all, the pertinent question is what are the rules and procedures for deciding and who are the ones assigned to interpret the rules about who gets care and who does not.  Those who supported the politicians who gave us Medicare, Medicaid, and health care reform should not be surprised that those in charge of those programs want the power to make those life and death decisions and might make them in a way that goes against the principles we believe in.

Dr. Tracy C. Miller is an associate professor of economics at Grove City College and fellow for economic theory and policy with The Center for Vision & Values. He holds a Ph.D. from University of Chicago.