yuck

America does not have a health care system, we have a capitalist system and health care just happens to fit in.

Perhaps this women shouldn't have smoked her whole damn life and then expected every other insurance policy holder to subsidize her feeble attempt at recovery.

Hmmm. What to do? Keep an old woman alive at an outrageous cost or use the money to cure some younger person/s who still has their life ahead of them? Limited dollars and outrageous costs. Hmmmm. Well one thing we have to do is negotiate drug prices, which the "pro-life" Republicans don't want because that would hurt the rich investors of drug corporations. The Republicans are responsible for an increasing death rate because of their irresponsible public policies. Maybe get the drug from Canada? Mexico? Syria? I'm sure they all get their drugs more cheaply than we do. Oh, that's right, the Republicans outlawed that. And they block any attempt to allow that. So die. Fifty bucks sounds good to me.

The health care system is broken. It's true. And that's a bad letter, but death with dignity is still a good law.

The Oregonian editorial, "Fix this medical Ethics Glitch" covers it well.

http://www.oregonlive.com/editorials/oregonian/index.ssf?/base/editorial/1217289319150190.xml&coll=7

"Predictably, critics of Oregon's unique-in-the-nation law are aflame over Wagner's story, some claiming it covers killing but not cancer. That's not exactly true, of course. The program that rations subsidized health care for low-income Oregonians has paid thousands of dollars over the years for Wagner's cancer care, and it will continue to do so.

It stopped short, however, of paying for a cancer drug that failed to meet the state's long-standing "five-year, 5 percent rule." It won't approve payment for treatment that doesn't provide at least a 5 percent chance of survival after five years.

In Wagner's case, administrators of the Oregon Health Plan had to make a difficult call. But that's what they do every day in performing the tough, thankless job of rationing government-paid health care to the needy.

What's unacceptable, however, is that Wagner's rejection letter included the offer of payment for doctor-assisted death. Such notification creates at least the appearance of an ethical conflict: state encouragement of dying as a cost-saving measure.

As the only state that both allows assisted suicide and tries to ration health care, Oregon has created a fine ethical line for state officials to navigate. In this case, they stepped over it. For the sake of ethical clarity in Oregon's Death With Dignity Act, the state health plan should stop offering to pay for those who use it."

My mother-in-law lived in Oregon, and she was diagnosed with a prolapsed uterus. The government did not consider it a serious health issue. She was in pain everyday, her limbs were swollen to twice their size, and she was going through all the heat flashes and irritability associated with menopause again. When she moved in with me, her doctor couldn't believe she had put up with it for so long. She's in the process of getting approved for surgery, and treating her health conditions on CA's dime.

Now while my sympathy for her diminished with the fact that she smoked all her life and only chose to quit after it was too late, it has not evaporated completely.

It's just an extremely callous thing to tell someone no matter what way you look at it.

I would be more inclined to think this was absolutely horrendous if the woman hadn't brought it upon herself with something so blatantly and obviously bad for her.

The quoted part doesn't exactly mention that the medicine perscribed, at $4K per month, had less than a 5% chance of keeping her alive. Even when we finally socialize it we're unlikely to approve a cost like that for a treatment highly unlikely to be effective.

You might want to include some facts like -

"...because the drug does not meet the "five-year, 5 percent rule" -- that is, a 5 percent survival rate after five years."

"The median survival among patients who took erlotinib was 6.7 months compared to 4.7 months for those on placebo"

In other words, an extremely expensive drug that has only a marginal impact on survival.

On a personal level I feel for her, but if we ever move to any type of a nation health care system we're going to end up having to do *more* of this type of triage.

Some of you are absolutely insufferable. I'd love to see you keep your wonderfully logical philosophies on the value of life when your own vices catch up with you.

The reality is, given a choice, more than 80 percent of Americans would choose the Canadian health care system over any of the options we're being given today.

And they'd be right.

I'm sure the media (fueled by pharmaceutical ads) will keep lying about such things, however.

Jeeze, So I guess it's only a matter of time before they decide that my $1,780 a month arthritis medicine isn't worth it and offer me the "$50 co-pay"

I wonder if the doctor will tell me or if he'll have me look the other way and remember the bunnies.

Didn't Howard Dean say that 90% of healthcare costs are incurred in the last 2 weeks of life? It is time to face the reality of a terminal diagnosis, and save the thousands of dollars for her 4-6 months for use by probably hundreds of other needy people who have healthcare needs as well. Sux we have so little to spend for healthcare for the needy, but she needs to remember she is not the only one in need. Death comes to all. Face it.

not exactly apropos, but i don't know why more terminal types don't do something useful with their last days like take out dick cheney or the pope. i mean, why not go out in style? i'd like to think that's what i'd do rather than take out a kodiak bear like that doucheboat kid wanted make a wish foundation to help him do.

Under a universal health care system, providing the Cadillac care that this woman seems to want would bankrupt us. At this moment, there are people in this country and especially around the globe who can't get even the most basic care. Let's focus on them, shall we?

The problem here is the way insurance works. You pay one of these companies your whole life and when you finally need the coverage, they can just choose not to pay. My question is, can situations like this be avoided under state-run health care?

Surely the letter was callous and unwise. That type of letter ought never to be sent again. It links two issues that are totally unrelated: assisted suicide for terminal patients who don't find pain management adequate (an ethically tricky issue that is worth a serious debate in this country) and how we as a society should prioritize our resources in providing publicly funded healthcare (another ethically tricky issue that is worth a separate serious debate in this country).

