The Freedom to Spend Your Own Money on Medical Care: A Common Casualty of Universal Coverage

  • Downloads

Most people would agree that a patient shouldalways be able to spend his own money on thehealth care services he desires. Yet that freedom isoften threatened or denied when government triesto provide universal health insurance coverage, asin the U.S. Medicare program, which provideshealth insurance to seniors and people with disabilities.Over the past 20 years, the Medicarebureaucracy — and to a lesser extent Congressitself — has limited the freedom of Medicare beneficiariesto purchase medical services with theirown money. Those limitations violate beneficiaries’right to privacy, undermine a tool that couldreduce the burden Medicare imposes on taxpayers,and may deny care to Medicare beneficiariesoutright, or deny them access to the highest qualitycare available.

Ironically, as the U.S. government has restrictedthe ability of patients to spend their ownmoney on medical care, Canada’s socializedhealth care system is moving in the opposite direc​tion​.In a landmark case handed down in 2005,the Supreme Court of Canada ruled that theprovince of Quebec could not prohibit its citizensfrom purchasing covered services through privatehealth insurance. That ruling recognized thatimposing limits on a patient’s freedom to spendhis own money can result in his being denied crucialand even life‐​saving medical services.

This threat to patients’ rights would growunder many proposals to have the federal or stategovernments provide universal coverage. Congressand the state legislatures should avoid universalcoverage schemes that would undermine this fundamentalhuman right, or tempt future legislaturesand bureaucrats to do so. Instead, Congressshould restore to American seniors the unfetteredright to spend their own money on medical care.

Kent Masterson Brown

Kent Masterson Brown is an historian, author, and attorney specializing in health, administrative, and constitutional law. He was lead counsel in Stewart et al. v. Sullivan (1992) and United Seniors Association et al. v. Shalala (1999).