Communications Department

The “Justice” Argument

Jun 1, 2007 | Medical Ethics

Is it “Unfair” to Let Older Americans Add Their Own Money To Government Medicare Payments in Purchasing “private-fee-for-service” Plans?

Imagine a law that said after age 65 it is illegal to spend anything other than your Social Security payments–that no older American could use savings, pension plans or any other source of income to supplement Social Security. Wouldn’t that be branded unthinkable and unAmerican?

Yet some argue that those over 65 should be prohibited by law from using their own savings or income for health insurance, adding their own money to government payments to select “private-fee-for-service” plans of their choice. It is wrong, they maintain, for some older people to be able to use their own funds to get better health care than others. From this perspective, the “just” thing to do is to force everyone to be equally at risk of rationing regardless of economic status.

Abolition of Cost-Shifting

In fact, trying to subject everyone to equal rationing, regardless of income, will cause greater harm to the very group whose interests it is supposed to protect–those who are poor. 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, this adds money to the system. 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 continue to provide services for poorer people at government reimbursement rates below actual costs. 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 life-saving medical treatment than if supplementation were permitted.

A Deadly Gamble with Human Lives

Some maintain that making sure that Americans of all income levels are equally subjected to rationing will lead to a broadpublic outcry that in turn will in future years convince Congress to raise taxes substantially in order to increase the Medicare payment rates to levels that will avoid rationing. But this deadly political gamble has not worked in other countries, like Canada, where citizen concern about rationing has not translated into a general political will to raise taxes so as to increase health care payments. On the contrary, public expenditures on health care have fallen, when adjusted for medical inflation, as the pressures to limit government taxing and spending have grown rather than diminished.

The result has been involuntary death for rich, poor, and middle class alike. Paradoxically, however, in such systems the rich and well-connected oftenescape rationing more easily than the poor people who are supposed to be the beneficiaries. That is because any rationing scheme is inherently subjective, with enormous discretionary power in the hands of those who make the decisions about who is to live and who is to die. Sometimes this leads to bribery; more frequently, those doing the rationing consciously or unconsciously assign more weight to the lives of the prestigious or well-to-do.

Ironically, therefore, preventing those who can afford it from adding their own money to obtain unrationed care through unmanaged fee for service insurance, supposedly in the name of a concern for the poor, will in fact cause greater harm to the poor while yet leaving escape hatches for the rich.

It is certain to coerce numerous unnecessary deaths.

How can anyone argue that people should be prohibited by law
from spending their own money to get unrationed health insurance?

National Right to Life Committee
Department of Medical Ethics
Updated July, 2007

Categories: Medical Ethics