Now, after Wednesday night’s debate, we’ve shifted into overdrive into declaring the Obama campaign dead and the Romney campaign roaring. Over the next couple days, as more polls come in, we’ll see how much of this translates into a real change in the landscape.

I didn’t watch Wednesday’s debate, opting instead for a trip to the Brewers-Padres baseball game in Milwaukee, near where I live. In retrospect, maybe it would have been more fun to watch Obama potentially cough up his lead than it was to watch the Brewer bullpen cough up their 6-0 lead, but after watching presidential debates since 1984 when I was a freshman in high school,  and my tolerance level for political spin has maxed out. But in reading the recaps, the candidates broached one topic that merits a more in-depth conversation, and it’s Independent Payment Advisory Board.

President Obama might not intend health care rationing, but the structure he put in place easily allows for just that.

You might recognize the Independent Payment Advisory Board (IPAB) as the “death panels”, that dominated the health care debate in the summer of 2009. Conservatives charged that the panels would ration health care and deny grandma the treatments she needed to stay alive for the sake of keeping within budget. Liberals furiously charged that this was a lie, that there were restrictions on what the IPAB could and couldn’t do.

Is it too bipartisan to say both bring a reasonable point? The IBPA has been granted the power to propose cuts in spending if health care dollars exceed a certain level, although Congress would have the option to come back with its own cuts. As a general rule, when Obama says he doesn’t intend that grandma be denied her health care, I’m inclined to believe him.

But what the president fails to grasp is that with the IPAB he has implemented a structure which can do just what his critics charge, regardless of original intent. And given the debate that goes on in the United States over end-of-life issues, is it really some huge stretch to suggest that a future panel might decide it’s best to save health care money by denying treatments to the elderly?

The fact the panel is unelected fits the needs of the cowardly politician perfectly. What better way to cop-out then by either claiming helplessness in stopping the evil IPAB, or even better, portraying themselves as outraged by the IPAB decisions.

And the mere existence of the IPAB is an example of why a market-driven approach to solving health care should be preferred. If you open up competition, put policies in place that allow people to own their own health coverage—as opposed to having it owned for them by their employer or the government, the competition for their business can produce more humane results. The government can then step in with Medicaid to pick up the slack where the market leaves off, rather than attempting to drive the whole process itself.

The IPAB is unlikely to have an impact on anyone’s life in the next few years, meaning it won’t get nearly the attention it deserves. But it is likely to have a major impact on everyone’s life 10-15 years from now. And if this sort of health care infrastructure is not what Americans want, the time to stop it is right now.

Dan Flaherty is the author of Fulcrum, an Irish Catholic novel set in postwar Boston with a traditional Democratic mayoral campaign at its heart, and he is the editor-in-chief of TheSportsNotebook.com