Arizona Funding Cuts Cause Patients to Be Dropped From Transplant Lists

In further news that the U.S. residents among us can be unspeakably proud of, the state of Arizona has, thanks to budget cuts, stopped funding some life-saving organ transplants for patients who cannot pay for them themselves. The result is that those who cannot come up with the money to fund a potential transplant — and let’s face it, if one was relying on state Medicaid, one doesn’t have endless supplies of money to pay for highly expensive medical procedures readily at hand — are being dropped from transplant lists. The NY Times reports:

Even physicians with decades of experience telling patients that their lives are nearing an end are having difficulty discussing a potentially fatal condition that has arisen in Arizona: Death by budget cut.

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.”

Organ transplants are already the subject of a web of regulations, which do not guarantee that everyone in need of a life-saving organ will receive one. But Arizona’s transplant specialists are alarmed that patients who were in line to receive transplants one day were, after the state’s budget cuts to its Medicaid program, ruled ineligible the next — unless they raised the money themselves.

If one can get past the unbearable horror of the situation long enough, they will also find the irony to be quite rich:

State Medicaid officials said they recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.

“As an agency, we understand there have been difficult cuts and there will have to be more difficult cuts looking forward,” said Jennifer Carusetta, chief legislative liaison at the state Medicaid agency.

During the debate on health care reform, many on the right-wing used scare-mongering tactics to suggest that a public health care system would result in “death panels” as the government rationed resources. This argument ignored how commonly insurance companies deny medical procedures and how frequently those without insurance are already unable to access care — but they also ignored that if anyone was going to favor balancing a budget over human lives, they were certainly not primarily going to be leftists. If anything in existence deserves to be called a death panel, it did not result from a commitment to public health care, but from the refusal to recognize health care access for people of all income levels as a human right. These cuts are not public health care gone wrong, but the devaluation of public health care systems reaching its logical conclusion.

The one positive thing to report is that so far, none of the approximately 100 people affected by the cuts have died directly as a result of them. And the good news is that many donors have come forward to assist those families that now need the help as a result of this decision.

But I would suggest that we shouldn’t wait for someone to needlessly die before we get outraged — if we do, we’ve already waited much too long. Further, while the stories of people wanting to help are heartwarming, and those who can assist with personal funds should continue to do so in the meantime, it’s my view that human rights are far too important and fundamental to leave to the chance of charity and individual goodwill. The lives of low-income people should not be left at the mercy of wealthy donors. And I should hope that those wealthy donors who have it in their hearts to offer assistance also know that this set up is ultimately far from ideal, unsustainable, and not right.

In the U.S., there are laws stating that one cannot buy or sell a human organs. These laws attempt not only to protect those poor individuals who could easily be exploited by an organ trade, but also to reinforce a basic value that the right to human life should not be able to be bought or sold. One’s right to live, we believe at least on the surface, should not depend on one’s ability to pay. Though it seems clear to me that these funding cuts do not in any way actually violate laws regarding the buying and selling of organs, it seems equally clear that they do violate the principles that such regulations represent. Because for those in need of the transplants for which funding has been cut, needing to be able to buy the right to continue living has become a terrifying reality.

But I also think that while the outrage at this particular funding cut in Arizona is genuine and entirely warranted, it’s incredibly myopic to treat it as an isolated abuse of health care resources. Thanks to the U.S. model of health care as commodity rather than right, people have been dying as a result of their inability to buy the continued ability to live for a long time. But the people who die all the time because they know something’s wrong but cannot afford to see a doctor in a timely fashion don’t usually make the news. Those who might not have died if they hadn’t needed to ration their necessary yet highly expensive prescription medications don’t tend to inspire the same outrage. People who don’t have access to a primary care physician and only receive health care when things get bad enough to go to the emergency room are rarely the recipients of large donations from strangers. After all, there’s just too many of them.

The U.S. for-profit health care system that puts tax cuts ahead of lower-income peoples’ lives is broken, and it’s taking lives every day. This particular example of just how broken it is certainly is outrageous, and particularly dramatic. But as we rightly express our anger and despair, it’s important to remember that this is merely a symptom of the problem, not the problem itself. We don’t need to restore transplant funding in Arizona; we need to create a system where the idea that poor people, and only poor people, can’t access potentially life-saving care seems not just absurd but also unfeasible.


