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Calls to Congress Needed Immediately Health Care Rationing Looms;
Ability to Spend Own Money to Save Life in Danger Nine years after the pro-life movement won the ability of senior citizens to avoid rationing of lifesaving medical treatment, food, and fluids under Medicare, this right is under renewed attack by leaders in the new Congress. At issue is the fundamental question of whether seniors will be prevented from using their own money, if they wish, to gain access to insurance that will not ration prescription drugs—or medical treatment. A partial assault, already passed by the House and likely soon to come to a vote on the Senate floor, would limit the ability of older Americans to use their own funds to obtain innovative lifesaving drugs. A complete assault—to repeal the right entirely, as it applies to medical services as well as prescription drugs—has been promised by a key congressional leader and will likely be up for a vote later this year. Why is NRLC involved? Since its inception, the National Right to Life Committee has been as concerned about protecting older people and those with disabilities from euthanasia as about protecting the unborn from abortion. In the words of NRLC Executive Director David N. O’Steen, Ph.D., “Government-imposed rationing is a form of involuntary euthanasia. It is outrageous when, by law, the federal government prevents people from using their own money to save their own lives.” It was for this reason that the pro-life movement played a key role in the early 1990s in defeating President Bill Clinton’s plan for national health insurance. The plan would have imposed “premium caps” to limit every American’s ability to pay for unrationed health care. The result would have been the denial of lifesaving treatment in circumstances in which, in the words of then-First-Lady (and current senator and presidential candidate) Hillary Clinton, it is “not appropriate—will not enhance or save the quality of life.” In 1997 the pro-life movement succeeded in creating an option in Medicare under which senior citizens can choose to add their own money, on top of the limited government payment, in order to select health insurance plans that are less likely to deny needed lifesaving treatment. These are called “private fee-for-service” plans. The economic reality is that in order to provide Medicare coverage for the baby boom generation as it retires without massive tax increases (which are highly improbable), government payments per beneficiary will not be able to keep up with medical inflation. If the funds available for health care for senior citizens from all sources are so limited, the only possible result will be rationing. Since senior citizens are required to participate in Medicare, this would amount to government-imposed involuntary euthanasia. Private fee-for-service Medicare plans created an escape valve. They represent an alternative to rationing that does not either break the budget or require new taxes. This alternative permits those eligible for Medicare to voluntarily supplement government payments for health insurance premiums with their own funds, if they wish, in order to obtain unrationed, unmanaged, private fee-for-service insurance. This is comparable to the way in which most retirees supplement government Social Security payments for living expenses with their own funds. In 2003, Congress added a prescription drug benefit. NRLC successfully fought to ensure that when provided by private fee-for-service plans, the new prescription drug benefit could be offered with unmanaged access to drugs, and would allow senior citizens to add their own money on top of the government contribution to get such unrationed drug insurance. About 1,040,000 older Americans are now enrolled in private fee-for-service Medicare plans, which is about 2% of all those receiving Medicare, and almost 14% of all those signed up for privately run “Medicare Advantage” plans (the others are managed care plans). However, on January 12, 2007, by a vote of 255 to 170, the U.S. House of Representatives passed H.R. 4, under which the federal government would fix an upper limit on what private Medicare plans could pay for each prescription drug. While everyone would prefer to pay less for everything, the reality is that government-imposed price controls result in the unavailability of goods or services that cost more than the government-imposed price. As noted in the sidebar (see page x), under government price-fixing in the Veterans Administration (VA) health program, veterans have been denied access to 81% of all the new drugs approved by the Food and Drug Administration since 2000. This has led 27% of those veterans eligible for Medicare, as well as VA benefits, to choose the existing Medicare prescription drug program. As noted in the sidebar, “A study from the National Bureau of Economic Research found that, on average, ‘persons consuming new drugs were significantly less likely to die by [the end of the study period] than were persons consuming older drugs’ for the same medical condition.” Government price-fixing would effectively deny older Americans the choice of paying their own money to select Medicare prescription drug plans that cover more costly, but more effective, innovative lifesaving drugs. President George Bush has pledged a veto. Senate Finance Committee Chairman Max Baucus (D-Mt.), who had previously voted against proposals to impose government drug price-fixing on private Medicare plans, has announced a change of position. A Senate Medicare drug price-fixing bill is expected to reach the Senate floor for a vote sometime after February 26, when the Senate returns following President’s Day. Even Worse Proposals Floated While adoption of government Medicare drug price-fixing would limit older Americans’ ability to get unrationed health care through premiums paid for private fee-for-service Medicare plans, other proposals would eliminate this option altogether. At an Urban Institute panel January 23, 2007, health policy wonks called for elimination of Medicare private-fee-for-service plans. The chairman of the House Ways and Means Health Subcommittee, Representative Pete Stark (D-Ca.), agreed. As health policy blogger Robert Laszewski of Health Policy and Strategy Associates pointed out, “[T]o the Democrats, this is not just about a fair funding level for private Medicare plans and whether they want to risk messing with them. It is about deep-seated ideological objections. ... “Democrats ... worry that the Republican ‘defined contribution’ private market strategy will stratify Medicare enrollees by what they can afford to pay. ... “To a great many Democrats, and in particular their leadership, this is about throwing a wrench into the Republican vision of what Medicare will look like in the coming years ... . They put Medicare fee-for-service right on top of their list.” In fact, money is added to the health care system when people are permitted to spend their own money for health insurance, and those who can afford it select the more expensive unrationed, unmanaged fee-for-service plans. Part of that extra money becomes available for private sector cost-shifting to help meet the needs of the poor. This provides the means for doctors and health care facilities to provide services for poorer people at government reimbursement rates, which are below actual costs. However, if it is illegal for older Americans to use their own money to supplement government payments when buying health insurance, little or no such cost-shifting will be possible. Poorer people will be far more likely to be denied lifesaving medical treatment than if supplementation were permitted. “Elections have consequences,” said O’Steen. “The pro-life grassroots worked tremendously in 1995–97 and again in 2003, often against obstacles from leaders in both parties, to win the right of older Americans to spend their own money to save themselves from rationing.” “Now, as a result of the 2006 congressional elections,” O’Steen continued, “all that is at risk. Only constant pressure, polite but relentless, from our state and local affiliates, and a stream of letters and phone calls from pro-life individuals, can avert the looming danger of government-imposed death for millions in generations yet-to-come through health care rationing.” See Action Alert on back cover. For fuller details, and regularly updated information on Medicare rationing, visit www.nrlc.org. |