By Burke J. Balch, J.D., director, NRLC's Powell Center for Medical Ethics

"Over-promising plus under-funding forces rationing." For months, the National Right to Life Committee has been hammering that point, as regular visitors to our blog at http://powellcenterformedicalethics.blogspot.com/.

We have repeatedly warned that rationing will result if the federal government creates a major new entitlement to health insurance for the uninsured, yet relies on vague hopes that greater efficiency will restrain health care costs instead of providing an adequate, sustainable funding mechanism to pay for the entitlement.

Now we are seeing clear evidence that NRLC is not exaggerating--it comes from Massachusetts.

Massachusetts Gov. Deval Patrick

In 2006, Massachusetts enacted a widely heralded plan essentially mandating universal health insurance coverage, with subsidies to enable the low-income uninsured to afford it. To pay for the subsidies, the state bill cobbled together a series of funding sources, including federal payments, existing state funds for health care for the uninsured, and other sources of revenue that shared one commonality--they were not based on what people actually pay for health care. (For background on why this is a fundamental error, see http://www.nrlc.org/MedEthics/SaveNotRation.html and the webinar that links to that page.)

After the first couple of years of the new program, Massachusetts began to face a mounting gap between the cost of health care subsidies and the available funds. Last year it relied on one-time funding from the federal stimulus bill to help bridge the gap.

This year, faced with mounting evidence that the state simply cannot afford the increasing outlays, Governor Deval Patrick on February 11 sent the legislature a bill that embodies precisely what NRLC has warned will happen on the federal level. Presumably to avoid a "two-tier" system in which the subsidized health insurance would be worse than the health care the rest of Massachusetts residents get, Patrick's bill proposes sweeping measures to limit what any of the citizens of Massachusetts would be ALLOWED to pay for health care!

The governor's bill would authorize the state's insurance commissioner to limit what hospitals and other health care providers, as well as insurers, could charge. In short, it would mandate price controls for health care services and insurance.

Now, everyone would prefer to pay less, rather than more, for health care, just as for everything else. So price controls sound appealing, and are often initially popular. But what must be understood is that when the government limits what can legally be charged for something, it is limiting the ability and right of citizens to use their own money to get the amount and quality of that thing they want or need.

If, concerned about the price of food in restaurants, the government prohibited charging more than $5 for a meal, consider what would happen. Restaurateurs couldn't afford to charge less for providing food than they had to pay for its ingredients--so the only food they'd offer would be things like hamburgers and tacos. Forget about being able to order lobster or steak!

The same--in a far more dangerous way--is true of health care. Limit what providers and insurers can charge for health care, and you get less of it, and poorer quality. Instead of allowing individual consumers and employers to balance cost against benefit in choosing among competing insurance plans--as they would when purchasing anything from a car to a photocopier--the government would rob us of the ability to get health care of higher value than it was willing to authorize. People literally would be unable to use their own money to save their own lives.

The whole country must not repeat Massachusetts' mistake. Now is the time to contact senators and representatives to urge them to vote "no" on the rationing proposals before the U.S. Congress--including the Senate passed health care bill that Speaker Pelosi intends to take to the floor of the House--before, as in Massachusetts, it is too late.