The philosophical struggle in Congress between conservatives and, let’s call them progressives, over how to loosen the entitlement noose around their collective necks invariably gets down to esoteric budget schemes. Among the more recent flags thrown by the progressives over Medicare rationing comes from a study this spring via The Commonwealth Fund, a NYC-based health care think tank, criticizing the two year waiting period imposed on Medicare-eligible patients with disabilities as a virtual death sentence for some. A coalition of thirty-some odd patient advocacy groups have taken the report "Too Sick to Work, Too Soon for Medicare" to Congress and calls on them to rescind the two year waiting period.

According to the report, nearly seven million people under age 65 qualify for Medicare because they have severe and permanent disabilities. About 1.5 million Americans are in the Medicare waiting period. Twelve percent of people in the Medicare waiting period die each year while waiting for their coverage to begin.

The response from the conservative think tanks predictably warns against opening the entitlement floodgates. Robert Moffitt, an analyst at the Heritage Foundation, said in a Dallas Morning News article that "Medicare is a financial wreck, with $33 trillion in unfunded liabilities", adding "This would be another nail in the coffin". Joseph Antos, a health care expert at the American Enterprise Institute, said, "Instead of opening the door to everyone, let’s do better at calculating financial need". He added, "Some people do have other sources of insurance, so we should be careful about expanding a program that’s already facing serious financial problems itself". (See Moos, Dallas Morning News, 4/26/07).

A more strident or at least less cautious conservative warning "while not speaking directly to this particular proposal" comes from a guest column by Pepperdine Economist Gary Galles. "Americans are sacrificing the future to the elderly-political complex," Gary Galles, wrote in a Baltimore Sun opinion piece: "For all their talk about future generations, seniors’ political groups are far more concerned about their short run than their heirs’ long run", Galles writes, adding, "That is reinforced by politicians’ bias toward immediate benefits and make-or-break issues for those who vote". As a result, "rather than reining in Medicare’s exploding liabilities, [seniors’ groups] constantly push to expand their benefits, increasing the burdens they will leave their children and grandchildren", according to Galles.

I suspect that many physicians, regardless of philosophical bent, take a different view from the exam room, where they are treating a disabled patient and can’t do anything for them other than pay the hidden tax of treating the patient gratis or for a below-cost discount. Let’s see what some of you have to say about this.