The move by the U.S. government to restrict the ability of Medicare patients to spend their own money on medical care is denying these patients an elemental right: the right to save their own lives. That is the conclusion of Kent Masterson Brown in the Cato Institute policy analysis "The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage."
"Over the last 20 years, the Medicare bureaucracy – and to a lesser extent, Congress itself – has limited the freedom of Medicare beneficiaries to purchase medical services with their own money," writes Brown. "Those limitations violate beneficiaries' right to privacy, undermine a tool that could reduce the burden Medicare imposes on taxpayers, and may deny care to Medicare beneficiaries outright, or deny them access to the highest quality care available."
As the Canadian health system – vaunted by proponents of socialized medicine as a smashing success – moves away from self-pay restrictions for medical care, the United States, in its effort to provide universal coverage, is moving in the opposite direction, toward a system of treatment by tribunal.
The danger of universal coverage, Brown argues, is when the government fails to meet the needs of patients, then prohibits them from purchasing medical care on their own, locking patients in a situation much like the cell of little ease, a torture device in which the prisoner can neither stand, nor sit, nor lie down. This is not merely something that is occurring under foreign systems of socialized medicine. Instead, it exists today, in the United States, under the federal Medicare system.
Critics of self-pay argue that allowing patients to opt out of Medicare on a service-by-service basis would create a two-tiered health care system in which only the wealthiest seniors would have access to free choice. But stripped of soundbites and reduced to its essence, the main argument against denying the practice of private payment is this: a self-governing people should not have to await the approval of a tribunal before making private decisions about their own health care. Says Brown: "No issue more clearly illustrates the threat that national health insurance schemes pose to individual rights than the federal government's attempts to prohibit Americans in the federal Medicare program from spending their own money on medical care."
Brown concludes by offering suggested remedies for reform. "Congress should restore the freedom of Medicare beneficiaries to spend their own money on medical care as they see fit and prevent the federal bureaucracy from interfering in purely private and voluntary transactions between patients and their doctors. Congress should do so immediately, before Medicare's looming financial troubles combine with this unwise policy and begin denying care to large numbers of seniors."