Monday, October 26, 2009

Randy Stroup, Barbara Wagner and the Misconceptions Surrounding End of Life Care.

Many opposed to health care reform have grabbed with both hands the cases of Barbara Wagner and Randy Stroup as examples of how "government run" health care preys on the elderly, terminal, and infirm. Their fascination with these two cases comes in part from their occurrence in Oregon, a state where Death with Dignity has been law since 1994.

Death with Dignity has long been opposed by "pro-life" groups as removing jurisdiction over suffering from God. Only God, they contend, may decide when life ends. This requires their application of complicity with God to medicine and the state, when it is on their side (as in Montana where constitutional aid in dying is being contested before the Supreme Court).

Where the state supports end of life choice, opponents to health care reform and Death with Dignity have worked to undermine it. Back to Barbara Wagner and Randy Stroup. Both were denied expensive treatments by the Oregon Health Plan because the treatments promised less than 5% efficacy over 5 years. OHP is notoriously poor at delivering bad news - just as doctors are! - and have been deeply criticized for offering Wagner and Stroup other options: palliative care, Death with Dignity, and hospice care. (I address the case of Barbara Wagner in my latest article for AlterNet on rationing.)

Because few understand what palliative care is and associate hospice care with euthanasia or "giving up" on a patient, these two cases have been used to bolster the fear that the state is not competent to manage health care services.

Firebrand, though an opponent of Death with Dignity, takes RedState to task for their use of Stroup as an example of "The Barack Obama's America.

There is another point about Mr. Stroup’s experience that was not made clear at RedState or at the Fox story RedState linked. The Oregon Health Plan does not offer terminally ill patients a choice between no medical care and State-paid physician-assisted suicide. Rather it offers terminally ill patients “comfort/palliative care” and - despite the title of my post (taken from the Fox story) - comfort/palliative care is medical care.

And shoots down the misconception that "rationing" doesn't and shouldn't exist:
The Oregon Health Plan is attempting to conserve a scarce resource: tax dollars available to fund health care for the poor and uninsured. The government of Oregon realizes that if agrees to pay for very expensive treatments with very little chance of success it will have to do one of two things: provide care to fewer poor and uninsured people or raise more money for the Health Plan through higher taxes. By focusing on physician-assisted suicide and failing to consider the broader offer of palliative care, the RedState story insures that anyone who reads Mr. Stroup’s story will insist the State should have paid for Mr. Stroup’s chemotherapy - and that their failure to do so is a condemnation of government-run health insurance.

Yet this formulation obscures the issue that is really at the heart of this story: are we willing to spend whatever amount of money it takes to make sure that everyone gets every possible treatment?

Posts like Firebrand's should be spread far and wide. The conflation of "rationing" (as something only employed by government-run health care plans) and euthanasia, Death with Dignity, or even hospice, palliative care and end of life choice is a ploy by health care reform opponents. They have long underfunded palliative care because it doesn't pay like ICU or hospital care (see my prior post). Hospice organizations rely on volunteers and bake sales for their funding.

The religious right is being used by the corporate health care industry to railroad reform. For their own ideological purposes, they are more than happy to complicitly spread lies about the cases of Stroup and Wagner.

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