Thursday, July 31, 2008

We won't pay for your medicines - but we'll pay for you to die!

I'm dumbfounded by the insensitivity of the Oregon Health Plan.

After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, [Ms. Barbara] Wagner was notified that the Oregon Health Plan wouldn’t cover the treatment, but that it would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide.

. . .

“Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit of the Oregon Health Plan,” said the unsigned letter Wagner received from LIPA, the Eugene company that administers the Oregon Health Plan in Lane County.

Officials of LIPA and the state Health Services Commission, which sets policy for the Oregon Health Plan, say they’ve not changed how they cover treatment of recurrent cancer, only clarified the rules.

But local oncologists say they’ve seen a change in policy, and that their Oregon Health Plan patients with advanced cancer no longer get coverage for chemotherapy if it is considered comfort care.

. . .

When the Oregon Health Plan was established in 1994, it was expressly intended to ration health care. A prioritization list was drawn up, with diagnoses and ailments deemed most important — pregnancy, childbirth, preventive care for children — placed at the top of the list. At the bottom are procedures such as cosmetic surgery, which would not be covered.

“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. “But there’s some desire on the part of the framers of this list to not cover treatments that are futile, or where the potential benefit to the patient is minimal in relation to the expense of providing the care.”

The mind boggles. To be told bluntly that "we won't pay for the drugs that might prolong your life, but we offer help with assisted suicide" (which is what the Oregon Health Plan's letter amounts to) is the most crassly insensitive, brutally bureaucratic arrogance I've ever heard of!

There is, at least in this case, some good news. The drug company manufacturing the medication prescribed for Ms. Wagner has offered her a year's free supply, to her relief. That's something to be grateful for, at least.

However, the reaction of influential opinion-makers leaves something to be desired. In an editorial on this case, The Oregonian called it a "medical ethics glitch", and concluded:

As the only state that both allows assisted suicide and tries to ration health care, Oregon has created a fine ethical line for state officials to navigate. In this case, they stepped over it. For the sake of ethical clarity in Oregon's Death With Dignity Act, the state health plan should stop offering to pay for those who use it.

Oh, really? How about not making life-or-death decisions in the first place? This is yet another example of the perils of socialized health care in operation. In England, doctors and hospitals can already decide whether or not to extend health care to the elderly or terminally ill - or discontinue treatment, leaving them to die. It's no longer a matter of the best interests of the patient: it's the best interests of the system that count.

Next time someone tries to sell you on the concept of Government-funded socialized health care, you might want to think about that.


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