health care – Page 13

Questions of life and death

A story that ran today on ABC.com is one of those stories that proves the how American politics has become incapable of dealing with difficult issues.

According to ABC, Barbara Wagner had reached the end-point with her lung cancer, with her only hope being “a $4,000-a-month drug that her doctor prescribed for her.” Her insurance company, however, refused to pay for it and instead offered a substitute.

What the Oregon Health Plan did agree to cover, however, were drugs for a physician-assisted death. Those drugs would cost about $50.

A heartless response, to be sure, but one that is wholly consistent with a medical system designed to generate profit and not necessarily to provide care.

I have always been ambivalent about legalizing assisted suicide. On the one hand, I don’t believe that we should empower anyone to help another take a life and I don’t think suicide is a solution, that death comes when it comes. But I can understand the urge, when faced with severe, longterm pain. And I’m uncomfortable giving the state a role in such a decision.

But I think the state has to have a role. There is a compelling interest in protecting the patient from a doctor, family member or even an insurance company from pushing death as a cheaper alternative than treatment.

I am not prepared to take a position on Oregon’s assisted-suicide law, or the ballot question being debated in Washington state, but I have to question whether we can continue to allow these decisions to be made based on the market and corporate profits.

“Her case is hardly unique,” said Michigan lawyer Geoffrey Fieger, who defended Dr. Jack Kevorkian’s crusade to legalize physician-assisted deaths. “In the rest of the country insurance companies are making these decisions and are not paying for suicide,” Fieger told ABCNews.com. “Involuntary choices are foisted on people all the time by virtue of denials.”

“I am surprised there hasn’t been a revolt in this country,” he said. “It happens every day and people are helpless.”

It would be easy to paint the insurance companies as the villians in this mess. After all, they sent a horribly insensitive letter and have crafted rules that limit the use of expensive drugs. But they are only acting in the role we’ve assigned them. We have put them in the role of gate-keeper of care, allowing financial decisions to trump medical ones.

First, we have to take the system back and remove profit as its guiding principle. As long as the goal is to maximize profit, we will be looking for ways to cut costs for the sake of cutting costs. That could mean, as in this case, opting for the cheaper drug and death over the expensive one that adds only a few months to life.

Consider this:

But But a 1998 study from Georgetown University’s Center for Clinical Bioethics found a strong link between cost-cutting pressures on physicians and their willingness to prescribe lethal drugs to patients — were it legal to do so.

The study warns that there must be “a sobering degree of caution in legalizing [assisted death] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care.”

Cancer drugs can cost anywhere from $3,000 to $6,000 a month. The cost of lethal medication, on the other hand, is about $35 to $50.

Strict guidelines are needed, and they can only be arrived at via public debate that asks the question: How much is life worth? How much would you be willing to pay to extend your life by a month? By six months? By a year? At what point is it no longer worth it?

And who pays? Should the answers to these questions depend on a patient’s financial situation, as they do now? (The wealthy can by medical services not available to the poor, meaning that the same $4,000 life-extender that was out of reach for Ms. Wagner might be easily obtainable for someone else — and not necessarily Donald Trump.)

The questions are not easy ones, but they have to be asked — especially with the accelorating pace of technological change creating treatment opportunities everyday that were not available in the past.

Another health plan to consider

I’m not sure yet what to make of this idea for universal health coverage, though it probably deserves some debate, at least along the lines of the discussion surrounding the Clinton and Obama plans.

The plan — sponsored by U.S. Sen. Ron Wyden (D-Ore.) and U.S. Sen. Robert Bennett (R-Utah) — decouples insurance from employment, calls for wage hikes to offset the lost benefits.

Employees, in turn, would be required to purchase private health coverage with their higher wages. To ensure that it’s affordable, the plan would fully subsidize the premiums for those who live below the poverty line. Those people between 100 percent and 400 percent of the federal poverty line would also receive subsidies on a sliding scale to help pay their premiums.

I’m not ready to comment on the plan aside from saying that it seems similar to the plans offered by the Democratic presidential candidates and to also say that I remain committed to single-payer coverage.

Single-payer, however, isn’t coming anytime soon so we’d better take a serious look at the more incremental approaches being floated in the hopes that some reform is better than none and, maybe, just maybe, these small steps can be the beginning of big change down the road.

South Brunswick Post, The Cranbury Press
The Blog of South Brunswick

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The real impact of a broken health system

Another hospital closing? Central Jersey residents may not care — we have access to numerous successful hospitals in New Brunswick, Princeton, the Trenton area, etc. — but we should. The closing of hospitals because of financial problems is a symptom of the larger failures of our healthcare system. The cost of treating the uninsured is strangling hospitals like Muhlenberg and can only get worse, spreading to healthy hospitals in a dangerous death spiral.

Reform is needed. Single-payer, universal healthcare is needed. The system just isn’t working.

South Brunswick Post, The Cranbury Press
The Blog of South Brunswick

E-mail me by clicking here.

Healthy debate

An interesting piece on the somewhat minor distinctions between the Clinton and Obama healthcare plans in Salon. As I’ve written before, the mandates included in the Clinton plan make it more comprehensive, though as Paul Krugman points out, it is likely that Obama will have to add the mandates at a later date. This, and Clinton’s repeated response that much of her plan would have to be hashed out in Congress, make them almost indistinguishable.

In any case, both are leaps and bounds better than the plan that John McCain is pushing.

South Brunswick Post, The Cranbury Press
The Blog of South Brunswick

E-mail me by clicking here.