Right now we leave it piecemeal to insurance companies, government agencies, doctors, and researchers to provide and evaluate the value of extending life. It's a squeamish discussion to have, but after reading this and a number of similar, extensive articles about certain drugs that have appeared in the last few months' New York Times, I'm convinced we need to openly discuss and debate how much we as a society are willing to pay to extend life for how long and at what quality of life. Doctors are human, too. When people come to them expecting a cure for their suffering they don't like to say that there isn't one. I've known family members of cancer patients who were totally unprepared for their relative's death because no doctor had ever said to them that there wasn't abundant hope. The average time spent in hospice care is 3 days--not enough for the benefits it can provide to actually be useful.

Obviously any of our answers to the question "is this drug worth the cost?" might change if we were the patient, or the patient's family member. It might change if we were the doctor prescribing the medicine, lobbied and feted by drug company representatives and looked to expectantly by a dying patient in search of anything that might possibly help, even if it's a long shot, and even if (as the case with a cancer medication covered in a NYT article) the slightly higher survival rate assumed concurrence with a type of chemotherapy treatment that was no longer applicable.

The fact that it is often harder to give up hope when the hope is of our own survival (or those we love) is not a reason not to have this discussion, though. To me this drug, which some study showed extended some patients' lives (perhaps slightly--it isn't clear, the average survival only goes up by 2 months), needs a little more justification to approve it.

At least if we had a public healthcare system we could be consistent and more transparent in making these sorts of policies. It would also make it easier to inform patients about what to expect in terms of coverage, something nearly impossible now given the number of payors and plans that exist.
Public health would be just as restrictive when it comes to extreme treatments but it could at least be fairer and clearer about that.

@12 - Howard Dean is correct.

Even if you have written and legally-binding instructions not to attempt resurrective techniques as you die, they tend to ignore them.

My brother (who thank God is a lawyer), literally had to stop them from resurrecting my Grandfather, who was almost 101, when he had given clear instructions not to keep him alive.

It's kind of sick how much we waste on those who clearly aren't going to make it even if you "save" them.

It's heartening to see that even as big a group of socialists as Dan's readers can see what Dan can't: that under a nationalized health-care system that reduced costs to European levels, a lot more people would be getting letters like this. Maybe the government bureaucrats would be more tactful than the insurance company bureaucrats. But I doubt it.

Where are the pro-life people now?

@18 -- I'm sorry about your grandfather.

However, with up-to-date DNR orders and POLSTs, medical professionals will honor your wishes.

http://www.ci.corvallis.or.us/downloads/fire/protocols/DNR-POLST.pdf

The few hard-and-fast rules regarding these orders are pretty clear.

1. The POLST has to be signed by a doctor within the last year.
2. The POLST has to be physically present.

@14, this is exactly why people like me are against universal health care (and to a lesser extent government programs); most people want more than what universal health care would be able to sustain and would think that they were entitled to it because it had the auspicious moniker of "universal"

Will @18: Fear of malpractice suits is very real among doctors. Suppose 101-year-old Grandpa had left clear instructions about how he wanted to die but some family member decided to sue when the doctor honored his wishes and withheld some sort of resuscitation procedure that would have given him a few more hours or days. It's CYA--doctors have to be able to honestly say they did everything they could to keep the patient alive if challenged in a court of law. Even if they win on the grounds that they were honoring the patient's wishes, they still have to spend lots of time and $$ on this case which could be better spent tending to other patients. And while I would not want to see limits set on settlements of malpractice suits such as that ballot question proposed some time ago (actual cases of malpractice really do exist and need to be dealt with) there is some truth in the charge that our litigious society is one factor in driving up health care costs.

My Dad had this same dilemma a couple months ago, and so now they are paying the 4K a month on a fixed income (even with Medicare and Private HMO payments, it was gonna be outta pocket
). Pretty shitty. The doctor said people actually make the call whether they want it or not, and a lot of them choose not to take it. You are literally putting a price on your life and how much it is worth to you, your family and the country.

Apparently last month when he was about to take one, he dropped a pill, and it fell into the sink and both he and my mom scrambled to make sure it didn't fall into oblivion. Each pill was $90. I reckon most people would do the same thing.

the real solution to the "insurance didn't pay" is to roll back tort reform and allow them to be financially liable for fucking you over when you've done what was outlined in the contract in regards to coverage for premiums.

@21 - we're talking DNRs since 2000 in Cali.

Nice try, though.

I really hate to say this next part, because I've never been diagnosed with a terminal illness or had a loved one been diagnosed with a terminal illness, and I can't imagine how it feels.

That being said, like it or not, we have limited health-care resources, and I'm not sure paying $4,000 a month for a drug that will slightly extend a patient's life is the best use of them. I'd rather the money go elsewhere.

Of course, if it were me or a loved one, I might have a different perspective.

And no matter what, that letter was one of the most ill-advised ideas I've ever seen. What a tactless thing to do.

Got to agree with the majority here - the woman was denied for solid reasons, not just to save cash [and the letter was beyond tackless]. My mother had a DNR was back in 1980 that was ignored. Her care, after her brain death, cost over $1 million [in 1980 dollars]. Want to know why asprin is $4 a pill when you are in the hospital - that's the reason. Unfortunately, DNR orders are routinely ignored, sometimes because they violate the doctor's morals and sometimes because they fear being sued.

Compatively, my aunt, who died of lung/ stomach cancer, had a relatively easy time of it. She never went into a coma, so she never lost control of her own health care, and she chose a hospice as soon as she knew the cancer was incurable. I'd much rather die like she did [of dehydration & starvation because the cancer blocked her stomach] than the way my mother died.

Why are people so terrified of death anyway? It happens to everyone.

We have a health care market not a health care system. That market is not a free market either; it is highly subsidized by the government and protected from the forces of competiiton.