Medicare services are already being rationed covertly via wait lists and via the increasing numbers of physicians who refuse to take Medicare or Medicaid.
The IPAB would most likely decrease access to services by cutting payments even further below market rates which would decrease supply of those services.
Couple that with the supply side problems where doctors need 7+ years of training before they can perform simple procedures like testing for strep throat or prescribing antibiotics, and the fact that a large fraction of medical spending does very little to prolong life or improve quality of life and you can see that the current health care system is incredibly wasteful.
Testing for strep and prescribing antibiotics represent the smallest fraction of healthcare resources. Why didn't you include brain or spine surgery on your list of things that shouldn't require 7 years of training? Expensive end of life care isn't the fault of hospitals or clinicians: it's the fault of families who can't say no to excessive and futile end of life care.
If you want to get into getting rid of "wasteful" spending, why aren't you recommending everyone should smoke a pack of cigarettes per day? Most people would work and live a productive life until they die of lung cancer at age 65? Saves 15-25 years of unnecessary "end of life" care.
I don't think we're actually that far apart on what we think the problems are. I wasn't trying to say that requiring large amounts of school in order to test for strep and antibiotics are the only cause of our high costs of healthcare, but they obviously contribute.
I agree (and I think any thinking person would agree) that you should have training to perform more specialized procedures.
Expensive end of life care is partly the fault of clinicians who get paid to authorize expensive procedures and who don't want to tell their patients and their families that there is very little they can do to prolong their life, so they should just surround themselves with loved ones and prepare to die.
And we can both agree that there is wasteful spending without arguing that people should kill themselves sooner. Just looking at our healthcare expenses relative to other countries shows we pay somewhere between 1.5-2x more for roughly the same level of care. That's obviously a market failure.
do you mean "increasing number of physicians"?