Sunday, July 26, 2009

Life and Death Decisions

One of the concerns that people express about reforming health care is that the government will be making end-of-life decisions.

First of all, for the majority of people facing these issues, the government is already involved through Medicare.

But for those facing these issues before they reach senior citizenship, consider the following:

(o) Most medical protocols require the involvement of medical ethicists in making these decisions, as well as others. So ethical guidance is usually provided.

(o) Private insurers are already making these decisions, and they’re not always in favor of the patient. Consider the case a couple of years ago, in which Aetna (it might have been Cigna) refused a liver transplant to a young woman, claiming it was experimental. Their former Director of Communications later admitted it was merely a cost-saving effort. Although public pressure forced the insurer to reverse its stand, such a situation was exceptional.

(o) Doctors make these decisions on-the-fly in emergency rooms all the time, often without consulting either the insurer or the patient, because of a lack of time.

All of that said, all of the proposals on the table for health care reform preserve the right to private insurance, if the patient so wishes. What it does, however, is ensure that the patient has coverage for pre-existing coverage, and won’t lose it should a serious condition continue.

On the witness stand before Congress, the leaders of the major insurance companies could not promise that they would do that without being forced to by law.

In other words, for those of you worried about preserving your options, just remember—under the current system, your options can be dropped the moment some number cruncher in the insurance company decides you’re too expensive to insure.

As David Brooks wrote in his Friday column in the New York Times, it's time to overhaul the system.

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