Death panels, and an actual death

We found some death panels. They didn’t come from health reform.

I previously noted a shattering NPR story by Ted Robbins detailing the impact of Arizona’s budget cuts on patients waiting for transplants:

Randy Shepherd is 36 and 6-foot-3, but he has to toss baseballs to his 3-year-old son, Nathan, while sitting in a lawn chair. Shepherd has cardiomyopathy; his heart muscle is deteriorating…..

You can hear the weakness in his voice, even though doctors implanted a pacemaker in 2008. They’ve told Shepherd that he needs a heart transplant to survive.
AHCCCS [Arizona Medicaid] was the only health insurance Shepherd could get because he had a pre-existing condition and, since he was forced to stop working in his plumbing business, little money. The agency authorized his transplant more than a year ago.

But as of Oct. 1, AHCCCS said it is unable to pay for Shepherd’s transplant. In fact, facing a $1.5 billion budget deficit, Arizona has cut out all state-funded lung transplants, some bone-marrow transplants and some heart transplants — including transplants for the condition Shepherd has.

Yesterday, KTAR reporter Bob McClay reports about another patient, Mark Price, whose transplant was apparently thwarted by the Arizona policy.

“AHCCCS patient dies awaiting bone marrow transplant”

PHOENIX — A Valley man who took center stage in the debate over state budget cuts that stopped funding for certain transplants has died.

Mark Price, 37, had battled leukemia for about a year. He died at a Valley hospital Sunday from complications of chemotherapy treatment.

Price hoped for a bone marrow transplant, but was notified in September that the Arizona Health Care Cost Containment System would not fund the $250,000 operation because it had stopped paying for certain transplants due to budget cuts. An anonymous donor came forward in October and offered to pay for the transplant. However, Price died before the procedure was done.

I have no idea whether Mr. Price’s bone marrow transplant was medically justified. It is possible that the low success rate and the accompanying traumas argue against this heroic procedure. I do know that Arizona’s decision to renege on its promise to pay for it as part of a policy initiative to cut public insurance budgets is appalling.

Except when I read

The family said Price was forced to allow his home to go into foreclosure as he struggled to deal with all the medical costs.

The term “appalling” seems inadequate.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

20 thoughts on “Death panels, and an actual death”

  1. I hate to say this but…

    Get used to it.

    This is the future of America.

    Do the math:

    Can't do + Won't do + Me first = American unexceptionalism.

    The poor will be left to fend amongst themselves…

    The dwindling middle class will invest in the lottery…

    And the rich will wall themselves apart.

    It is happening everywhere.

    Arizona isn't even on the cutting edge.

    The choice is simple in its starkness:

    The country can either tax itself and fix the leaks…

    Or keep the Bush cuts…

    Guess what is going to happen?

  2. I wonder if Jan Brewer really knows how to run a government for the people, by the people and of the people? I wonder if she is a believer in the Right to Life? I wonder if she thinks the only thing for a governor to worry about is headless torsos in the desert instead of the health of Arizona's citizens no matter the level of income they may be making? I wonder why Americans of all stripes put up with austerity measures when sensible tax policy once determined, and once implemented could provide more fully for the health and needs of all our nation's citizens.

    To initiate, talk, and advocate sensible tax policy, though, risks speaking truth to power – which seems to be a bit passe these days!

  3. I think the explanatory principle is that we Americans just hate ourselves. I mean, no Swiss would put up with this BS.

  4. No, Betsy, we don't hate ourselves. We hate 'them.' The 'them' who isn't as healthy as we happen to be at this moment, and who have medical needs that we don't have right now that they can't pay for. The 'them' who have better insurance than we do. The 'them' who have less than we do, so they might run out of resources a little while before we do in a crisis in their lives, and need help. The 'them'' who have a bit more than we do, and are therefore (presumably) less anxiety-ridden about their futures, as well as being able to buy 'more' stuff right now. The 'them' who have kids in school who need educating, and the 'them' who don't, so how can they possibly know what it's like to raise children today? The 'them' who can manage to have a stay-at-home parent, and the 'them' who are single parents struggling to put food on the table. The 'them' who have lost jobs and can't find work, so they deserve what they get because they're lazy, and the 'them' who had and have good jobs, and educations in fields that ensure they will continue to do so. The 'them' who lost their home to foreclosure, and the 'them' who can still buy houses, cars, and luxury items. We don't like any of 'them.'

