From a managed care List to which I belong:


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Los Angeles Times
     Monday, February 2, 1998

PERSPECTIVE ON HEALTH CARE
     Red Flag on the Slippery Slope

     HMOs' resistance to expensive treatments
for chronic diseases puts them in good form to
support assisted suicide.

     By LAURA REMSON MITCHELL

     If physician-assisted suicide ever is
legalized, your access to high-quality health
care is likely to be significantly reduced,
even though taking your own life may be the
farthest thing from your mind. And if you
happen to have a disability or serious chronic
illness, you will be particularly at risk.

     That's not just because of abuses,
although I believe there would be many.

     It's not just because of fears and
stereotypes about disability that are so deeply
rooted in our society, although such prejudice
increases the danger.

     The basic problem is that legalized
physician assisted suicide would inevitably
become the ultimate financial escape hatch in a
health care system that increasingly is
dominated by cost considerations, even at the
risk of patient well-being.

     Consider this: In the last few years, the
Federal Drug Administration has approved three
new drugs that, for the first time in history,
have an impact not just on the symptoms but on
the actual disease process in multiple
sclerosis, a disease that has driven a
significant number of people into the arms of
Jack Kevorkian. Unfortunately, these drugs are
expensive--about $10,000--$12,000 a year per
patient.

     Now think about the bean counters at
BigBucks HMO. Under current law, if the HMO
refuses to cover one of these drugs for an MS
patient who needs it, and if the disease gets
worse, the plan is on the hook to provide care
that may turn out to be even more expensive
than the treatment that was rejected. If the
HMO refuses to provide care at that point and
the patient's condition continues to decline,
family members and friends are likely to start
calling government regulators, elected
officials and lawyers. Bad press about cases
like this also could mean the loss of
multimillion-dollar employer contracts for the
HMO. So, all things considered, BigBucks HMO
has good reasons to think twice about denying
coverage.

     But in a world where physician-assisted
suicide is legal, the HMO would have other
options. It could simply drop expensive
treatments and services from the plan's benefit
package, provide minimal care and, when the
patient finds that life no longer is tolerable,
offer "compassionate" assistance in dying.

     Family and political outrage are unlikely
to be much of a problem once the idea of
physician-assisted suicide becomes routine.
Suicide would end the patient's "suffering"
(and the stress that suffering puts on the
family) and the patient would be dead. Would
anyone then even think to challenge the pattern
of decisions that pushed the patient to the
point of asking for help in dying?

     Recent reports suggest that with managed
care dominating more and more of the industry,
health plans are less able to avoid high-risk
patients than in the past. That's probably one
reason why more plans are finding their profit
margins shrinking or disappearing. I believe
many also are now paying the price for failing
to meet the earlier needs of the high-risk
patients they couldn't avoid.

     Yet the first response of the health care
industry (and many business purchasers of
health benefits) to reforms like those
recommended by the President's Advisory
Commission on Consumer Protection and Quality
in the Health Care Industry and the California
Managed Health Care Improvement Task Force has
been to reject such proposals as "too
expensive."

     Legalizing physician-assisted suicide
would allow health plans, insurance companies
and public programs like Medicare and Medicaid
to appear "compassionate" while they cut back
or eliminate coverage for the health and
support services that can make for a good
quality of life even in the face of significant
disability and illness. For that reason,
legalization is likely to reduce access to the
very things that might give a seriously ill or
disabled person a desire to continue living.

     But the ramifications of legalization go
even further. If health plans begin cutting
back on coverage of expensive new treatments
for serious diseases like MS, Alzheimer's and
AIDS, it would significantly weaken or even
destroy the market for such treatments. And
without a market large enough to at least
recover their costs, the pharmaceutical
companies and other investors who turn
scientific research into usable health care
products aren't very likely to spend the money
necessary to develop those treatments. As a
result, we may never see cures for many
serious, currently incurable conditions, or
improvements in the quality of life for people
with severe disabilities and chronic health
problems--even though such developments may be
well within our reach.

     As a public policy analyst, I've watched
HMO problems that I anticipated five or six years
ago become pronounced enough to create a consumer
backlash and demands for change--even though most
people ignored what I was saying years ago or
dismissed it as "catastrophizing." Unfortunately,
the effects of legalized physician-assisted suicide
on the health care system would be subtle and
insidious. By time they are recognized (if ever),
it may be too late to change course. That's why we
should avoid the mistake of moving down that road
in the first place.

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Laura Remson Mitchell is a Los Angeles-based
public policy analyst, consultant and writer
specializing in economic, health-care and
disability issues. She has lived with multiple
sclerosis for many years.



Copyright 1998 by Laura Remson Mitchell

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Best,

Bob

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ROBERT A. FINK, M. D., F.A.C.S.
Neurological Surgery
2500 Milvia Street  Suite 222
Berkeley, CA  94704-2636  USA
Phone:  (510) 849-2555   FAX:  (510) 849-2557

WWW:  <http://www.dovecom.com/rafink/>

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"Ex Tristitia Virtus"

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