Posted on 08/09/2009 11:12:40 AM PDT by GiovannaNicoletta
The powerful story of Barbara Wagner demonstrates why this discussion is of utmost importance. When Barbara’s lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon’s state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
In stunned disbelief you may ask, "How can this be? This happens in Europe. I’ve heard stories of Britain’s National Health Service delaying intervention until the patient dies or reports of physician-assisted suicide in the Netherlands. But in America?"
The answer is simple. Oregon state officials controlled the process of healthcare decision-making—not Barbara and her physician. Chemotherapy would cost the state $4,000 every month she remained alive; the drugs for physician-assisted suicide held a one-time expense of less than $100. Barbara’s treatment plan boiled down to accounting. To cover chemotherapy state policy demanded a five percent patient survival rate at five years. As a new drug, Tarceva did not meet this dispassionate criterion. To Oregon, Barbara was no longer a patient; she had become a "negative economic unit."
In 1994 Barbara’s state established the Oregon Health Plan to give its working poor access to basic healthcare while limiting costs by "prioritizing care." In 1997 Oregon legalized physician-assisted suicide to offer "death with dignity" to patients who chose to die without further medical treatment. In the end, the State secured the power to ration healthcare in order to control its financial risk, even if that meant replacing a patient’s chance to live with the choice of how to die.
When queried about withholding Barbara’s treatment, Dr. Walter Shaffer, a spokesman for Oregon’s Division of Medical Assistance Programs, explained the policy this way, "We can't cover everything for everyone. Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people."
Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, echoed Shaffer, "If we invest thousands and thousands of dollars in one person's days to weeks, we are taking away those dollars from someone [else]."
Twice Barbara appealed the ruling. Twice Oregon denied her treatment.
Government compassion sounds so noble when first introduced. In fact, this well-intentioned motive fueled the creation of the State-sponsored health plan that now denied Barbara’s treatment. As "we the people" become more and more reliant on the government, inch by precious inch, liberty slips away. Citizens become powerless in dependency. Seduced by sweet words of compassion, the welfare of the State silently usurps the wellbeing of the individual citizen. Secure in the belief that government will care for them, many Americans slumber in complacency until one day, "we the people" awake to find liberty lost.
This is merely an extrapolation of how legal abortion has led to a callousness toward life. That’s my opinion anyway. The unborn and the very old are expendable.
The Nazis were defeated, but their ideas live on.
I was surprised that you home page didn't include the Libertarian description. Conservative Taxpayers are willing to pay for a lot of things, that you would find burdensome.
Only to Eugenics Proponents.
Eugenics manifesto
Eugenics manifesto was the name given by popular press to an article supporting eugenics.This manifesto was published on American magazine Nature (journal) in 1939[1][2]. This manifesto gave on September, 1939, support to eugenics; at least the kind of eugenics not linked to nazism. The original name of this manifesto was "Social Biology and Population Improvement"[3][2]. Eugenics remains with followers[4].
Their Ideas were prevalent before Hitler, right her in the good old USA, they are just now climbing out from under the rocks, we need to put them back.
Fogot to ping you, Lancey, since I first heard about this story from you.
Thanks!
I would not describe myself as "Libertarian", except perhaps as regards some personal behaviors many here might like to regulate - there are good reasons why "Libertopia" has never been seriously attempted, even on a planet that has seen recent large scale experiments with other 'topias such as Communism, Maosim and Islamic Theocracy.
For that matter, I'm probably more willing than many here to pay taxes to provide medical care for others.
However, the fact is that no one I know is willing to pay for unlimited access to Medical Services for others (everyone here who wants to pay for unlimited cosmetic surgery for anyone who wants it raise their hand) - the question is clearly where to draw the line.
And it's also clear that - in much if not most of the US - voters are not inclined to elect representatives who are going to vote to increase funding for very expensive end of life care, and that means that rationing of life itself is a fact of life (and death).
And it seems to me that a lot of people aren't willing to level with themselves about this: they are outraged that every possible medical intervention is not available at public expense to individuals at the end of life, but they are equally outraged at the prospect of having to pay the taxes to provide it.
For example the unpleasant truth is that for many metastasized cancers there are no good therapies; we hear that drug X extends life by 41%, what we are unlikely to be told is that means that on the average patients are living another nine weeks. We're also not told - usually - that for many of these drugs there are extremely unpleasant side effects, some of which can themselves be life shortening.
