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Matters of Life and Death Essay

This case surrounds the controversy brought about by the Arizona state legislature defunding life-saving organ transplant operations. In 1987, the Arizona state legislature voted to eliminate funding for most organ transplants for the indigent through the Arizona Health Care Cost Containment System (AHCCCS). At the same time of this decision, the legislature voted to extend health coverage to pregnant women and children in a “notch group.” The public controversy began when Dianna Brown died after being denied coverage for a liver transplant that would have saved her life. After her death, there was wide spread coverage of the issue that brought the defunding of certain organ transplants into the national spotlight. The decision to move funds for the poor to mothers and children rather than to life-saving transplant services put the legislature under scrutiny. This case presents that scrutiny and the legislature’s reasoning behind their decision.

III. Required Methods
In order to complete this analysis, I will have to deal with issues dealing with cost/benefit thinking in a context of fairness dealing with medical procedures. I will need to look at whether or not moving funding from transplants to mothers and children did something financially astute for the state of Arizona or if this is a case of mismanagement by the government. I will also have to deal with the issues of limited public resources, growing costs of medical technology, and diminished control of medical services.

IV. Analysis
Question 1: Was the Arizona legislature right in deciding not to fund certain kinds of organ transplants for indigents under the state’s indigent health care program? I believe that the Arizona legislature was not right in their decision to not fund certain kinds of organ transplants. In this case, there
are several issues that arise including the concepts of distributive justice, cost-benefit analyses, and the role of government in society. The fact that the legislature looked at the increased number of organ transplants and the growing costs associated with them and compared them to another development in the state’s health care system does not seem fair. By defunding the organ transplantation services, they took away the right to choose from individuals in life threatening situations. With costs being a driving factor behind this decision, it was questioned whether the state should be spending so much on high risk, high cost procedures. In the case, there was an excerpt that explained the money-making aspect of the health care system. “If it was a pure concern about the medical needs out there, we’d have far more burn units than we have transplant units. The reality is they make money on those units.” I do not believe this is how the health care system should be run. Whether it is political or judicial pressure, there is too much political influence in the health industry. There is the argument of transplantation services being more readily available to those with money and political connections, but I feel that policy should be able to set specific guidelines by which all of this can be overridden. I understand the fact that if you are to make exceptions in certain cases you are starting down a slippery slope and that initially, the decision to either have transplant services or to do away with them completely was somewhat justified. Further, the decision to fund only the most cost-effective services was also justified. Everyone had a fair shot at services if they needed them. When services began being compared to each other is where I have a problem. There is no way to justify comparing deliveries to transplants. In one analysis, Shaller compared the costs on society from a bad child to a transplant. In the end he came up with the fact that the cost of 8 heart transplants would cover 700 deliveries. He said “in public program, that has the widest range of responsibilities, and limited resources to handle those responsibilities, I think it’s unacceptable to use those limited resources in a way that really doesn’t further the public good.” I can agree with this statement but still do not feel that the personal health choices that can save an individual’s life should be left in the hand of a capitalistic government. In rebuttal to the governmental policies and financial analysis, Dr. Copeland argued that even
if the AHCCCS were to deny funding to transplants, the health care system would still end up incurring costs associated with hospital costs till death as well as social security benefits to the families of patients who die without receiving a transplant. Also, he mentioned that Medicare would soon approve his transplant center as one of the 10 in the country to be covered. This came under much scrutiny and in the end a compromise was reached to look at each by a case-to-case basis. After the drama surrounding Diana Brown’s death, it was the opinion of the Arizona legislature that it would make the decision that would most benefit the residents of Arizona. In the end, “the public generally is not willing to, say, double the taxes in this state to insurance that everyone got the maximum possible health care.”

While the decision may have had justifications by the state legislature, completely defunding organ transplantation services takes away the rights of patients and makes it so that health care is a privilege. I do not believe this is how health care should be. With so many changes being discussed simultaneously, this issue seems to have slipped through the cracks and caused unnecessary deaths to patients who had their right to life-prolonging health coverage denied in order to fund a “notch group” that had household incomes higher than the AHCCCS maximum but were below the official federal poverty line. This does not seem ‘fair’. In the end this case asks many ethical questions dealing with fairness and equality as well as whether access to health care is a right or a privilege.

Question 2: On what principles do you position in the answer to question 1? (As an example, do you consider health care a right, and if so, why?) I believe that health care is indeed a right. Especially in a country like the United States where health providers and insurance companies are big business and make huge profits each year while millions may suffer from their lack of coverage or inability to pay. In the US, healthcare providers charge premiums on insurance. Whether or not they chose to cover a condition is largely up to them and in the past few years, insurance companies have tripled their profits. “According to the World Health Organization and the Physicians for a National Health Program, the United States spends twice as much per capita on healthcare compared to other countries such as Canada,
Britain & Germany, who have universal healthcare.” According to statistics, in other countries with universal healthcare, there is less bankruptcy and better economies. I believe that there is too much political and outside influence in health care and that the industry is more of a money machine than anything. With the economy in a slump and an exceedingly large population not being able to afford health insurance, I believe that those individuals have a constitutional right to receive care that will prolong life. Laws regulating health care serve to benefit the population, not punish it. With so many gaps in the system nowadays, the ACA being upheld shows that the government believes that everyone should have equal access to healthcare. Providing health care to all benefits society by providing those with an opportunity to normally operate in society and benefit society through work, social, or economic aspects.

