After weeks of bad news, things turned Barbara Wagner’s way this week.
Last month her lung cancer, in remission for about two years, was back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, Wagner was notified that the Oregon Health Plan wouldn’t cover it.
It would cover comfort and care, including, if she chose, doctor-assisted suicide.
Then on Monday a representative of the pharmaceutical company Genentech called Wagner and offered the medicine for free.
Wagner said she didn’t know whether to laugh or cry, so she did both.
Treatment of advanced cancer meant to prolong life, or change the course of this disease, is not covered by the Oregon Health Plan, said the unsigned letter Wagner received from LIPA, the Eugene company that administers the plan in Lane County.
The Oregon Health Plan started out rationing health care in 1994.
Conditions such as pregnancy, childbirth and preventive care for children lead the list. At the bottom are uncovered procedures such as cosmetic surgery.
“We can’t cover everything for everyone,” said Dr. Walter Shaffer, medical director of the state Division of Medical Assistance Programs, which administers the Oregon Health Plan.
“Taxpayer dollars are limited for publicly funded programs. We try to come up with polices that provide the most good for the most people. Most cancer treatments are high priority on the list,” Shaffer said.
Wagner said she was devastated when she found out the plan doesn’t cover Tarceva.
“I think it’s messed up,” Wagner said, bursting into tears.
“The letter said doctor-assisted suicide would be covered. To say to someone, `we’ll pay for you to die, but not pay for you to live,’ it’s cruel,” she said. “I get angry. Who do they think they are?”
Dr. John Sattenspiel, senior medical director for LIPA, said that at some level doctor-assisted suicide could be considered as a palliative or comfort care measure. “We had no intent to upset her, but we do need to point out the options available to her under the Oregon Health Plan,” he said.
More. As I’ve noted previously, there really is no such thing as universal healthcare. No government funded program, no matter how lavish, is going to pay for every treatment that could potentially save someone’s life. In fact, if recent experience in Massachusets is any indication, mandating universal health care won’t even ensure that everyone has health insurance, let alone that they receive needed care.
Whether cases like this would end up being repeated on a grand scale is, of course, speculative. But it’s not out of the question, either. Medicare already has long term unfunded liabilities of more than $65 trillion, and the more the government is forced to engage in health care rationing for seniors, the more attractive government funded assisted suicide will appear, at least to some. This, in my view, is not the only reason to be wary of an increased government role in paying for health care. But it’s not an insignificant one.
““The letter said doctor-assisted suicide would be covered.”
Although Morning’s Minion will probably be annoyed with you and accuse you of taking notes from a right wing think tank or something, thanks for posting this. It’s amazing how gullible certain people can be in thinking government can fix everything for our good. Here we see the cold, hard truth: government doesn’t love us but pretends to, so that it can control us. And once we become too much a burden…
The fear expressed here is not irrational. After all, it’s not as if the two issues are completely unconnected: given that liberals are the ones who argue for universal health care, any such system would doubtlessly be designed and run by some of the same liberals who also lobby for assisted suicide.
Most recently, look at who dissented in this case: http://www.nytimes.com/2006/01/17/politics/politicsspecial1/18scotuscnd.html
I really wish people would note why she was turned down. She was turned down because there was less than a 5% chance she would be living in 5 years with this treatment. Much of the rest of this is a reflection of other things. Since many on the right believe that all of health care’s problems are due to over consumption, one would think they would be applauding the government turning down such an unnecessary expenditure.* Would the same result not be expected if she lacked medical assistance? Heck she probably wouldn’t have received the first cancer treatment without MA. But that isn’t going to stop people from posing for holy picutres about how evil the government is for denying care in this instance.
* A line has to be drawn some where. One can certainly feel free to draw it elsewhere. I’m afraid many are in pollyannish land and think all we need to do is get rid of waste, fraud, and abuse, the solution to every spending problem.
My concern with an anecdote like this is that the ultimate injustice is not the gov’t health care system, but the Oregon assisted suicide law: in other words, this discontinuity is not functional in the other 49 states where assisted suicide is still illegal. How many HMOs in Oregon would have made the same choice?
MZ hits the nail on the head in this intellectually dishonest piece. No health insurance scheme will pay for everything under the sun, nor should it. In fact, the pseudo-conservatives frequently argue that health costs are high because we try to keep people alive at the end of their lives by all means possible– and this kind of treatment is terribly expensive.
But let’s get some perspective here. Yes, Medicare has major cost issues– but evidence shows that a single payer system, minimizing the role of profit-making insurance companies, can deliver more efficient health care with better outcomes; in other words, an improvement in ecvery way. See what happened when Taiwan switched from a US system to a single payer system.
