Healthcare Armageddon 2

New Year’s Can’t Stop Healthcare Armageddon!

This a follow up to a previous post about the Arizona legislature’s decision to stop paying for certain transplantation procedures for Medicaid patients.

As predicted, the shit has hit the fan for the both the medicaid recipients who lost funding for their transplants and the legislators who did the cutting. News about the cuts for transplantation funding has been disseminated  via news outlets and the blogosphere, indeed a google of “Arizona transplant” hits npr, cnn, huffington post, the wall street journal, and the new york times. The reason this  debate occupies drive space on this server has little to do with the ethical  dilemma, nor because of the people it will so dramatically impact.  It interests me because I think it is emblematic of the coming debate over the next several years. As the states start to finally and realistically look at the huge clusterf$#k that is their unfunded liabilities and the skyrocketing costs of healthcare, there are going to be increasing turf wars over what will be covered and what the transaction price will be. If what has transpired so far in this debate is what we can expect from both our legislators and ourselves as healthcare professionals, well then we’re screwed.

My beef here has not been with either the patients or the legislators, both sides seem to have legitimate concerns that have yet to be fully addressed. No, our beef here is  with our own medical societies who provide little constructive input other than screaming and hollering about funding cuts to our particular piece of the pie.

Enter Exhibit A: Dr. Michael Abecassis, President of the American Society of Transplant Surgeons has taken up the call to war, and in this instance has essentially become the voice of physicians in this debate. Among statements to the media, Dr. Abecassis has said that the situation “focuses our attention on the rationing debate”

. . . ya, you heard right. The dude used the “R” word.                                                                  

In addition, on a conference call with some of the Arizona representatives he told them that “the rationale for this is stupid” as it was based on faulty data. Needless to say, the call did not go well.  While I probably would not have made these points as eloquently, the surgeon does have a point.   

It is becoming increasingly evident that the legislators used data which was out-dated to make some of these decisions. How out-dated? Well, out-dated enough that even the authors of the study that was referenced were crying foul. The legislators did appear to consult some experts on heart, lung and liver transplantation. The heart transplant expert’s advice was that the transplants are indicated when patients “meet criteria” and when “all other medical and surgical modalities have been exhausted” To which I can only imagine the Arizona people replied “huh?” The consultants for the liver and lung transplants are hiding somewhere in the Degobah System and have not been heard from. 

Fortunately, the cutting sundevils were presented with a new and presumably more robust dataset on transplantation outcomes. Whether that presentation included any sound medical advice other than “don’t cut anything” is unclear, as it was presented by a consortium of Arizona transplant centers, who appear to have the most money to lose if the cuts remain in force. Another question is whether the Arizona legislators unwittingly used flawed data which led them to flawed conclusions, or whether they used flawed data to justify predetermined conclusions.

What is clear from this whole debate is that there is no clear system for legislators and the medical community to work together to determine where the inevitable budget cuts should occur. And because of that, I think we will be revisiting this scenario again in the not-too-distant future.

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