“I’m not ready, I’m not ready to die. I’ve got things I’d still like to do.”1 Sixty-four-year-old Barbara Wagner wiped her tears as she spoke of her cancer’s return.
After two years in remission Barbara’s non-small cell lung cancer reappeared during the spring of 2008. Her oncologist recommended aggressive treatment with Tarceva, a new chemotherapy, but Oregon’s state run health plan denied the potentially life altering drug. Instead, the State plan offered to pay for either hospice care or physician-assisted suicide.
In stunned disbelief Americans ask, “How can this be? Yes, this happens in Europe. I’ve heard stories of Britain’s National Health Service delaying intervention until the patient dies or reports of physician-assisted suicide in the Netherlands. But in America?”
The answer is simple. Oregon state officials controlled the 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.”
In 1994, Barbara’s state established the Oregon Health Plan to give its working poor access to basic healthcare while limiting costs by “prioritizing care.” In 1997, Oregon legalized physician-assisted suicide to offer “death with dignity” to patients who chose to die without further medical treatment. In the end, the State secured the power to ration healthcare in order to control its financial risk, even if that meant replacing a patient’s chance to live with the choice of how to die.
When queried about withholding Barbara’s treatment, Dr. Walter Shaffer, a spokesman for Oregon’s Division of Medical Assistance Programs, explained the policy this way, “We can’t cover everything for everyone. Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people.”2
Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, echoed Shaffer, “If we invest thousands and thousands of dollars in one person’s days to weeks, we are taking away those dollars from someone [else].”3
Twice Barbara appealed the ruling. Twice Oregon denied her treatment.
The shortcomings of America’s healthcare system confront both patient and physician daily. The myriad and complex questions that surround healthcare offer no easy answers. Yet, as Americans contemplate the future of healthcare, they must begin with this foundational question, “Who should control the personal and complex process of medical decision-making? The patient together with his or her physician? Or the State?”
Many politicians trumpet “universal healthcare” with emotive plea. “America is the only developed nation whose government does not provide healthcare for its citizens. We should be ashamed!” Yet behind the soaring rhetoric lies this sober truth: Whoever pays holds the power to choose, and the government cannot provide everything for everyone. When the State controls the allocation of healthcare dollars, patients are left with no recourse. Both patient and physician are stripped of their autonomy.
Barbara now understood. When interviewed about the experience she reflected, “To say to someone, ‘we’ll pay for you to die, but not pay for you to live,’ it’s cruel. I get angry. Who do they think they are?”4 The once unthinkable, State-sponsored euthanasia, circled Barbara with unflinching stare.
“We want every American to have access to healthcare.” Who argues with this sentiment? Government compassion sounds so noble when first introduced. In fact, this well-intentioned motive fueled the creation of the State-sponsored health plan that denied Barbara chemotherapy. Even more, this same argument fueled much of the passion behind the federal Patient Protection and Affordable Care Act (PPACA) of 2010.
However, as We the People become more and more reliant on the government, inch by precious inch, our liberty slips away—we become powerless in dependency. For seniors, nothing drives this point home more than the PPACA. Washington cut $500 billion from Medicare simply to say, “we reduced the deficit.” As President Ford once noted, “A government big enough to give you everything you want is a government big enough to take from you everything you have.”5
Seduced by sweet words of compassion, the financial welfare of the State silently usurps the wellbeing of the individual citizen. Secure in the belief that government will care for its citizens, Americans slumber in complacency until one day, when needed most, We the People will awake to find liberty lost.
This is an excerpt from Dr. Gray’s book The Battle for America’s Soul: Healthcare, the Culture War, and the Future of Freedom. To learn more, obtain educational materials, and help the effort to keep patients at the center of American healthcare go here. To learn more about Barbara Wagner and watch her interview go here.
CL Gray, MD
Founder and President Physicians for Reform