MEDICARE RATIONING DECISION STILL IN DOUBT.

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 ...