Communications Department

The Pro-Life Position on Medicare

Jan 17, 2007 | Medical Ethics


Since its inception, the National Right to Life Committee has been committed to protecting the right to life from conception until natural death, which means that we have fought just as strongly against infanticide and euthanasia as against abortion. In particular, we have strongly opposed involuntary denial of life-saving medical treatment through rationing. It was for this reason that we strongly opposed both premium cap price controls of the Clinton-Gore Health Care Plan of 1993-94 and the Clinton-Gore position on Medicare in 1995-97.

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 politically unrealistic), 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.

In 1997, however, at the urging of NRLC and other groups, Congress created an escape valve–one alternative to rationing that does not either break the budget or require new taxes.

That alternative permits those eligible for Medicare voluntarily to 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, as one alternative. This is comparable to the way in which most retirees supplement government Social Security payments for living expenses with their own funds. Another alternative is Medical Savings Accounts (see next page).

Will older Americans, as a whole, be able to afford to add enough money to obtain unrationed care? See “Can We Afford More Health Care” from Sherry Glied, Chronic Condition. If those who can afford to, do so, will this help or hurt those who cannot afford it? See “The Justice Argument.”

At a minimum, the National Right to Life Committee (NRLC) believes it imperative to maintain the legal possibility of adding one’s own money to obtain private fee-for-service insurance in any Medicare reform that may be enacted by Congress.

NRLC takes no position on the appropriate level of government funding for health care, including Medicare, so long as Americans are left free, if they wish, to make up government shortfalls with their own funds and to have the legally available choice of unrationed, un-managed health insurance.


Managed care’s strong suit with patients is its furnishing of routine care. For the relatively inexpensive provision of childhood immunizations, flu shots, and the like, managed care is generally adequate. It is when you have a significant illness or injury for which lifesaving treatment is expensive that you are most likely to encounter rationing as a result of utilization review, capitation, and the other strong cost controls that are endemic to managed care.

But it is precisely for coverage of expensive treatments that catastrophic health plans exist. The high deductible plans do not include the costs of providing routine care nor the very significant administrative costs of processing large numbers of small claims. That means they are likely to be able to make catastrophic coverage provided in anunmanaged fee for service plan available at an affordable cost.

So someone who is concerned about the prospect of a devastating illness or injury might do well to pick an MSA with a high deductible unmanaged fee for service plan instead of a managed care plan.

It is true that a more standard unmanaged fee for service plan with a lower deductible might be an attractive alternative. However, its premium would undoubtedly have to be higher. While that would not be the case for the government fee for service program, there is a significant danger that in the long term it may be difficult to find enough doctors who can afford to continue to see patients in the government fee for service program as the government reimbursement rates continue to fall farther and farther behind the actual costs of providing treatment.

Thus, in the long term, MSAs and catastrophic insurance may be one of the most viable ways to escape rationing for many older Americans.

Categories: Medical Ethics