Human Exceptionalism

The Harsh Values of Health Care Rationing

The Oregonian is trying to defend the Oregon Medicaid rationing scheme and its offer to pay for the assisted suicides of patients for whom it denied life-extending chemotherapy. The idea behind the Oregon scheme was to expand coverage to people who were not the poorest of the poor, but at the cost of restricting treatment to certain patients. Politics came into the system early as late stage AIDS patients–who would have been opted out in the early iteration of the plan–were opted in because of the political clout of their community. But some cancer patients don’t have such clout, so they are out of luck.

From the editorial:

The money Oregon can spend on health care is limited. Currently, 576,000 Oregonians have no health insurance coverage whatsoever. Many are people formerly on the Oregon Health Plan whom the state can no longer cover because of the ever-rising cost of medical care. Some of these Oregonians will develop cancer but, unlike those still on the state’s health plan, they will not have coverage for even a first round of chemotherapy, or for potentially curative surgery.

The reality is that if we pay for marginally effective, expensive, second-line treatments for one person, we would be denying access to well-established, first-line treatments for others

So socialized health care, leads to rationing, which leads to patient groups vying against each other for coverage.

And get this crass reaction of the Oregonian toward Medicaid telling patients “we won’t pay for you to live but we will to kill you:”

Weighing the cost of end-of-life treatment against the voter-approved Death with Dignity Act was never a part of those discussions. No treatment has ever been denied because death would be more “cost effective.” The very idea is both abhorrent and a blatant distortion of the facts.

The Oregon Health Plan is charged with prioritizing services that reflect the values of Oregonians, who have made it clear–twice–through their ballots that physician aid in dying is an option they want at the end of life. But the fact that it is covered by the health plan has no bearing on the decision in this or any other case.

It’s deeply regrettable that insensitive wording in a letter caused a patient distress

That’s it? It is “regrettable” that the patients were caused “distress?” What compassion!

Moreover, the editorial is factually wrong. The threat of the state or HMOs paying for killing but not for caring has been repeatedly raised by opponents of assisted suicide. Indeed, reflecting my Naderite roots, I began warning about this potential as soon as I entered the fray about the issue in 1993. We were called alarmists by the likes of the Oregonian, of course. But we were clearly right.

Which raises another point: The Oregonian–which once opposed PAS–has predictably fallen in line to march to the logic of the culture of death. Once its values are accepted by a society, every time an abuse comes to light it is shrugged off or justified–just like the Oregonian did about this travesty.

If this keeps up, in thirty years Oregon will be precisely where the Netherlands is today, if not sooner.