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.

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.

 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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