PRO-LIFECHALLENGE Federal Legislation EUTHANASIA BATTLES IN 2003 AND 2004.

The year 2003 saw a massive victory on the euthanasia front against Medicare rationing and national attention to the averted - - for the present - - starvation of Terri Schindler-Schiavo. 2004 is likely to see battles at least two states over the legalization of assisting suicide in a continued fight for Terri Schiavo's life and the lives of others like her threatened with starvation and dehydration, and struggles over involuntary euthanasia.

MEDICARE

Since 1993-94, when the National Right to Life Committee played a key role in helping to defeat the Clinton Health Care Rationing Plan, the euthanasia battle has included working against government-imposed rationing of lifesaving medical treatment. Of particular importance has been the threat of rationing for older people under the government Medicare program.

Since Medicare's inception in the sixties, when retired people were first required to obtain their primary health insurance through the program, it has been financed by a combination of payroll and general taxes. Benefits for older people have been paid for by these taxes on the working population. The impending retirement of the large baby boom generation will mean such a shift in the demographic balance that it will be impossible to maintain per-person Medicare payments at current levels without massive tax increases, which are improbable. Consequently, NRLC has long realized that as a matter of practical reality, either older people will have to be permitted to use their own money to ensure unrationed care or the limitation of funds available from the government will impose increasing denials of treatments necessary to prevent death.

Until 1997, the Medicare law effectively prohibited senior citizens from spending enough of their own money for health insurance or health care to be able to be sure of avoiding rationing. A major effort by the pro-life movement that year established that they could do so if they selected private traditional indemnity "fee-for-service" insurance (under which a patient can choose any doctor or hospital, and tests and treatments are reimbursed whenever patient and doctor agree upon them) and paid the difference in the premium above the government's contribution using their own funds.

In 2003, amendments included in the Medicare prescription drug bill clarified that senior citizens may also voluntarily add their own money, on top of the government contribution, for "preferred provider organization (PPO)" plans and most forms of managed care plans as well as part of the private fee-for-service option. Under a PPO, one of the most common forms of contemporary health insurance, the insurance company negotiates rates with a selected group of providers. Beneficiaries of the plan can go to providers outside this group, but incur higher co-payments if they do so. The 2003 legislation also allows senior citizens who choose the private fee-for-service option and who wish to do so to add their own money on top of the government contribution to the new prescription drug benefit scheduled for 2006 in order to avoid drug rationing.

It will now be necessary to persuade health insurance companies that there is a market for more costly plans that are less likely to ration and to convince senior citizens to take advantage of such plans that are offered. However, there is now no government-imposed legal obstacle to obtaining unrationed health insurance for senior citizens - - a major breakthrough in the fight against rationing.