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ABLEnews Extra

                        Discounting the Disabled

                                                              Nat Hentoff
          
Sen. Al Gore was right when he said that the controversy over
Oregon's proposal for rationing health benefits is "the single
most important debate on the future of health care in the United
States." (Gore opposes the plan; Bill Clinton supports it.)

The debate is not over. Although the president [George Bush], in
the most humane act of his administration, has rejected the
Oregon plan, there are intimations from below that Oregon may yet
get its way if it can sufficiently cosmeticize its proposal so
the plan will appear to be in consonance with the Americans with
Disabilities Act. [CURE Comment: These prescient pundits were
proven right when Federal protections were waived by the Clinton
administration.]

Disability rights advocates accurately condemn the plan because
it judges the disabled as having a lower "quality of life," and
therefore they fail the cost-benefit analysis that determines
which levels of care will be paid for by Oregon through Medicaid.

The plan covers all of the poor in the state but then removes
from the rolls those of the poor whose treatment is too costly in
that it is not likely to sufficiently "improve" the patient's
condition or is of insufficient value to society.

Those found ineligible thereby save Oregon the money to pay for
those of the poor who are judged to have a better "quality of
life." [CURE Comment: This is what the care-cutters cynically
call "universal coverage."] It is a proposal that Jonathan Swift
might have written.

The attraction of the Oregon plan, of course, is that it provides
health benefits to those now without medical insurance; and if
Oregon is eventually allowed to go ahead, other states will
follow. There is bipartisan political support for the plan, and
the Oregon Medical Association has also approved it.

The increasing number of physicians and politicians around the
country--convinced that money is wasted on people with a low
"quality of life"--might think for a moment on the advice of the
18th century German physician Dr. Christoph Hufeland, who also
was a professor of medicine. A humanist, he wrote on Goethe and
Herder as well as on medicine. Said the doctor:

"If the physician presumes to take into consideration in his work
whether a life has value or not, the consequences are boundless
and the physician becomes the most dangerous man in the state."

In a series of exchanges on the Oregon rationing design during a
recent "MacNeil/Lehrer Newshour," correspondent Lee Hochberg
pointed out that an analysis by the Congressional Office of
Technological Assessment notes that the plan--with its cutoff
point of allowable ailments--fails to treat "a substantial number
of medical conditions that in the absence of treatment have
serious clinical consequences."

For example, pulmonologist Dr. Alan Barker of Oregon Health
Sciences University cannot understand why chronic bronchitis is
not qualified for Medicaid payment under the Oregon plan. Dr.
Barker points out that "chronic bronchitis is clearly a treatable
condition. Medication is important [and includes]
bronchiodilators, aerosol steroids, antibiotics...and
occasionally oxygen that has to be prescribed."

But in Oregon, the poor with bronchitis would have to do without
treatment and in time, their "quality of life" would be abysmal.
Yet, in a lead editorial bitterly lamenting the Bush's
administration's rejection of the plan, the New York Times said
that the Oregon legislature had made "an honorable choice" when
it approved this approach to giving some of the poor the black
spot--for the greater good of the greatest number [CURE Comment:
a form of utilitarian euthanasia]. 

Also on the MacNeil-Lehrer  hour was David Robison, who has AIDS
and has developed cancer. With less than a 10% chance of living
for five years, he would not be eligible for Medicaid in Oregon.

Robison does not see this as "an honorable choice" for him. "So
have we decided," he says, "that if a person has less than a 10%
chance of living five years, that's it, the person's life is
over? I was raised to believe that if a person only has one day
to live, then that one day is very precious to that person, and
no other human being has a right to deny that person one extra
day of life."

And Robison's doctor, David Reagan, adds: "What if he has
treatment, his disease is put into remission, and a year from now
a dramatic breakthrough occurs?...We can't turn our backs on that
group of patients. I think they have a right to try therapy
before it's bureaucratically taken away from them."

A women in Pennsylvania once told me of an ancient folk saying:
"Once you put a price tag on a person's life, inevitably it will
be marked down." Not only marked down for a particular individual
but for those throughout the society who have to depend on the
state for health care." CURE Comment: CURE believes in fighting
for one we fight for all who wish to live against the odds.

[Putting Price Tags on Lives in Oregon, Hentoff, op-ed, 8/18/92]




