• Sometimes there is no way to laugh

    I’ve had a long week.  I won’t bore you with the details, because this blog isn’t about me, nor are my problems worth your time.  I tell you this only because as much as I wish I could bring it, I’ve got no snark for this.  It’s too much.  From yesterday’s NYT:

    Effective at the beginning of October, Arizona stopped financing certain transplant operations under the state’s version of Medicaid. Many doctors say the decision amounts to a death sentence for some low-income patients, who have little chance of survival without transplants and lack the hundreds of thousands of dollars needed to pay for them.

    “The most difficult discussions are those that involve patients who had been on the donor list for a year or more and now we have to tell them they’re not on the list anymore,” said Dr. Rainer Gruessner, a transplant specialist at the University of Arizona College of Medicine. “The frustration is tremendous. It’s more than frustration.”

    I think I’ve built up enough credibility to say you’ll know I’m not posturing when I say that we do need to reduce health care costs.  We do.  But this is just wrong.  You don’t get a transplant to feel better about yourself.  You don’t get one to have a slightly better quality of life.  You don’t get one because you can’t be bothered to make lifestyle changes.

    You get a transplant to save your life.

    Evidently, Arizona has decided to discontinue to allow Medicaid to pay for lung transplants, and some liver, bone marrow, and pancreas transplants.  Want to know how much they will be saving?

    About $4.5 million.  Seriously.

    But that’s not why I can’t make a joke.  It’s because, when confronted with this, the governor of that state couldn’t stop politicking.  When asked why Arizona was doing this, she blamed it on “Obamacare”.  There’s just one small problem.  The Arizona bill was voted on in March, “before before President Obama signed [PPACA] into law.”

    I really don’t know how to joke.  Some people complain about government spending, but can only find a way to cut a few million dollars, and do so by literally depriving life saving treatment to poor people who need it.  These same people then dare to utter words like “death panels” when referring to something that is nothing of the sort.  And when confronted with the facts of what they’ve done, they blame something else, something that factually could not be the cause, because it occurred after their decision.

    I’m done.  I hope you have a good weekend.  I’m cutting out and heading over to Sun King Brewery to refill my growlers.  If something good happens, please do let me know.

    • Aaron,
      This is an actual death panel.
      Words fail me.

    • But I thought only Canada denied health care to people, you know:

      I’ve stated this before, but it bears repeating; all the things the anti-health-care-reform people keep alleging about the Canadian system invariably seem to be actual problems peculiar to the US.

    • And they couldn’t look at Oregon, who long ago prioritized the relative benefit of different medical therapies/ treatments, and decided not to treat things like laryngitis, which fully resolves without intervention, but continued to pay for life-saving transplants?

      At least the first version of healthcare reform (Obamacare) ATTEMPTS to achieve improved outcomes and reduced costs via comparative effectiveness studies and not overpaying for prescription drugs. I haven’t seen anything else under discussion that looks for these types (and other) important and much-needed efficiencies.

    • I’m sure my post will make some people mad, but I’ll say it anyway.

      If you’re so outraged by these cuts, why not take the money you’re about to spend on refilling your growlers, and use it instead to help pay for these life-saving treatments?

      In fact, why don’t we all? I’m planning to go see ‘Black Swan’ this weekend. For my wife and myself, it will cost at least $20. Why are we choosing to do this instead of giving that $20 to help save someone’s life?

      Because, like most people, we simply don’t care enough to do so. We’d rather pass the buck on to others (“government”), so that when it doesn’t get done we have someone to blame for not caring besides ourselves.

    • “If you’re so outraged by these cuts, why not take the money you’re about to spend on refilling your growlers, and use it instead to help pay for these life-saving treatments?”

      How? We had charity care as the norm for poor people in the past. It did not work very well. No, this illustrates the problem with no insurance coverage. It means that some w/o it will die. Those who opposed health care reform always glossed over this. They wanted to think that someone, somewhere was providing emergency care that somehow was providing all the care people needed.

      I am a believer in first principles. We need to decide if we will provide care for those who cannot afford it. If we decide that we are not going to provide care, we should at least be honest and admit that we are willing to let people die. If we decide that we are going to provide care, it needs to be more than emergency care or, as illustrated by Aaron, people will also suffer and die. People who do not want to reform health care need to take responsibility for what follows.


    • Sam,

      Between income tax, sales tax and property tax, my real tax rate exceeds 50% of my income annually. THIS is MY contribution to the government social services (Medicaid is administered in the same office as Medicare) that provides health care for those unable to afford health insurance through an employer or individual plan. While I do not know the exact percentage of my federal income tax that goes to support Medicaid programs, I feel if it is allocated wisely, then it should be enough to cover the majority of care that is needed. Other countries manage this, why can’t the U.S.?

    • Wendy, your point is valid. But my point is that we each still choose minor pleasures over saving other people’s lives. Last month I bought a new car. I didn’t need it, but I wanted it. The cost was around $35,000. I *know* that money could have saved several lives, but I chose to buy a car instead.

      Steve is right; we need to be honest and acknowledge that as a society we are willing to let people die so that we can enjoy frivolities. Because we are willing. Each of us is, only semantically different than watching a person die for want of $20 while we choose to buy movie tickets instead.

