Dec
6

Health care rationing – reality in Arizona

Friday’s NYTimes reports Arizona has decided to stop funding certain organ transplants under the state’s Medicaid program. According to the article, “lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year” were ended in October.
While it’s tempting to make political hay out of this, the reality is Arizona’s decision, as painful as it may be, reflects decisions we as a society have to make.
The $4.5 million saved could be spent on preventive medicine, diabetes screening, cholesterol medication, pre-natal care, and other high-value services, services that would likely reduce the need for future acute care while improving the health of many more Arizonans. And the decision process used by the state, while not perfect, is one that we as a society must come to terms with.
The reality here is the government – ‘faceless bureaucrats’ to some, compassionate and caring stewards of taxpayers’ funds to others – determined who will live – perhaps if only for a few more months – and who will not.
Before instituting the change, Arizona studied the outcomes of transplants funded by the program. The results were pretty bad – according to the state, 13 of 14 patients under the state’s health system who received bone marrow transplants from nonrelatives over a two-year period died within six months.
Other disagreed with the state’s assessment; outside specialists said the success rates were considerably higher, particularly for leukemia patients in their first remission.
I’m not qualified to determine which side is ‘more right’, and anyway, that’s beside the point.
Which is starkly simple. We as a nation cannot afford to provide every health care service that may help every patient.
As db said on his blog;
“We can ration health care rationally or irrationally. We can ration health care based upon emotionally appeals or based on data. We must remember that a decision to pay for one treatment or diagnostic test may deprive someone else of a different treatment or diagnostic test. Or even worse, one treatment may cost so much that many other patients will go without a vaccines or preventive visits.
Rationing exists, it will continue to exist, and we have an obligation to ration in a fair way. We should not value some diseases over other disease. We should avoid emotional appeals, but rather look at data to make the difficult decisions that must be made.”
I find it intriguing that a state governed by the GOP is in the forefront of this issue (along with Oregon, which has been addressing Medicaid rationing for years). I sincerely hope – but highly doubt – this will result in an honest, open, and non-politicized discussion of what we can and cannot afford, and why, and how we’re going to allocate scarce resources.
Because that’s exactly what we must do.
Currently, Medicare is legally prohibited from setting payment based on the efficacy of a specific procedure/medication/treatment. This has to change. It is fiscally irresponsible to pay the same amount for treatments that have a one percent and a one hundred percent effective rate.
Unless and until we address this issue head on, our efforts to reduce the deficit are pointless.