Remember how many people in the US are rationed by cost, both the uninsured and the underinsured– 75 million people. And how many others have insurance but are routinely denied treatment from insurance companies whose shareholders demand a miniization of “medical losses”? This is a grave scandal. This is the true issue in US health care.
And I love the idea of the humanitarian drug company– the same people who fought tooth and nail to protect their profit margins in the face of attempts to allow the government behave like any large purchaser and negotiate prices.
Ah, yes–the Associated Press, spokepiece for the Vast Right Wing Conspiracy.
Perhaps more cogently, from single-payer Canada:
http://www.thestar.com/News/GTA/article/439665
I know–more pseudoconservative propaganda from the Toronto Star.
The only conspiracy I claim the press has a part is laziness and incompetence. Needless to say they excel at both. The story Mr. Price links is hardly exceptional, but makes a fine human interest story.
“evidence shows that a single payer system, minimizing the role of profit-making insurance companies, can deliver more efficient health care with better outcomes; in other words, an improvement in ecvery way. See what happened when Taiwan switched from a US system to a single payer system.”
You bring that up constantly and I am obliged to counter with the Singapore system which is private and more effective than Taiwan’s.
I wasn’t addressing you, MZ, who made no accusations of press bias.
But “a fine human interest story”? As the Psalmist said, she is being treated “like a dead man, like a thing thrown away.” What she is experiencing is nothing short of Hellish.
While I have no brief for the current health system in this country (my wife and I lost a dear friend who was uninsured to an undetected cancer at age 34), it’s folly to think that an even grimmer rationing won’t occur under a single-payer system. Throw in the march of euthanasia and utilitarian thinking, and you have a guarantee for many more Tejadas and Wagners.
Understood on the press bias.
I used the term human interest story, because it didn’t address the policy implications. Outside of appeals for amnesty or refugee status, I am not aware of a country that will give permanent resident status or citizenship to someone gravely ill. The other class is people senior in years without money that won’t get consideration. The Phillipines is fully capable of providing eol care, and she isn’t claiming otherwise.
I can understand concerns over rationing. I do think it is somewhat over blown. Our highway system is rationed, but most of us don’t give it a second thought. I know in Michigan they are having issues in this regard due to money shortfalls. Obviously this means that some areas will have repairs put off and other areas won’t see expansions. But roads aren’t going to disappear; careers in the state house would disappear before that. I don’t see why we would expect such a lower level of service on the health care side by turning funding over to the political process.
There are two issues here. The first relates to the denial of care. Mr. Forrest and Morning’s Minion both point out that no system is going to pay for everything. True enough. But proponents of a free market system of health care generally don’t claim that their system will do everything, whereas those who advocate a government system do often imply this. The term “universal health care,” is here second only in its deceptiveness to its second cousin “free health care.”
The second issue is euthanasia. My argument is not that governments will be more likely to pay for euthanasia than will private issuers (they might; they might not). Rather, it is that the looming fiscal shortfalls in government funding for health care will make the legalization of euthanasia more likely, though I think that, like the eugenic argument for abortion, it will be an argument rarely made explicit.
I would add, as an aside, that I’ve heard plenty of liberals argue over-consumption is a real problem with health care too, though they generally do so sotto voce, so as to remain free to demagogue conservatives on the point when necessary.
But proponents of a free market system of health care generally don’t claim that their system will do everything, whereas those who advocate a government system do often imply this.
The phrasology here I would modify. Free market proponents don’t merely claim their system won’t do everything, they claim universality is an inferior good to ability to pay. Government system advocates believe funding should be subject to the political process to insure goods like universality. What I find offensive about all this is the people willing to condemn Oregon for denying care here while they would advocate no government provision for her treatment in the first instance of cancer. For me looking in, the belief this $50,000 low probility of success treatment should have been covered appears to be a feigned belief. Ironically, if Oregon changes its policy, a perfect example is provided of the political process addressing the issue, something critics seem to believe is impossible under gov’t health care.
I’m familiar with some advocates who claim overconsumption. My general reading is that is more a criticism of the type of consumption. My uhc advocates believe for example that more care should be done at the GP level.
There are more than sucker choices for health care. Take a look at *Fair Care* as described in America’s Health Care Crisis Solved: Money-Saving Solutions, Coverage for Everyone by J. Patrick Rooney and Dan Perrin. The authors have long experience in medical insurance. For anyone tired of the familiar, partisan arguments, this book is worth reading.
I find it amusing (not really) that MM and MZ so carelessly say the woman deserved to be turned down for treatment because of the “chances” of her surviving.
Isn’t that the very reason certain people are turned down for private insurance? Doesn’t Obama want people to be covered no matter their pre-existing conditions? Where’s the money going to come from?
[...] out the full article here at Vox Nova. H/T to Jay Anderson at Pro [...]
