Oregon Health Care System Denies Care - Pharmaceutical Company Comes to the Rescue
I’m sure that this would never happen under Healthy Wisconsin.
Last month, she found out that her lung cancer, which had been in remission for about two years, had come back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, Wagner was notified that the Oregon Health Plan wouldn’t cover the treatment, but that it would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide.
Then, on Monday morning, a representative of the pharmaceutical company called Wagner and told her it would provide the medicine for free. Wagner said she didn’t know whether to laugh or cry, so she did both.
“I am just so thrilled,” she said. “I am so relieved and so happy.”
Wagner had to rely on the charity of a drug company because the Oregon Health Plan wouldn’t cover her treatment.
Wonderful. They’d cover the expense if she killed herself, but not to prolong her life.
Welcome to government run healthcare. This is what we will see if the lefties get their way and get the single payer plan. I bety the lefties like scott are jumping for joy over this. BTW, the conservatives predicted this and the lefties/socialists said this would never happen. So who lied?
Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 0155 hrs
I am neither praising nor condemning that decision from Oregon. But frankly, for those of you so concerned about how taxpayer dollars are spent on low-income individuals, denying her chemo that would not have cured her was probably a good bottom-line investment. So maybe conservatives should be praising government’s decision to not spend taxpayer dollars on a therapy that wouldn’t have been administered with any real hope of curing her disease.
The other thing I will point out is that the OHP doesn’t do anything that managed care doesn’t already do. Or do you actually think your HMO will give you unlimited chemo whenever you want it and for whatever reason you’d like it?
In fact, the quote from the doctor who heads up OHP, “we can’t cover everything for everyone,” is pretty much a variant of what I read so many of you write around here about everything else government spends money on.
As long as there’s an option for the sick individual to purchase denied care privately (or obtain it on a charitable basis), I’m not sure what the objection here is. Or maybe some of you would like to assert that this woman has a right to all the taxpayer-funded treatment she’d like?
Posted by Recess Supervisor on June 10, 2008 at 0218 hrs
Obviously, Recess, the her doctor and the pharmaceutical company thought the medicine they were providing would do some good, so your arguement is shot to hell right there.
Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 0337 hrs
The more I’ve looked into healthcare, the more I realized it’s pretty much a quasi-socialist system already, especially if you have it through your employer.
What’s key here is that a private business, working in a capitalist system, stepped up to help.
What we need to do is release all employers of their ties to healthcare companies and instead give what they companies WOULD pay toward the plan directly to the employees (plus the employees get to keep their portion). Then we need to open up the market just like car insurance, where insurers compete for the best plans at the most affordable prices.
With a *limited* safety net for those who truly *cannot* afford it.
Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 0337 hrs
If we went to such a single payer system controlled by the government, I will guarantee people that are sick, but non-terminal, will be denied care just like this woman in Oregon because some government worker is too lazy or looking to exact some revenge on an critic of government policy.
Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 0601 hrs
Perhaps it’s meant to cure, but the fact for this woman is that using chemo to suppress the cancer is palliative care.
Whether public or private, health insurance with rigid codes that don’t recognize creative ways to treat people often leaves people like Ms. Wagner out in the cold.
Posted by tee bee on June 10, 2008 at 0938 hrs
Managed care, Dan, is not always about whether something makes the patient feel good, regardless if that system is public or private. The essence of managed care is focusing limited dollars on treatments that contribute the most to the health of the public as a whole. And it’s clear from the article that while this treatment may extend the woman’s life, it’s not going to cure her. At best, it’ll buy her some time.
Let’s say it buys her a year, and OHP (read: taxpayers) agrees to pick up the tab. The money spent on her is money that can’t be spent on something else. So let me ask you, Dan: what’s a year of her life worth to you? Because, whether you like it or not, questions like that are the very essence of managed care. If that year cost taxpayers $10K, would you be willing to open your wallet? What about $100K? What about $1MM? What about $100MM?
That’s not rhetorical. I’d be interested in your answer. After all, this is hardly the first time a managed care system has overruled the decision of a doctor. Or would you rather have government-run health care programs become “unmanaged” care, in the sense that we make the programs sum-sufficient and automatically authorize whatever treatment a doctor approves for a patient, regardless of the cost or the efficacy of the end result?
In saying no, the OHP is defending Oregon taxpayers. Are they wrong to do that? Or should they always say yes?
Posted by Recess Supervisor on June 10, 2008 at 1017 hrs
Recess, your arguement makes no sense. Then why have government health care in the first place? I work with severely disabled kids and the government spends thousands, if not 10’s of thousands of dollars a year on them. Should we deny them a new wheelchair? How about the kids who quote unquote have no quality of life, should we spend $80,000 to keep them alive even though they pee in their pants, don’t know where they are, can’t talk and have the mental ability of a 6 month old even though they are 20 years old, should we deny them the medical care needed to keep them alive?
The difference here is between private health insurance, where you do have a choice to take it or not, and granted, it is a tough choice not to take the private health insurance. And with government, where people don’t get to pick and choose.
So, to directly answer your question, if the medical treatment is legitimate and the illness is legitimate, then whatever expense there is then pay it. There has to be common sense involved. For instance, I would not support doing a heart transplant on her, if she had a bad heart and the severe cancer. But chemo, yes, it sounds like a legitimate expense.Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 1225 hrs
This has nothing to do with government run health care. Her private insurance company, which administers the Oregon plan decided to not cover the drug.
Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 1405 hrs
Is your argument then that the private insurer is incorrectly interpreting government policy, John? Clearly, the insurer is deferring to OHP guidelines in denying the coverage. Their argument is that they won’t pay for it because the terms of OHP won’t allow them to pay for it. Given that, I’m not sure that the focus on OHP policies is unreasonable.
Posted by Recess Supervisor on June 10, 2008 at 1412 hrs
I have a friend who works for HUD. Smart guy, masters degree, decades of experience. He tells me stories where he is almost crying for the people he is trying to help, but due to government policies, he can’t do what is often a less expensive option, that would provide maximum benefit.
The private sector (left alone) is always going to be more efficient than the public sector. Please show me an example of someone who walked in an emergency room with a serious medical issue that wasn’t addressed - whether they had health insurance or not.
Posted by .(JavaScript must be enabled to view this email address) on June 10, 2008 at 1432 hrs
Bill said,
Please show me an example of someone who walked in an emergency room with a serious medical issue that wasn’t addressed - whether they had health insurance or not.
Likewise, show me an example of that happening in a hospital without a sign that says treatment cannot be denied by law.
This thread brings up the great conundrum when it comes to insurance: with private insurance a conservative is paying for health care for other people, and the state denying care in circumstances like this is the same as a private insurer denying care because of the profit motive that is supposed to make everything better.
I’m all for deregulating the market and for decoupling health insurance from work, but at the end of the day “health care” and “profit motive” don’t exactly fit together all that well.
Posted by .(JavaScript must be enabled to view this email address) on June 11, 2008 at 2106 hrs
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