• I’m forced to go there

    Let’s start here, since Louis CK explains this better than I can:

    I accept that this is the way the world is.  I accept that we make decisions every day that affect others.  I accept that the freedoms we enjoy come with the reality that others go without because of them.  I’m not asking for that to change.

    However, it’s important that we acknowledge these facts.  It’s important that we be honest about them.  And, it’s important that we try to do the best we can.

    I bring this up because I just can’t drop the Arizona Medicaid transplant decision.  I’m appalled at how little attention it’s getting.

    To bring you up to speed, in an effort to cut the budget in Arizona, the state decided to cut coverage for transplants for many people in Arizona who are covered by Medicaid.  Without these transplants people will die.  There are really no alternatives for them, no cheaper therapies to offer.

    Make no mistake about it.  This is a cost decision.  Arizona is saying that these people will not be covered because it’s too expensive:

    “Arizona simply doesn’t have the money,” Brewer told Channel 4’s Sarah Smith when asked why it appeared that she was willing to risk the lives of endangered patients all for the purpose of slashing the $1.4 million transplant program amid $1 billion Medicaid budget shortfalls.

    Arizona is potentially going to let people die because they don’t want to spend the $1.4 million.

    One of the reasons that people like me sometimes say that a public system is better is because it’s transparent.  We all know, and can decide, what public systems should and should not cover. Decisions are made in the light of day. We all know this is happening. But changes only get made if the press covers it, or people care.

    Do you?  I ask, because many of you seemed to think that ACA contained panels that would, well, decide when people should die because the cost was too high.  You seemed pretty upset by that.  I’d just like to know why this is different.

    No one needs to lecture me on the fact that we can’t afford everything.  I’ve said that many times.  I just don’t understand the priorities here.  Why would the thing you cut be the lifesaving measure? Especially when the cost savings are, well, ridiculous.  I made this from a news report in Arizona:

    On the right there is the Medicaid shortfall.  It’s huge.  Next to it, are the discretionary funds Arizona has received already from the federal government that the reporter in this piece says are not well accounted for.  The second column from the left is for a renovation Arizona is doing for a coliseum.  The first column is the transplant program they cut.

    I swear it’s there.  You can’t see it because it’s so small.  So you have to ask, why?

    Please understand, if you think that this is a reasonable decision, so be it.  There is not an unlimited amount of money in the world, and we cannot pay for everything.  But if you think that this is OK in Arizona, if you defend it, then you should at least take the time to stop and think about what that decision means for real people – people who may die.  You should not be afraid to say it out loud, and you should be prepared to acknowledge that this is the case.  Don’t blame it on others, don’t blame it on the President, and don’t blame it on a law which really hasn’t gone into effect yet.  Own that you believe that other things are worth more than this, and that this is OK to cut.

    And never, ever say the words “death panel” again.

    • “Arizona is potentially going to let people die because they don’t want to spend the $1.4 million.”

      1. Donations may save the day for those people we could all give if we felt is was a good cause verses all the other charities.
      2. It is not like the transplants will all make the recipients all live long and well. Some may live surprisingly long without the transplant, we may get some valuable data out of this.
      3. How many Haitians lives could one save $1.4 million?
      4. How many lives could be saved by a 30 mph speed limit.
      5. People are not that nice. IMO that is why Christianity asks for only 10%. We give our 10% to charity and then fee; free to enjoy our 90%.
      4. How many lives could be saved is we opened our boarder with Mexico.

      Adam Smith’s “The Theory of Moral Sentiments” has a lot to say about this sort of thing.

      I feel worse about how high I live when I see people in Haiti than I do about those people. We will all die one day.

      There is a bad thing here though, that is that the people who need the transplants were lead to believe that they would get them. Some stopped fund raising. I think that the should be grandfathered in.

    • Doesn’t the ACA actually cover the additional expenses in Medicaid for 3-4 years? I’ve read this recently, but don’t recall where. If it indeed does, doesn’t this make the AZ situation all that much more grotesque, is the opposition to the ACA seems all that much more political.

      FED-Here’s some money AZ to help your Medicaid expenses.
      AZ-No thank you…

      (AZ announces decision stop paying for certain transplants, says Obamacare is making it more expensive. NOTE: The ACA pays all additional medicaid costs until 2016 and 90% after that provided certain criteria are met..)


      Its disgusting…

    • Very well said.

      To read more about the Arizona Medicaid crisis, go to:


    • Dr. Restrepo’s blog post contains a quotation from Dr.Rudolph Virchow that I hadn’t heard before and that bears repeating. Physicians, Virchow said, are the natural attorneys for the poor.

    • I am with you here. The lack of coverage on this is surprising.


    • I don’t think Arizona’s decision is reasonable, so I won’t even try to defend it. But they key sentence in your post, I think, is this: “There are really no alternatives for them, no cheaper therapies to offer.”

      There are no alternatives. You could accept this as just a tragic fact of life, but you don’t have to. Under a government-run system, there will never be any alternatives. Arizona decides what to cover and what not to cover, and you don’t have a choice. If you need a transplant, tough luck, you’re gonna die.

      In a private system, these people would actually have alternatives. They’d be able to survive. If one insurer refused to cover it, they could stop doing business with that insurer and go to one who did cover it. And I’m not saying that we should stop helping poor people. We just need to do it in a smarter way. Take all the money that’s funneled into Medicaid and put it into HSAs or something like that. Give the people who need it the choice of how to spend it.

    • Scott: “If one insurer refused to cover it, they could stop doing business with that insurer and go to one who did cover it.”

      What country do you live in? Certainly not the US. Insurers routinely deny coverage to people with minor pre-existing conditions, let alone those who are sick enough to need an organ transplant.

    • David, as politicaljules mentioned, those who are currently on the organ transplant list in Arizona will still receive Medicaid funding. The decision only affects those who don’t need transplants yet (or even know that they will someday in the future need one). Since they are currently healthy, yes, they could actually change private insurers if they wanted to.

      And as a matter of fact, I don’t live in the US. I live in BC, where there truly are no alternatives. My insurance covers what the Gordon Campbell and Colin Hansen want it to cover, and nothing else. If they decide not to cover organ transplants, I’ll be in the same situation as those Arizonans, thank you very much.

    • Unless we find a way to provide health care more efficiently, economic rationing will become the rule. FYI Washington State is in the process of doing away with it’s subsidized health insurance program for the working poor.

      It’s a fact we simply can’t afford our health care non-system.


    • Will any of the organs that the Medicaid patients are denied be wasted (ie, not used)? If they are used, they will save other people’s lives, so what’s the problem? If there were an adequate supply of organs (which would require incentives for people to donate & for hospitals to sign them up), this would be an issue — but since there is a shortage, and organs are allocated not to those most likely to benefit, but to those who so sick they are about to die, a lot of these organs for Medicaid patients are wasted anyway.