TeutonicTim,
You have no clue what you are talking about. Before you “carelessly” impugn me, figure out what you are talking about.
M.Z. You’re the one that said:
“She was turned down because there was less than a 5% chance she would be living in 5 years with this treatment.”
As justification for you saying this:
“But that isn’t going to stop people from posing for holy picutres about how evil the government is for denying care in this instance.
* A line has to be drawn some where.”
So I’m not sure what I said that I don’t know about…
MM here: No health insurance scheme will pay for everything under the sun, nor should it.
MM on a previous post about a girl in California who was about to die anyway and who was denied an unproven experimental procedure that wouldn’t have saved her life:
http://vox-nova.com/2007/12/21/negligent-insurance-companies-claim-another-victim/#comments
And:
Moral: MM is very flexible and can argue for completely inconsistent positions. If an insurance company is the entity denying payment for a worthless experimental procedure that is likely worthless, MM will point the finger, cast blame, and insinuate that this sort of event wouldn’t happen in a universal system that lacked the “profit motive.” If it’s a state system is the entity denying payment, then he’ll scrap about for excuses.
SB if you cannot see the difference between minimizing “medical losses” to keep shareholders happy and having some retrictions on what can be can be covered by an insurance scheme, especially if it would provide little benefit to the patient……
I don’t see the difference at all. In both cases, there were restrictions on what can be covered by an insurance scheme, particularly treatments that would provide little benefit to the patient. That’s precisely what happened with the Cigna case — Cigna consulted with independent medical experts, who all said (to put it in blunt terms) that it would be a waste to give a healthy kidney to a leukemia victim who would die shortly anyway.
Cigna, by the way, wasn’t trying to “keep shareholders happy,” given that it didn’t have to pay for the procedure at all; instead, it was functioning merely as an administrator of a health plan that was paid for by someone else. Try to be more accurate.
MZ and MM both appear to be saying that a line must be drawn somewhere, while decrying insurance for drawing the line somewhere. From appearances here, you seem to contradict yourselves.
As far as insurance companies go vs. government health care, rationing does, indeed, happen with both. As the article above states, the pharmaceutical company stepped in and offered the drugs to her for free, and this is actually not unusual. My aunt died just under a month ago from a brain tumor, and her insurance covered precious little of her medical care. She was not turned away, and she certainly was not treated as inferior because of it, either. Whether or not my family had the ability to pay for everything, she was seen at MD Anderson by a top-quality specialist, and the pharmaceutical company offered them the drugs she was taking at a reduced price when insurance turned them down flat.
Again, as far as the “line-drawing” goes, and others have brought this up, as well, I don’t see how saying such things reflects our Catholic belief in the inherent dignity of this woman’s life. I’m sure that we all agree that the fact that the “free” healthcare Oregon offers included allowing her doctor to kill her while not even assisting in paying for the drugs she needed to fight the cancer is a true tragedy. But in addition to the rationing of healthcare, under a universal system such as the one proposed by the Democrats (both Obama and Clinton), there would be plenty of other difficulties. Ask anyone who has been in the military what it’s like to get help under the government-run medical system. It’s not pleasant, and you tend to get a real run-around for the most simple procedures. (A very recent account of a military family’s situation was posted at Catholic Matriarch in my Domestic Church; this link is for part two, but you can find part one within a click-through at the post.)
The difference between limiting care to keep the shareholders happy and limiting it to keep the taxpayers happy seems rather thin.
I hate being misrepresented, so get my position clear or really just get lost. I haven’t made gerrymands against insurance companies. I’m going to be like like the lawyers for a moment here and say I’m not going to bother to talk to people who don’t understand how the health care system works. It is a waste of my time, and I’m dumber for the experience. I certainly not going to put up with lectures from idiots who don’t know that this story has nothing whatsoever to do with pre-existing conditions or idiots who don’t understand what treatment is and its purpose.
MZ, I do hope you aren’t calling me an idiot for my comment when I clearly said it APPEARED that was what you were saying.
In any case, the general impression that most people seem to have about universal health care is that it will take care of all their needs, and that is clearly not the case. The worst part is that Oregon was willing to pay for his woman to be killed by her doctor, but not for treatment for her cancer. Whether or not the 5% chances are enough for any insurance or government plan to pay for it still doesn’t change the offense that they were happy to pay for her death instead of treatment, or that health care would definitely be rationed when paid for by the government. Catholic Mom (see my previous link) has some excellent points about healthcare in this country.
Personally, I’ve also dealt with my insurance company declining certain treatments and care, so I know just how it works, too. (For the record, the care was adjusted so that similar care could be provided with coverage, and it was for hyperemesis during my second pregnancy.)
“I’m going to be like like the lawyers for a moment here and say I’m not going to bother to talk to people who don’t understand how the health care system works.”
?