Sunday, December 28, 2014

"Death Panels" Have Arrived in Arizona

Remember the dire warnings about the future of health care under reform? Rationing, death panels, government coming between you and your doctor. Well, the future has arrived, yet it is still three years before Obamacare fully takes effect. Lifesaving care is being rationed not by the federal government under health reform but by the government of the red state of Arizona.

“Death Panels” Have Arrived in Arizona

By guest blogger Robert Field:

 Remember the dire warnings about the future of health care under reform? Rationing, death panels, government coming between you and your doctor. Well, the future has arrived, yet it is still three years before Obamacare fully takes effect. Lifesaving care is being rationed not by the federal government under health reform but by the government of the red state of Arizona.

Faced with a serious shortfall in the state budget, Arizona looked to its Medicaid program for savings. It saw the chance to save about $4.5 million a year by terminating coverage for transplants, including those of the heart, lung, pancreas, and bone marrow. The change was effective on October 1.

Transplants are already rationed because of the limited supply of organs. The procedure is allocated based on factors such as the patient’s health status and likelihood of adhering to follow-up care. Arizona’s plan, by contrast, rations transplants solely in order to save money.

Transplants are a treatment of last resort. The alternative for most patients is death. About 100 Medicaid patients are presently on Arizona’s transplant waiting lists, and they have no medical alternative (see NY Times). Some of them have been waiting for months, expecting help as soon as a suitable organ became available.

The cuts were signed into law by Governor Jan Brewer, a Republican, after a state review questioned the effectiveness of transplants for saving lives (see Slate). Most physicians would be quite surprised by this conclusion. Transplants have added decades to the lives of countless patients.

To be fair, the cost pressures on Arizona are real. Moreover, health care rationing based on financial considerations is not new to America. Access to many kinds of care is routinely denied to those who lack insurance to cover the cost. What is different in Arizona is that the government is explicitly pulling the rug out from under people who had previously been assured of coverage.

It is possible that Arizona will relent. In the face of widespread criticism, the legislature may consider repealing the cuts when it convenes in January (see NY Times). Hopefully, this would come in time for the Medicaid patients who are on transplant waiting lists.

So, we did not have to wait for the implementation of Obamacare to see government rationing of lifesaving health care. It arose not from a particular ideology but from the exploding costs of health care and the limited options available for controlling them. What we need now is not continued finger-pointing and scare stories but a serious debate over how to resolve the cost dilemma.

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About this blog

Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
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