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Thursday, August 13, 2009

To Live And Die In Oregon

I managed to track down the story of the Oregon woman who was denied cancer medication. Here's the short version:

Woman's Insurance Denies Cancer Meds, Approves Suicide Meds

64-year-old Barbara Wagner, whose lung cancer had returned and was deemed terminal, had her claim for a $4,000 a month medication to extend her life denied by the state-run Oregon Health Plan while they approved palliative, or comfort, care only.

The rules governing Oregon Health Plan say that drugs must meet a 5% survival rate after five years to be covered by the plan. The prescribed drug, Erlotinib, has a median survival rate of 6.7 months in patients who had already completed chemo.

The Oregon Health Plan provides care to those whose incomes fall under the poverty level. Coverage is prioritized from prevention through chronic disease management, mental health then heart and finally cancer treatment.

Did you catch the key phrases? The Oregon Plan is to cover poor people. Coverage is prioritized. Cancer treatment is the lowest priority.

In other words, if you're poor, we're denying you expensive medication (meds which another commenter pointed out have a survival rate of 40% after the first year, contra the 5% claimed by the state) but we'll gladly pay for meds so you can kill yourself.

Keep in mind that most of the poor are women, minorities and people with disabilities. Women have always suffered a financial gender-gap due to their tailoring their lives to those of their children and spouses.

The talkback comments are always very illuminating, albeit the would-be masters and mistresses of the universe who opine in that forum are harsh indeed. Most wrote in to say she "deserved" to die because she was a smoker and/or old; that they felt $4000/month for meds was outrageous and the state shouldn't pay it just to extend the old lady's life for 6 months (studiously ignoring the writer who commented that the statistic as reported is incorrect and that survival rate is 40% after the first year); why should some other person die because the state wasted all this money on an old woman with cancer, etc....

I doubt they would comment in this fashion if they were the ones with cancer--or if the patient were a spouse, a sibling, a parent, a child.

That's her picture. Does she look like a woman who wants to die? I didn't think so, either.

Another site had this to say:

Oregon state officials controlled the process of healthcare decision-making—not Barbara and her physician. Chemotherapy would cost the state $4,000 every month she remained alive; the drugs for physician-assisted suicide held a one-time expense of less than $100. Barbara’s treatment plan boiled down to accounting. To cover chemotherapy state policy demanded a five percent patient survival rate at five years. As a new drug, Tarceva did not meet this dispassionate criterion. To Oregon, Barbara was no longer a patient; she had become a "negative economic unit."

Well, we certainly can't have THAT--we don't need any "negative economic units" in our society, now, do we? How disgustingly Orwellian.

Am I the only one who finds this appalling and outrageous?

Searching the web, I found this:

For Barbara Wagner, too, there is something of a happy ending: The pharmaceutical company making Tarceva agreed to donate a year's supply of the expensive drug, and to consider providing further medication free of charge if she is still living and wishes to continue taking Tarceva in a year's time.

In other words, Big Business came to the rescue, not the bloody government!

However, for other patients with advanced cancer, there may be few options. The Oregon Health Plan will not cover chemotherapy unless there is a better than 5% chance it will help patients live for five more years. Patients who don't meet that standard get a letter denying coverage for chemo and suggesting comfort care, including pain relief and, potentially, doctor assisted suicide.

Hence, Barbara is not alone:

Since the spread of his prostate cancer, 53-year-old Randy Stroup of Dexter, Ore., has been in a fight for his life. Uninsured and unable to pay for expensive chemotherapy, he applied to Oregon's state-run health plan for help.

Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup's request with a letter saying the state would not cover Stroup's pricey treatment, but would pay for the cost of physician-assisted suicide.

Got that? He's 53. That's NOT old. I understood that the purpose of government's universal health care was to make sure that people, especially the unemployed and working poor, would be covered by health insurance which is currently purchased through one's employer in group plans which many still decline because even the group plan is too expensive.

So here's Randy with prostate cancer and who needs chemotherapy, and the state's insurance plan tells him, essentially, "drop dead."

Eventually the state reversed its decision and paid for chemotherapy because Randy fought this decision.

Whatever happened to "First, do no harm."?

There are a couple of lessons here:

First, don't be poor and live in Oregon.

Second, be careful what you wish for--any government backed universal health care under consideration should be carefully scrutinized. Your life, your family members' lives, may someday depend upon what is written there.


Blogger Gila said...

Under the current set-up in the United States, what care would either Randy or Barbara get if they were poor and/or uninsured...and not living in Oregon?

Saturday, August 15, 2009 at 6:01:00 PM GMT+3  
Blogger aliyah06 said...

They would get Medicaid, which is really what the Oregon Health Plan is--every state gets Medicaid funds, which unlike Medicare, are needs based. Each state also gets to administer those funds as they see fit. The difference is that OHP has chosen to ration services and prescriptions. In California, it is called Medi-Cal and is far more comprehensive than what Oregon has chosen to offer its citizens. Every state has Medicaid, often under different names, but in many states the program is eating up huge portions of the state budget--which is why Oregon and other states ration care or have limited enrollment regardless of need. This is probably why Obama wants create a unifom, federal health care system akin to Medicare but make it available as an entitlement rather than as needs-based. The glitch is--will the federal government, to balance ITS budget, resort to rationing aid to elders, people with high-cost treatment (HIV, cancer, etc.) and cut Rxs to chronically ill people the way Oregon has done?

I think folks would be much calmer if they had the answer to these questions.

Saturday, August 15, 2009 at 8:37:00 PM GMT+3  

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