Question 3: What roles do economic and financial analyses play in your position on the state’s responsibilities?
While the state has a job to provide care to its citizens, it is also obligated to maintain financial stability within the state and contribute to its infrastructure. A cost-benefit analyses of moving funding from organ transplantation services to the “notch group” of pregnant women and children shows that while looking at services offered, the state will be able to control their overall costs. In situations like this where the healthcare system is often viewed as a money machine, it is almost impossible to overlook the exceedingly high costs of transplants. In one analysis, Shaller compared the costs on society from a bad child to a transplant. In the end he came up with the fact that the cost of 8 heart transplants would cover 700 deliveries. He said “in public program, that has the widest range of responsibilities, and limited resources to handle those responsibilities, I think it’s unacceptable to use those limited resources in a way that really doesn’t further the public good.” While this analysis has many problems with it, the financial and economic implications are exactly what a business would want. By cutting, the high-risk, high-cost procedures, the state would be able to begin making money from the health care system. While I can understand the business aspect of health care and understand that economic and financial analyses play a large role in allocating resources and money
towards services, I still feel strongly that healthcare is a right, not a privilege. The state has a responsibility to maintain financial stability. In this case, stability was enhanced by cutting services to transplants and focusing on individuals that would be able to give back to society over a longer period of time.

Question 4: How does the analysis of this case inform your position in the current debate about health care reform? This case has made me think of the question can medical services ever be rationed fairly. The Patient Protection and Affordable Care Act (ACA) which was recently passes should accomplish a lot of good for the greater portion of the population. It will not only reduce the number of uninsured but also protect those at risk of losing coverage. Additionally, the ACA aims to reduce health care spending and reduce costs for patients. This plan will not only extend coverage to those that may not be able to afford coverage, but will also aim to try and cut costs for the health care industry. This is a fusion of two of the debated points in this case. In the case, we looked at cutting funding from one service in order to provide services for another set of the population. The ACA aims to try and provide services and coverage for all. Overall, there are many questions that this case made me think of regarding the Affordable Care Act. I was not fully aware of the health industry being a big money business and how much of a part politics played in it. Additionally, the case opened my eyes to the fact that no matter what is done, not everyone is going to be satisfied or comply with the new policies. There are always specific cases that will cause questions to be asked, but if exceptions are made, then there will have to be exceptions in every similar case. The current debate about health reform addressed these questions and now that the ACA will remain in effect, it is still to be seen the impact that this makes on not only the economy, but also how it affects the rights of Americans to utilize healthcare.

V. Recommendations
After reading through this case and thinking about the financial issues presented in the case, I understand the financial and economic issues that have to be addressed while also considering providing the best care for the
greatest number of people. In order to decide cutting services, this case addressed governmental policy that may cause unfavorable health decisions to pass in order to remain financially stable. In the end, I believe that health care is a right, not a privilege and the decision to life or death should never be put in the hands of a third party or up to money. The right to decisions about life and death should not come down to how much money you have, but should be a human right that is extended to those in need.

VI. References
HHS Gov. “Through the Affordable Care Act, Americans with Medicare will save $5,000 through 2022.” United States Department of Health and Human Services. N.p., n.d. Web. 11 Nov. 2012. <http://www.hhs.gov/news/press/2012pres/09/20120921a.html>

“The Health Care Law & You | HealthCare.gov.” Home | HealthCare.gov. N.p., n.d. Web. 11 Nov. 2012. < http://www.healthcare.gov/law/index.html>

Houseman, Michael . “The Health Care Law & You | HealthCare.gov.” Home | HealthCare.gov. N.p., n.d. Web. 11 Nov. 2012. <http://assets.wharton.upenn.edu/~housman/files/UrbanInstitute.pdf>

VII. Lessons Learned
I enjoyed doing this case report as it dealt with many issues outside of finance as well as important financial issues. In order to complete this analysis, I had to deal with issues dealing with cost/benefit thinking in a context of fairness dealing with medical procedures. I looked at whether or not moving funding from transplants to mothers and children did something financially astute for the state of Arizona or if this is a case of mismanagement by the government. I also dealt with the issues of limited public resources, growing costs of medical technology, and diminished control of medical services. In the end it was a decision that would have to either be based on financial considerations, ethical considerations, or a mix of both. A lot of the issues in this case have also been discussed in my
public health ethics class this semester, so this case allowed me to utilize knowledge from other classes along with new financial concepts in order to do my analysis. Whether it is fairness or equality or even cost-effectiveness, there are problems that arise with each approach when used alone. From a financial standpoint, using cost effectiveness analysis is very important in determining social policy matters even with its downfall that it cannot suggest how priorities are set. I would have liked to deal with some numbers associated with cost-benefit analysis just to see how they were done but I was able to understand the basic principles behind the theory through my analysis on this case.


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