Wednesday, November 17, 2010

Liver Transplant Denied Medicaid Patient

Medical Quack, a blogger/tweeter on various topics, posted a story about a man who was denied a liver transplant in Phoenix. Due to budget cuts, Arizona Medicaid recently decided not to pay for such transplants for patients who had liver failure due to hepatitis C. The hospital would have had to absorb the cost of the procedure, estimated at some $200,000 to $500,000, and a hospital spokesman pointed out that there are 22 other patients with Medicaid on their liver transplant waiting list. The local news reports deplored the situation as did Medical Quack.

This is a sad story but what is the solution to the problem? Who is going to pay for this man's (and the other 22 patients') liver transplant? Both the news reporters and Medical Quack did not offer any suggestions. I have always been amazed that people seem to believe that the money will appear like magic. The fact is that health care for people without money has to be funded by people with money. It can come from taxes, surcharges on insurance or whatever. The reality is that some degree of health care rationing is inevitable, especially in a down economy.

Other ethical questions to ponder:

What if the patient had been an illegal alien lacking even Medicaid coverage? Should the taxpayers foot the bill? The cost of care of illegal aliens has been paid for by the taxpayers or absorbed by hospitals for years but how much longer can it continue?.

Did the Phoenix patient acquire hepatitis C while abusing drugs? If so, should it matter? Should the taxpayers have to fund all of his medical care including a liver transplant?

Should the taxpayers have to pay to support people who abuse themselves by using drugs,alcohol or tobacco? What about obesity? Somewhat of a precedent exists regarding alcohol. Over 2/3 of states still have the Uniform Accident and Sickness Policy Provision Law on their books. This law permits insurers to deny coverage for any policyholder who is injured while under the influence of alcohol or narcotics. I recently participated in the care of a patient who was readmitted to the hospital for the umpteenth time with acute respiratory failure secondary to chronic obstructive lung disease. She is on oxygen at home and continues to smoke. Yes, it can be done. She removes the oxygen tubing and lights up.

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