The United States is rationing health care while writing blank checks for environmental health hazards.

The mechanism may be to forbid individuals to write a check for ``excessive'' medical care while forcing them to write a blank check for ``abatement'' of a real or hypothetical environmental problem.

Future medical rationing may be explicit as in practice guidelines that exclude treatment for certain conditions (metastatic cancer, for instance), certain persons (those past a certain age or those afflicted with a genetic disease─Tay Sachs, if not sickle-cell trait), or certain circumstances (say expenditures exceeding a ``global'' budget).

Current rationing is by means of ``utilization review'' and price controls. Due to price controls in public programs such as Medicare and Medicaid, physicians and hospitals may not even be able to recover their overhead costs when treating patients ``covered'' by this type of ``insurance.'' Patients can still usually receive treatment because of cost shifting to private patients or to physicians' charity. This safety valve is progressively being sealed off.

Calls for medical rationing are often based on complaints that we spend $800 billion on medical care (or x% of the Gross Domestic Product), while some persons still do not receive basic preventive care.

Actual expenditures are much higher than that. If we add to the medical budget the cost of preventive care such as exercise and nutrition, as well as the cost of complying with environmental, occupational, and product safety regulations, medical expenditures soar to $975 billion. Compliance costs are about $140 billion (Regulation, summer, 1992).

The problem mushrooms further if we add the indirect costs of government regulation. The total regulatory burden may come to some $8,000 per American household (Competitive Enterprise Institute UpDate, March, 1993). Some find the cost still higher, between $10,922 and $20,376 per household, possibly exceeding the total cost of taxation (and certainly exceeding the cost of medical insurance!)

There are many uncertainties in calculating the costs of regulation. But the Environmental Protection Agency consistently underestimates them. For example, the city of Columbus was told that its November, 1990, storm-water permit rule would cost the city $76,680. The lowest bid received from contractors to implement the requirements was 23 times higher ($1.8 million). This, along with many other examples, is included in Dixy Lee Ray's new book Environmental Overkill: Whatever Happened to Common Sense?

Advocates of medical rationing demand extensive research to determine ``what works.'' New measures such as ``quality-adjusted years of life'' are created to quantitate the benefits of medical intervention. Such calculations assume that an individual human life has a finite, calculable value. But the EPA and other government agencies are under no similar obligation to calculate the cost:benefit ratio of their regulations, not even the net cost in human lives. The implicit assumption is that the environmental value to be gained is of infinite worth.

To restore common sense and require a scientific assessment of risks to be affected by EPA regulations, Senator J. Bennett Johnston (D-LA) added an amendment to the bill that would elevate the EPA to cabinet status. The Johnston Amendment would also require an estimate of the cost to the government of implementing the regulation and the cost to the public of compliance.

Testimony on this Amendment revealed that the EPA almost spent $3.2 billion to enforce a limit on Carbon-14 emissions. But the Director of the Department of Energy Office of Civilian Radioactive Waste testified that the threat to human beings was equal to the difference in the amount of radiation received from the sun when one is seated as opposed to standing up (From the Trenches by Putting People First, 5/27/93).

The Amendment passed the Senate 95-3. Substantive discussions are underway in the House of Representatives though the Amendment has not yet been introduced. It is strongly opposed by some self-styled environmentalists.

A complete cost:benefit assessment would also include the cost in years of human life lost because of diversion of funds to less cost-effective purposes. Hypothetical risks also encompass effects on disaster preparedness. For example, regulations against underground fuel tanks prevent the stockpiling of diesel fuel (which deteriorates rapidly due to heat when stored above ground).

To learn more about a rational approach to the environment, here's what you can do:

Rush Limbaugh

A few environmental facts from the book:

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