What's this got to do with rationing?
Funds available for both basic and applied medical research are limited, and the money dumped into the health-care system to pay for this kind of marginal improvement in end-of-life survival is money that's not available to fund the work that creates more meaningful advances... this really can be a case where the good is the enemy of the best - and that in fact dumping a lot of money into these treatment modalities is in effect "rationing" the availability of much better care in the future.
See from this perspective the cost of providing this kind of treatment is not only the immediate expenditure of dollars that might be spent on something else today, it's also in part the cost of deferring further into the future fundamentally better alternatives - in this respect it's a form of "rationing" that is rarely discussed, and one that can't be avoided in the present no matter how great your personal resources.
When Barbara's lung cancer reappeared during the spring of 2008 her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy. However, Oregon's state run health plan denied the potentially life altering drug because they did not feel it was "cost-effective." Instead, the State plan offered to pay for either hospice care or physician-assisted suicide... Oregon state officials controlled the process of healthcare decision-making -- not Barbara and her physician. Chemotherapy would cost the state $4,000 every month she remained alive; the drugs for physician-assisted suicide held a one-time expense of less than $100.But don't worry -- you still have physician choice. Quitcher bitchin.
Thank you for your best wishes and yes, she has been taking neurontin for quite some time. But having been a junkie, they never are happy without getting stoned.
There couple of assumptions there may not be correct.
The first is that we are obtaining additional useful information we would not have otherwise possess as a result of additional clinical experience with many of these therapies.
The second is that there no significant clinical downsides to the use of such therapies, or at least on the whole outcomes are superior to not using them.
The third is that market forces are reasonably effective way of allocating resources with regard to the development of treatments of such diseases, especially at end-of-life.
Every one of these assumptions is highly suspect in at least some situation. (If you would like, I’d be happy to suggest some resources for better understanding each of them).
Good red herring throwing cosmetic surgery in the mix. Ask the New York Fire Department, how far people are willing to go to save the lives of others. You sir have no clue.
Let’s start at the most basic philosophic question about rationing: do we believe that some people should have better access to health care than others, based on the personal resources available to them?
1) My sense is that majority of posters here believe that they should have the right to purchase all the health care they can afford.
The logical consequence of that is a system in which some people will receive more and better health care than others - that is, a system which rations healthcare on the basis of personal resources (which by the way include intelligence, access to information, family support system and a lot of other factors in addition to financial circumstances).
In such a system a primary role of government is to ensure that the insurance companies at a minimum play by their own rules: that when you buy insurance it is possible for a typical purchaser to understand what they are buying and that the insurance company provides the services for which the purchaser is paying. (As a practical matter pure market forces can’t provide this function because the disparity of power between the insurer and insured is too great. If the insurance company cancels a policy for an invalid reason they may have have a lawsuit, but you may have a funeral).
2) But it is also my sense that many posters here are extremely disturbed - as for example in this case - by the fact of such rationing when it actually happens.
If you wish to prevent such rationing from occurring (or control how rationing is performed) there has to be public provision of health care to people who lack the resources to buy it (this could be anything from a single-payer system to a system of subsidized individual purchase of private insurance).
In this situation a primary role of government is to reflect the choices of voters in constructing rules to control how rationing is performed, irrespective of whether those rules are administered by the government or by private insurers.
Now, there is no reason why you can’t combine the two objectives and attempt to balance these concerns - in fact our current system does this, however it does it in a way that makes it difficult to really understand both the rules and the costs.
For example one possible solution to the rationing of end-of-life care would be to require the purchase of private insurance covering curative medical care up to some reasonable point (say, a life expectancy of six months) and palliative care beyond that point, and allow individuals to purchase additional private insurance to provide for treatments likely to provide short additional extensions of life at high cost.
(If you don’t want to require people to buy insurance, that’s fine - just understand that unless you want to deny care, taxpayers are going to pick up the tab, either directly in the form of increased taxes, or the form of increased health care premiums due to “cost shifting”).
There many such possible solutions, my point is that whatever solution we adopt should make such “rationing decisions” explicit and transparent in contrast to the current system, where there are as many different sets of rationing rules as there are insurers and it’s very, very difficult to determine what the rules are, or determine in advance exactly how they will be applied.
But this requires that voters and their representatives squarely face the reality of rationing, which is something that appears majority of voters are trying very hard not to do.
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