•  The department of Health and Human Services (HHS) will be empowered to impose so-called "quality and efficiency" measures on health care providers, based on recommendations by the Independent Payment Advisory Board, which is directed to force private health care spending below the rate of medical inflation.  In many cases treatment that a doctor and patient deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which runs afoul of the imposed standards will be denied, even if the patient wants to pay for it.

•  The law empowers HHS to prevent older Americans from making up with their own funds for the $555 billion the law cuts from Medicare by refusing to permit senior citizens the choice of private-fee-for-service plans whose premiums are sufficient to provide unrationed care but which HHS, in its unlimited discretion, disallows.  The Obama health care law could thus lead to elimination of the only way that seniors will have to escape rationing -- by limiting their right to spend their own money to save their own lives.

•  The law instructs and authorizes state bureaucrats to limit the value of the insurance policies that Americans may purchase.  Not only will the exchanges exclude policies from competing in an exchange when government authorities do not agree with their premiums, but the exchanges will even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by spending what those government authorities claim to be an "excessive or unjustified" amount.  This will create a "chilling effect," deterring insurers who hope to compete within the exchanges from offering adequately funded plans even outside of them, so that consumers will find it increasingly difficult to obtain health insurance that offers adequate and unrationed health care.