Three card monte is a scam in which the sucker is led to believe he is following the winning card, when in fact the skillful dealer has distracted the sucker into following the wrong card. The sucker never wins.

Right now, everyone’s focus is on Obama’s “historic” speech to the Muslim world in Cairo. But the real action came in a letter Obama sent to the Senate proposing to empower the 17-member Medicare Payment Advisory Commission (MedPAC) with the same level of power over the health care system as the Base Realignment and Closure Commission had over the closing of military bases:

To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC’s recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.

The 2009 MedPAC member list is here. While MedPAC currently only makes suggestions regarding Medicare payments and costs, the Obama proposal would greatly expand MedPAC’s power over a large percentage of the economy — and the health and welfare of tens of millions of people — because MedPAC’s actions would have the force of law without any significant accountability. The likelihood of a joint resolution of Congress against anything MedPAC did is so small as to make MedPAC a law unto its own.

Since Medicare rules and funding drive so much of the health care industry, MedPAC will become a de facto health care Czar. And it would not be surprising if MedPAC’s jurisdiction was expanded beyond Medicare itself.

While some are cheering that the move “actually looks able to deliver on controlling costs,” such controls will come at the cost of citizens having any control over their health care. Somehow blind faith in an unaccountable commission has become the method of rescue for those who otherwise demand freedom. If you didn’t like when a military base was was closed in your state, wait until you are denied a surgery or treatment because it is deemed too expensive by MedPAC.

The analogy of closing military bases to making health care costs decisions if fallacious. The base closing commission was a reaction to large excess capacity in military bases, largely as a result of pork barrel earmarks. Taking politicians out of the closing process was the only way to close military bases, so that politicians would not take the blame. There is no excess capacity, however, in health care services. To the contrary, if anything, there is a lack of capacity, or at least a capacity which costs too much because of new technologies and treatments.

An unaccountable commission restricting access to health care services simply is nothing like an unaccountable commission closing unneeded military bases. And if the history of the Base Closing commission is any indication, there will be plenty of irrationalities from this supposedly rational process, mostly in the form of illusory cost savings.

There will be winners and losers, and the losers will lose not their jobs, but potentially their lives. No wonder Obama wants to rush this through Congress this summer in time for an October signing. If people really knew and had time to focus on what Obama was proposing, the MedPAC and similar proposals would fail.

Obama’s speech to the Muslim world will change nothing. Obama’s MedPAC and similar proposals will change everything. And you were watching the speech.

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