      I have found that once I realized that about myself, I came to much more realistic conclusions about how I believe health care should be handled. And it has a lot more to do with personal responsibility, and a lot less to do with handing off ownership of individual’s health to nameless, faceless bureaucrats. Life and death decisions about my life are too important to me to cede them to Nancy Pelosi.

      One of the most compelling arguments against government provided health care, in my opinion, is the current gridlock in congress. No matter which political flavor one is, he is likely to be terrified to turn his health over to the other flavor. How many democrats *really* would want George W. Bush and Mitch McConnell to decide what health care they can receive?

    • I spent $10 on a comedy show tonight. I’m going to spend another $10 to see the same show tomorrow night. (I only spent $5 on Thursday to see that show.) And I recently bought a new car. Next week I’m flying to Puerto Rico, ’cause I feel like it.

      Yet, we in Canada don’t seem to have those same types of issues.

      It seems to me, given the vast dollars spent in the US for health cares, it should be even less of a problem in the US.

      But I suppose that is Dr. Carroll’s point.

    • Unless those above who are advocating awareness of discretionary expenses are also advocating increased taxes dedicated to subsidizing medical care for those who cannot afford it, I don’t see much point in ruminating on how we all spend some percentage of our time, lives, and money foolishly or selfishly.

      There are many real problems exposed by Arizona’s decision, not the least being the basis for making it. Supposedly, the decision to eliminate payment for certain stipulated transplant operations was based on a review of the efficacy of these transplants. Did these transplants give sufficient value for their cost? If the review were sound, then why should this decision apply only to the state of Arizona and only to the Medicaid patients within that state? Why should any insurer pay for these operations and why shouldn’t all potential transplant recipients be subject to the decision?

      This decision exposes the terrible disparities in the health care available to the indigent, the disadvantaged, and the uninsured in this country. Were these people not living in Arizona, they would not be denied their transplant. Even more egregiously, were they suffering from end stage renal disease, they would be receiving Medicare and thus be unaffected by Medicaid curtailments, no matter where they lived.

      The problems with American health care access and affordability are not insurmountable. We could fix these things. We could enact the sorts of strict regulation that make all-payer systems work; we could enact a national system such as that in HR 676. We could. And then you could still go to the movies in your brand new car and not feel bad when you have fleeting thoughts about some poor guy in Arizona who’s dying because he can’t get his liver transplant.

    • “Being a bear of very little brain”, I need some help with a pretty simple point on health care that I just can’t see. What I can’t seem to figure out, is just where the hell is all the money going? Judging by what I see at the nursing and practitioner level, it ain’t there. The hospitals don’t seem to be over-capitalized. The high tech equipment manufacturers (eg. Intuitive Surgical are doing OK, but laminating their buildings in gold. Given people are being charged over six figures for less than a week hospital stay, it would seem that somewhere there should be a river of currency as deep as the great abyss. How can we “follow the money”?

    • Chuck- Follow the link. Aaron did a nice series on the topic. Your observations are good. May I suggest that if you travel outside of the US, look at medical facilities where you go.



    • Thanks, Steve. Aaron really put forth a tour-de-force. I really wish all of our politicians would read his analysis. Do you think I am right concluding that there is no one big well of wealth where the health care cash is going? It seemed to me that there are a couple of places where we are blatantly paying too much (perhaps medical specialists and drug research for example), but mostly we just choose to have more medical goods and services than other places in the world. In some of these cases we have individuals living higher on the hog than deserved, but mostly this cash I am looking for has just been reinvested back into the economy as purchases of foodstuffs, electronics, education, autos, utilities, building materials and so forth.

      My experience with health care in other countries is limited, and I would appreciate your take on the difference. I have been to hospitals in the Caribbean and thought they were professional but less well appointed. It also struck me that I only saw a fraction of the CVS/Walgreens type health supply outlets, and their druggists were significantly smaller.



    • Chuck- I think that the data shows that we both use more services, though not as much in some areas as you would think, and pay much more for those services. Speaking for myself, you should read Aaron and Austin to see what they think, I think we err when we try to blame high costs on one or two groups. It is a systemic problem. Almost every step in medical care is involved. However, we do know that other countries manage to provide roughly equivalent care for much less, so it is possible that we could do the same.

      I am not nearly the world traveler that my wife has been, but when I travel I look at other medical facilities when I can. What I think I see, of course I start with my own observational bias, is less money spent on facilities. I seldom see anything approaching what I see in our local surgicenters with their fountains and flat screens.


    • I would like to see Aaron and/or Austin delve a little deeper into the concept of “using more.” I don’t think that it is necessarily as straight forward as it might appear. For instance, if we have a lot more knee replacements, we are using a lot of resources for that operation, recovery and rehab, but we are not reducing illness nor perhaps prolonging life. It could be argued, though, that we significantly improve the quality of life. I don’t know how to measure and compare quality of life,but I do know that I will pay to have mine increased. Whether I am getting a fair price for it, is where I need the “A” team to step in. I have to agree with Steve that our US facilities seem rather luxurious in comparison to some of the facilities out of the US that I have seen, but so are our supermarkets and we don’t seem to have the same problems there.

      Thanks for your insight, Steve, you have obviously thought a lot about these issues.