    For whatever reasons, we no longer seem to consider ourselves as communities. Not in neighborhoods, towns, states, or the nation. We no longer feel we should pay taxes for schools if we have no kids in school, or for health care for everyone, or for maintaining our crumbling infrastructure, or for apparently anything else that benefits 'us' as a whole society, and for which we or someone we love will use, need, or suffer from the lack of. Nope, don't need it right now, tough for those who do, move along folks, nothing to see here.

  5. I think it is fascinating that a nihilistic and brutal attitude towards others seems to be strongest among those who prattle most loudly about "values." It is really well beyond the limits of mere hypocrisy at this point.

  6. I don't think that this is anything new, or all that uncommon. Coby Howard, a 7-year-old boy, died in 1987 because Oregon's Medicaid program didn't cover bone marrow transplants. His case became somewhat famous, and actually led Oregon to institute more explicit and systematic rationing in their Medicaid program.

    For more details see: http://content.healthaffairs.org/cgi/reprint/10/2

  7. Another immoral consequence of a society that treats health as a profit center, rather than a human right as most advanced nations do.

  8. I find odd (but not surprising) the correlation between two sets of people. The set for whom not only is abortion abhorrent, but particularly horrific is the idea that prospective parents might use testing to discover that a fetus has a propensity to, or even outright confirmation of, a serious developmental or health issue and then abort that fetus specifically because of this finding. The second set is those who opposed to the idea that health care is a right, and that bad luck in coming down with a medical condition is just an example that life is fair, and no one else should be expected to pay for the treatment.

    The intersection of these two sets, which seems to be fairly large, completely boggles my mind. I simply can't make it work as an idea.

  9. Yes, J. Michael Neal, it helps if you think about Puritanism. A lot of our political / social outlook as a nation seems to be explainable by a widely held attitude that "If Santa didn't bring you any toys, you must have been a bad boy." Also expressed as the predestinatory view that your moral status and sins are reflected in your worldly status. A fetus hasn't been born, so perhaps it doesn't have any sins. Whereas the person with the "bad luck" you cite is actually … just BAD.

    It's just another version of the "Just World" fallacy, but it has a strong hold on the American consciousness.

    I think it's partly a result of Puritanism and partly a result of an (officially) classless society — where there is no class indicator of status, monetary well-being, moral status, or simple good fortune becomes the indicator of where you stand.

  10. PS Not only does this attitude explain the protections that the evangelists are willing to give a fetus, but not a child once it's born — it also explains why Medicare is OK but not other social welfare programs. Namely, if you make it to 65 in a just world or predestinatory system, you must be deserving and have God's favor.

  11. Thank God it wasn't a blue state–Oregon, for example–or we'd see cheerleading for it.

    I'm left confused about the objection here. It isn't that the state is making health care decisions–that's not objectionable. And Harold, at least, considers the possibility that the unfunded transplants aren't medically justified (justified of course including some reference to the costs), but says that those concerns can't overcome Arizona's "promise" to pay. Why couldn't they? No reason is given. It seems the real objection isn't the promise, but the fact of budget cuts. If the money went to pay for someone else's health care, would it be ok then?

  12. Isn't this what we'd expect in a system with some level of cost-benefit analysis–that some treatments that might work, but are both unlikely to work and very expensive, aren't funded?

    (I thought the Oregon plan was sensible, so I've wanted this trade-off to be made, and made explicitly, for years.)

  13. You're right, the term "appalling" is inadequate. I think the word you're looking for is "murder".

    Now obviously, one can accept the rationing of food, or healthcare, or oxygen if the case arises, when there's no choice – when resources are physically limited, e.g. adrift on a lifeboat, and someone has to die so others may live.

    But to let someone die so others may keep their yachts – for that, I'm afraid that murder is the only appropriate term.

  14. "I’m left confused about the objection here."

    As my law school professor once said to a fellow student, your confusion is self-inflicted.

  15. Insurance Company A sells me an insurance policy covering $250,000 bone marrow transplant. I pay all my premiums. I need a bone marrow transplant. Insurance Company A says, sorry, but we've had to cut back on the coverage that your policy covers and that you paid for and we refuse to pay.

    Sure, nothing wrong with that at all . . .

    That Insurance Company A would also be paying million dollar bonuses to its top management and an incentive bonus to the claims adjuster who denied my claim would simply be icing on the cake. At least we don't have to worry about that with the AZ system, right?

  16. Thomas- You seem t think liberals are as sociopathic and prone to tribalism as the people you defend.

    On the whole, I'm afraid not.

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