Abortion Foes Warn GOP Its Health Plans Are in Peril : Medicare: Party allies ‘sound alarm’ on managed care. They fear ‘involuntary euthanasia’ of elderly, disabled.

Conservative members of Congress who killed the Clinton health care plan, condemning it as dangerous “rationing,” may soon get a taste of their own medicine.

And the dose could come from a striking source: the nation’s leading anti-abortion group, which in recent years has become one of the Republican Party’s most reliable sources of support.

Warning that certain GOP proposals for reforming Medicare by prodding elderly patients into managed care could lead to “involuntary euthanasia” of the poor, the old and the mentally disabled, leaders of the National Right to Life Committee urged their members at the organization’s convention this weekend to “sound the Klaxon of alarm.”

Last year, the group used its formidable lobbying and grass-roots organizing to help GOP leaders defeat the Clinton Administration’s health care reform plan. But Executive Director David N. O’Steen is now urging activists to unleash the same tactics on Republican legislators who have embraced managed health care as a key way to reduce projected spending on Medicare and Medicaid by an estimated $288 billion between now and the year 2002.

That call could presage a massive, and until now largely unheralded, collision between the central goal of the Republican majority in Congress--balancing the federal budget--and the core beliefs of anti-abortion activists. Reducing the rapid growth of Medicare and Medicaid spending is a crucial element of all plans to balance the budget, and nearly all proposals to reduce those costs rely to one extent or another on some form of managed care.

Advocates of managed care, whether in the Administration or in Congress, routinely deny that their proposals would lead to health care rationing or limit life-saving treatment.

But Right to Life Committee leaders disagree. By encouraging doctors to toe a budgetary line on treatment, managed-care programs create an inherent conflict of interest, said Dr. Carolyn Gerster, the committee’s vice president for international affairs.

Every day, Gerster argues, physicians are being asked to make decisions about who should live and who should die. Now, with such a high percentage of national health care expenditures going to people age 65 and older, “there is a tremendous effort by the government to cut costs at this time of life,” she said.

Many of the nation’s elderly are at risk of being labeled economically non-viable as society turns to various forms of “rationing,” she and her colleagues contend.

An editorial in the June 15 issue of the National Right to Life News puts their position this way: “With little opposition, save from the ranks of pro-lifers, there is strong sentiment that those who fail to establish their ‘value’ to us--like unborn babies, children born with severe disabilities and the medically vulnerable elderly--should be given their rightful comeuppance: death.”

The potential conflict between these activists and the Republican leadership may come as a surprise to outsiders, accustomed to labeling abortion opponents as reliably “conservative” political players. But the two groups have already clashed over welfare reform, with anti-abortion activists arguing that proposed limits on payments to mothers could lead poor women to have abortions rather than additional children. Activists interviewed here say that on health care too, the bottom line for them is not about a budget.

Many Right to Life Committee members, Gerster said, “are social conservatives but not fiscal conservatives. We think anyone who needs health care should be able to get it.”

Committee leaders admit that because of the intricacy of health care issues, this new front is a dangerous one for their organization. Rank-and-file members who are passionate about abortion may not easily grasp the effort to fight on the other end of what the group’s leaders call the “life spectrum.”

There are also strategic perils: “We run the risk,” Gerster said, “of making enemies of some friends--some conservative senators and congressmen we worked hard to help elect.”

But the committee’s communications director, Michele Arocha Allen, said: “If you can spend your life working for someone that so many people have difficulty even perceiving--an unborn child--it’s easy to work to save someone you’ve already formed a relationship with.

“Everyone has an 80-year-old mother or a disabled brother.”

In any case, O’Steen said, the group is standing on principle. The committee’s goals cannot be defined as liberal or conservative but only as “life or death,” he said.

The battle, as committee members see it, is on behalf of the helpless, people who would otherwise be crushed as mere obstacles by a society stampeding along in reckless self-indulgence. Their language echoes both social conservatives’ rhetoric about the nation’s moral decline and liberals’ traditional defense of “the marginalized.”

Jane Grimm, a committee member from Ohio, said: “It’s time to show people we’re willing to stand by our principles, regardless of which party is in office.”

Peggy Lehner, the political action director for Ohio, agreed. “It’s going to demonstrate quite clearly we’re not owned by any party . . . but it’s a complicated issue that’s going to be the hardest part, getting the American people to understand it.”

Seeking to rally a ballroom full of activists to the new campaign, O’Steen put the question like this: Why is it that “the wealthiest, most comfortable people who have ever lived on the Earth” cannot afford to treat their sick?

Outside the ranks of the anti-abortion movement, the link between managed care and euthanasia may seem unlikely. But interviews with the group’s leaders shed light both on the reasons for their view and the intensity with which they hold it.

Gerster, for example, says she was drawn into the anti-abortion movement by concern about euthanasia. An Arizona cardiologist who co-founded that state’s Right to Life Committee in 1971, Gerster says she has studied the literature on Nazi doctors and remains stunned by those physicians’ calm persuasiveness in arguing that their murder of society’s “undesirables” was motivated by mercy.

She points to that moment in history when asked if the movement’s notion of the “slippery slope”--a presumption that societal acceptance of abortion will lead to involuntary euthanasia--doesn’t suggest a degree of paranoia, or at least a decidedly base view of human nature.

Audra Arseneau, a 27-year-old member from Grand Rapids, Mich., said: “Once people start judging whose quality of life is acceptable, we’re really in trouble.”

Burke Balch, an attorney who heads the group’s medical ethics department, says his commitment to the committee stems from an early devotion to civil rights.

As a child in Poughkeepsie, N.Y., Balch says, he took to heart the late Sen. Hubert H. Humphrey’s principle that a civilization is judged by the way it treats those citizens “on the margins” of society.

Sitting in the lobby of Nashville’s Sheraton Music City Hotel, with swarms of well-dressed, mainly white, uniformly well-mannered Right to Life Committee activists streaming by, Balch noted that medical ethicists tend to define a fundamental distinction between a “quality-of-life ethic” and a “sanctity-of-life ethic.” In his view, which he calls “an equality-of-life ethic,” every person “should be regarded as having equal value, and their life should be given equal protection”--regardless of their intelligence, mobility, race, age, gender, suffering, or any other supposed qualitative measure, he said.

That ethic has motivated his career and is driving his battle against managed care, he added.

To illustrate what he sees as the dangerous forces at loose in medicine today, Balch points to a complex Massachusetts case from earlier this spring, in which a state court jury decided that doctors at a Boston hospital had been within their legal rights in refusing to resuscitate the comatose Catherine F. Gilgunn, 71, even though she and her daughter had requested that every medical effort be made to keep her alive.

Balch and other Right to Life Committee leaders see a trend in that controversial decision. Society, they believe, is increasingly giving health care providers and doctors the power to make decisions that should belong to the individual or the family.

Balch contends that two of the three broad approaches to Medicare and Medicaid reform proposed by the Republicans would push patients into the sort of managed-care programs that his group equates with that sort of life-threatening “rationing.”

The only alternative his committee can live with, he says, is a third plan that recommends a voucher-style “defined contribution” system, which gives patients more freedom to choose their treatments.

That plan is far from perfect, Balch says, but it represents the least of three evils, given the nation’s budget-cutting mood.

Face-to-face, Balch is precise and animated, his hands slicing the air with a high school debate champ’s fervor. On stage, a lectern becomes a pulpit. Aphorisms fly.

“What is managed care? A lot more management than care!” he thunders, his thin frame shuddering. “Whenever you put a price on human life, the price goes down!”