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

As NRL News goes to press, the key senators and representatives meeting as a conference committee to produce a bill adding a prescription drug benefit to Medicare had not yet definitely decided whether older Americans will be permitted to use their own money to choose unmanaged, unrationed coverage.

If the bill reported from conference committee confirms the right of senior citizens to use their own money to save their own lives, both in regard to prescription drug coverage and for medical care in general, it will represent a substantial victory in the fight to prevent what amounts to involuntary euthanasia in the retirement years.

In a number of countries - - including one of our two closest neighbors, Canada - - the government effectively sets limits, based on its own budgets and tax revenues, on what can be spent to save lives through medical care. Citizens are literally prohibited from using their own money to save their own lives.

Until 1997, this was in large measure true of Medicare - - although many senior citizens would not think so, since one could always purchase "Medigap" insurance to cover categories of treatment (like most prescription drugs) not included in Medicare, and to reduce Medicare's co-payments and deductibles. Moreover, favorable demographics (the ratio of a large proportion of taxpaying workers to a smaller proportion of tax-spending older people) and other factors have meant that few have been aware of any real rationing pinch. Medicare has generally paid for necessary lifesaving treatment.

As most recognize, however, the demographics will soon change when the baby boom generation retires. At that point - - in the absence of massive new tax increases - - there will (after adjusting for medical inflation) gradually be less and less government Medicare money available per beneficiary.

Many have assumed that this economic reality means that rationing is inevitable, and we have no choice but either to plan for a way of implementing it fairly or let it occur haphazardly. In fact, however, on a societal level the continuing increases in productivity across much of the economy have freed up more and more resources for more and better health care, and there is every reason to believe that these trends will continue.

Take the fact, bemoaned by so many, that the percentage of personal consumption expenditures has soared decade after decade. What few realize is that at the same time, the percentage needed for food has declined equally dramatically - - largely as the result of continuing increases in agricultural productivity.

The share of personal consumption expenditures for food and health care has remained virtually constant at about 30% to 31% for 50 years. In other words, the increase in what we have spent for health care has been wholly offset by the decrease in what we have spent for food.

Without massive tax increases, government alone will not be able to afford to provide unrationed health insurance through Medicare. Yet, on the average, Americans can afford unrationed health care. How can those be put together? Simply by freeing Americans who choose to do so to add their own money on top of the decreasing (in medical-inflation-adjusted dollars) government payments for Medicare health insurance.

What of those who cannot afford to do so? Are they condemned to rationing? On the contrary. If middle-income older Americans are allowed to add their own money - - which many are likely to be motivated to do to escape rationing - - that will put more money into the medical system. That, in turn, will free doctors and hospitals to provide significantly more uncompensated and under-compensated care to those who truly cannot afford it - - as they used to do before the constant ratcheting down of government reimbursement rates to meet budget constraints made it harder and harder to afford to do.

In 1997, because of constant pressure by those in the grassroots who constantly met with legislators, mailed them, and called them, the pro-life movement secured a foothold on the ability to add one's own money to escape rationing. Now that foothold may be expanded - - or eliminated - - depending largely on what the conference committee reports out, and how senators and representatives then vote on that report.

Check frequently for updates on the Medicare situation. YOUR CONTACT WITH YOUR SENATORS AND REPRESENTATIVE MAY BE URGENTLY NEEDED - - watch for legislative alerts!