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17 Responses to Arizona Funding Cuts Cause Patients to Be Dropped From Transplant Lists

  1. andrea says:

    I Still have trouble wrapping my head around the idea that healthcare isn’t a universal right. I’ve reflected quite a bit that if it were not for our system here in Canada, I would be dead a few times over now, because I sure as hell wouldn’t have been able to afford the treatments I have needed, and in at least one incident, hesitation in going to see my doctor due to the cost would have definitely resulted in my own preventable death.

    In a socialized healthcare system, there’s no ‘death panel’ – the cuts that get made are to non-essentials programs and things, like optometry or routine diagnostics (in Ontario, eye doctors are only covered for children and seniors).. inconvenient, yes, life-threatening, no.

    I can’t even fathom how the decision gets made to just suddenly cut people’s hope of survival based on their income bracket, or even on the chances of success.

    I’ll continue putting up with the shitty weather in exchange for the knowledge that there’s no cut-off price for my life.

  2. And I bet that people who had to rely on Medicaid for transplants had to deal with minimal services and long waits. Where I used to live in Alabama, there was approximately one center that even took Medicaid patients. Because of that, one was scheduled three and four months in the future.

    I can’t imagine how long it took to have a transplant, since providers and doctors would have been paid a fraction of the cost that private health care plans provide. And this isn’t to criticize Medicaid as to express my incredible anger that profit is more important than the lives of fellow human beings.

  3. Kristen J. says:

    Evil. Period.

  4. Bitter Scribe says:

    If conservatives notice this at all, it will be to twist and distort it so that it somehow becomes an object lesson in the evils of government-subsidized health care.

  5. Jadey says:

    Yeah, when people say “death panel”, this is basically what I imagine. I’d say that the irony burns, but I don’t know if anyone’s insurance is going to cover that.

  6. bleh says:

    “putting up with the shitty weather in exchange for the knowledge that there’s no cut-off price for my life.:

    But Andrea, some of us live in North Dakota.

  7. GallingGalla says:

    I’m in this situation now. I’m unemployed and don’t have health insurance. I am having unexplained chest pain (I’ve ruled out indigestion / GERD and other simple-to-experiment-with ideas) that could be from anything ranging from ulcers to heart or lung disease. I know that I’m at high risk for a lot of these things; nearly every member of my family has had or currently has heart disease and cancer – my mom had cancer three times (thyroid, breast, lung).

    I’m not even bothering to see my doctor about any of this. She’d have to order diagnostic tests that I cannot afford in order to figure this out, so what’s the point? Even if somehow I could scrape the money together for tests, what’s the treatment going to cost?

    So my only choice is to wait it out, hoping that it’s something self-limiting like bronchitis, and dreading that it’s something major like heart disease.

    Please note that I’m not asking for nor do I desire any off-the-cuff diagnoses or “did you try this or that?” suggestions. I’m saying this specifically so that y’all understand that there is at least one (and probably many more) regular reader of Feministe in this situation. And I’m not that old, only in my early 50’s.

    (Also, can I tell you how much fun it is to self-treat / self-mobilize a frozen shoulder (adhesive capsulitis), because I can’t afford the physical therapy? Not fatal, but disabling.)

  8. Jadey: There is no irony here. When you take politicians that believe things like “Government run health care is inherently horrible and leads to Death Panels”, and put them in charge of a government, you inevitably get horrible care and death panels. From the conservative viewpoint, this is a feature, not a bug.

  9. Jennie says:

    Ok, so this is what I don’t get: Why don’t you just do the damn operation?? Yes, I understand they’re expensive. But you’re a doctor! More than that, you’re a human being! Can you really just stand around and let someone who could be saved die because of money? I couldn’t. I don’t understand how someone else could. If a person needs treatment (especially life-saving treatment!) they should get it, end of discussion. I’m not suggesting they shouldn’t pay. You can bill them later. Have them owe you money until they die 40 years later. The point is they’ll be alive and isn’t that what doctors are supposed to be going for anyway?

    • Cara says:

      Jennie —

      Unfortunately, the expenses don’t just come down to the doctors’ time. Many are willing to donate their time, but there’s also operating room time that needs to be accounted for, as well as the equipment used to preserve the organs and do the transplants, the cost of the hospital stay and care during recovery, etc. It’s not about doctors.

