Insight, analysis & opinion from Joe Paduda


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.

3 thoughts on “Health care rationing – reality in Arizona”

  1. Re: Arizona issue-aside from the Republican hypocrisy regarding “death panels”–it is easy to say we have to evaluate who gets what based on money, when you are not in the situation like that of the 32 year old father of 4 Gail Collins in the NY Times was referring to. Or me-An AML Leukemia survivor who received the best care (and expensive) at the Hospital of the University of Pennsylvania in 2006 and was then able to walk her daughter down the aisle in 2008. So don’t so quick to equate money with health care – are you willing to be the one who dies because of “data”? Or let your spouse or child die? The costs could be mitigated by, for example, gee, taxing the 1% of the wealthy for example,maybe? Oh, can’t do that for two more years at least. Or making state employees pay part of their health care costs like the rest of us. I am sure there are many ways to cut and save if our politicians really put their minds to it and stopped worrying more about being reelected.

  2. Martha, first off I am very glad to hear you are well today, received the treatment you deserved and were able to be there for your daughter. Your story is truly an example of what our medical system is capable of.
    I do take umbrage with your suggestion that a mitigation to the cost of our current medical system could be to tax the top 1% of the wealthy. I believe that that everything the government does must be based on some type of logical foundation.
    What moral or logical foundation do we have to tax someone at a higher rate just because they are able to earn more money? What is the logical connection anyone makes between earnings and taxes? Does the fact that someone has the abilily, uses it successfully (and legally) and earns higher wages mean they somehow enjoy more of the American dream than someone who earns less? Should they therefore be taxed by the government at a higher rate or level because of their greater enjoyment of the American Dream? If you cannot morally or logically connect wages to taxes, then taxes based on wages quickly becomes nothing more than tyranny of the majority (theft); a way for the majority to get the minority to pay for the things it (the majority) wants that they themselves cannot afford. Sooner or later, you always run out of other peoples’ money.

  3. Martha,
    I think you raise the most interesting point of it all and one Joe pointed out in the article. It’s not easy, and few things in life are especially when dealing with literal “Life and Death” issues.
    I’m a native Arizonan and still live here. In some regards we’re still the “Wild West” (and that can be positive or negative, I’ll stipulate to that) and at the same time we can be on the “progressive” (not necessarily a political appellation) side of things. No one here (Democrats or Republicans, Liberal or Conservatives) has a lock on wisdom.
    And that is Joe’s point; it is a discussion we NEED to have and it won’t be pretty, and there will be strong opinions voiced, but at the end of it we need to have it and work through it to get to a rational and yet humanitarian end, whatever that is. If we’re going to have this discussion, we ALL need to leave the sort of bitter vindictiveness that has unfortunately characterized this debate at the door.
    I would agree that the whole commotion over “death panels” was inappropriate, just as calling Arizona Republicans hypocrites is.
    My opinion and $5.00 buys a cup of coffee at Starbuck’s.
    Best regards,

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Joe Paduda is the principal of Health Strategy Associates




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