  10. Natalia says:

    Evil. Period.

    Yes.

  11. Jess says:

    Jennie,
    My FIL is a surgeon and often does surgery for nothing or for a side of beef or something (farming area). But the bulk of the cost comes from the hospital itself. My FILs fee is high, but the cost of the gauze, the suture material, the nurses who circulate, the meds, anesthesia, the room, the meals, the damn tissue box stocked in the room: you are billed for all of it, and it adds up. Especially if it is a major surgery and the patient is going to be on a ventilator etc. Doctors are (sometimes) part of the problem, but hospital administration is perhaps the bigger issue.

  12. Paraxeni says:

    @andrea – this snowed-in Brit agrees wholeheartedly. Reading about the politics of US healthcare devastates me. How many people like me just died because they were too poor? It’s inhumane and despicable.

  13. Tei Tetua says:

    OK, but how about considering the financial aspect of this as seen by the state, and the taxpayer? That’s already very much an issue in countries with publicly funded health systems, like Britain. The government assigns a budget for the medical system, and everyone has to be treated within that. If there are a few very expensive treatments, then there definitely is the urge to refuse to provide them, in the name of “the greatest good to the greatest number”. Add there’s the possibility that these things might not have much value in terms of extending people’s lives, even if the patients want them, and yes, you get the equivalent of “death panels” or more likely some bureaucratic, less emotional name.

    The things that the death panel (lovely name, let’s keep using it) would consider would be how many cases are there likely to be in the budget period, and how healthy and how young are the people who need the treatment. Because obviously, they want to get the best value for the outlay, in terms of extending a young person’s life rather than an old person’s–and maybe not at all, if the patient is likely to die of something else soon, or if a sober opinion is that the treatment won’t help much.

    Maybe this topic would be more interesting if you consider all its aspects, especially where the money comes from and how it gets allocated, and when there will ever be a limit to it. Just to look at the suffering of people who are shut out makes it seem as if we want benefits without costs, and without tradeoffs.

  14. Usually Lurking says:

    It’s reasonable to promote a “right” to have basic medical care, because there is no theoretical bar to giving everyone basic medical care.

    It’s not reasonable to promote a “right” to have an organ transplant, because organ transplants are a fundamentally limited medical procedure. So long as we have an organ shortage, the question isn’t WHETHER someone will be denied an organ at any given point in time, but rather WHO will be denied an organ. That’s not politics, it’s just fact. We need more organs than we have, so we can’t give them to everyone.

    And once you’re in the second phase, then you start running into the basic sticky questions: is everyone equally entitled to get an organ? If not, why not? (there are a lot of excellent arguments for equality) If so, why? (there are also a lot of excellent arguments for taking account of things like life expectancy.)

    Same with health care. In a perfect world we would provide every person with the complete medical care which s/he wanted. But as soon as you step outside that perfect world, even a little bit, then you’re in “who gets screwed over?” territory. When there’s not enough to go around, then someone is going to go without. And we are far, far, outside that world.

    So I’m having a hard time seeing rationing as inherently evil, even though there are individual results which I don’t like. I suppose the real question for me is “if you ration, what happens to the extra money?” If an agency decides to stop giving liver transplants (so 10 people die) in order to have $3,000,000 to use for more effective medical care, so that it saves 100 people… is that really bad? From my perspective, that’s a good thing. It’s rational, and it’s effective. It’s based on medical reality. Isn’t that how we WANT agencies to behave?

  15. Paraxeni says:

    Tei Tetua – are you living in a country with public health, or talking out of your arse? There are no death panels, nobody goes untreated. The only refusals are for unlicensed drugs available in the US that cost tens of thousands of pounds that would not save lives, merely extend them for a few weeks. Those patients are still treated and cared for with gold standard therapies.

  16. ella says:

    I live in Arizona and I do not have access to medical care. We simply cannot afford the $800 mo. employer insurance and we make just a couple hundred dollars too much to qualify for the state insurance. My last pap was precancerous. I have 3 small children. I’m having severe cervical pain but I cannot put my family in debt.

    Arizona has failed me and my children.

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