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Arizona Governor: No to Medicaid Transplants

Discussion in 'Political Discussion' started by scout, Nov 24, 2010.

  1. scout

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  2. Real World

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    I'd personally prefer to see ( and I'm not sure why they didn't) a few million bucks slashed elsewhere, than there, but I'm not from there so I'm not sure why that wasn't the case. What this does point to though, is the "death panel" angle of gubmit care. To keep costs in order, it will be decisions like these that have to be made. Questions like whether or not it's viable to spend $500k dollars on a transplant for a patient who has a 10% chance of surviving the operation, and only so for a limited time should he. As a human being I want everyone to live, but from a non emotional standpoint, is that realistic? At what point do you say the cost for X treatment isn't worth it? I know this sounds inhumane, and barbaric, but it's a legitimate issue none the less.

    It's easy to say that at some point a line does have to be drawn in the sand, in order to keep the costs remotely managable, when you're not in need of urgent care. If you're one of these 98 people, or their family, you obviously won't see it that way. Nor would you/I/anyone see it this way if we/me/anyone was old, or in need of risky treatment in order to stay alive. This is one of the biggest conundrums that HC reform faces. Where do the moral obligations stop, and the fiscal limitations begin? Or should there even be any?
  3. Michael

    Michael Moderator Staff Member PatsFans.com Supporter

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    And now for some facts:

    The cuts represent a savings of about $4 million per year, AHCCCS officials say. AHCCCS spokeswoman Monica Coury said her agency had the "horrible task" of putting together benefit reductions, and that the transplants affected represent a small number of patients....

    A lung transplant does not cure cystic fibrosis, Coury said.
    "Patients with cystic fibrosis who get a lung transplant might get extra time with a good quality of life, but inevitably the CF will reinfect the new lung," she said. "It's a horrible discussion to have, but that's the situation."
    A University of Arizona College of Medicine report from earlier this year said 78 AHCCCS patients statewide were waiting for a transplant that won't be covered. But Coury believes 78 is a misleading number.
    "Not everyone on that list is going to get an organ anyway," she said in an e-mail. "There is a shortage of viable organs for these folks waiting on the list."
    Coury stressed that AHCCCS is still covering transplants that have what the agency says are good success rates. All transplants for children will still be funded, she noted.

    Transplant dream fading

    Keep voting for Obama care. It will get muuuuch better. :rolleyes:
  4. Mrs.PatsFanInVa

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    Apparently a roof was more important.

    These Republicans could have covered the shortfall by directing funding from the Stimulus for this life-saving program, but chose instead to spend over $1 million in Stim money to repair the roof of a sports stadium. What’s worse, had they applied the Stim money to save the transplant program for the uninsured, the state would have been eligible for an additional $15 million in matching funds from the federal government.

    Pensito Review GOP AZ Gov Brewer, Legislature Kill Transplant Funding for Uninsured – Republicans’ ‘Death Panel’ Selects Who Will Die Based on Income
  5. scout

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    I guess it only matters when a tragedy hits home to count. Let's not give a transplant to a CF patient, because eventually they will need another transplant. BTW, the CF disease gets no funding from the government. Not enough patients.
    It's only a matter of time before someone combs through the Arizona budget and finds items containing waste.
    As for you "facts", how do you know? Saw a show the other night where a major health care professional (Signa) apologized to Michael Moore for his blatant distortion of facts and attacks on Moore's movie Sicko. Of course, let the campaign begin to damage this person's reputation.
  6. Mrs.PatsFanInVa

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    Let's not also forget that they are denying bone marrow transplants, also, which have a 45% long term survival rate.
  7. Real World

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    Not exactly.

    I'm not trying to be insensitive or anything, but the use of "some" would indicate that only certain bone marrow transplants are being denied. Probably for similar reasons, i.e. survival rates.
  8. Mrs.PatsFanInVa

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    AHCCCS no longer funds non-relative bone-marrow transplants, along with lung transplants and certain types of heart, liver and pancreas transplants.

    AHCCCS says the benefit reductions were made based on studies showing they would affect the fewest people or, in the case of transplants, represented the least effective treatment.

    But Schriber says lawmakers based their decision to cut the transplants on flawed data from AHCCCS, which showed that no patients had survived beyond one year following the procedure.

    Schriber, director of the state's largest adult bone-marrow transplant program at Banner Good Samaritan Medical Center, has been trying to alert Brewer, legislators and AHCCCS officials since last year that his own data show a 42 percent survival rate for his patients over the past seven years.


    Arizona Democratic Party: AHCCCS memo from 2007 said transplant cuts could kill; special session mulled
  9. lostjumper

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    There is alot more to deciding who does and does not receive a transplant than money. It's going to become a higher part of the equation due to the rationing of care that is coming, but right now its a very small part. You're wading into a discussion that you most likely have no idea about.

    They have to consider the age of the candidate, relative health, the disease/incident that caused the original organ to fail, their lifestyle, and their blood type and antigen match. Then they have to match up a donor. For Bone marrow, liver, and kidney you can have a live donor, which they are saying they will continue to cover. That ups the success rate dramatically. But that 78 figure is most likely a misleading number. It's probably a couple.
    Last edited: Nov 24, 2010
  10. Mrs.PatsFanInVa

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    There are 98 people in Arizona who have been affected by this law. All 98 of them were already accepted into transplant programs and were on the waiting lists. I assume, therefore, that they had already met all of the criteria necessary, such as age, relative health, disease/incident, etc., which are deemed necessary to be enrolled in a transplant program.

    It follows, logically speaking, that the only reason they are being denied is financial.

    As to the live-donor marrow transplants, they are no longer covering non-relative live-donor transplants.
  11. lostjumper

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    You are incorrect in your assumption. Just because you are on a transplant list does not mean you are guaranteed a transplant as long as funding is there.

    Truthfully, its a case by case call. Since this is all Hippa protected, we'll never really know how accurate this is.

    I wonder when we'll start to see people taken off of dialysis machines? That treatment is expensive, and if its not being used to carry someone over until they get a transplant, should it be used only to extend someone's life? Ahh, the decisions that need to be made when healthcare is rationed!
    Last edited: Nov 24, 2010
  12. DarrylS

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    Gee that sounds like a death panel, who decides who lives and who dies???
  13. Mrs.PatsFanInVa

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    Getting on a list means you have been pre-screened and have met all necessary criteria. I never said anyone was guaranteed a transplant simply because they were on the list - of course their condition could have changed in the meantime, the donated organ needs to go to the most compatible recipient, the area you are in will matter, etc.. However, getting on the transplant list does mean that you are guaranteed a chance......which is what the people who have been taken off the list due to their financial status in Arizona are being denied.

    To be included on the national waiting list, a patient must first find a transplant team that will treat him or her. The transplant team, a group of surgeons, nurses and other health professionals at a hospital, evaluates the patient to decide whether he or she is a good candidate for transplantation. In addition to assessing the patient's physical condition, the team will consider the patient's attitude, psychological state and history of drug abuse, among other factors. Donated organs are a rare and precious commodity, so doctors don't want to proceed unless they are confident that a patient is physically and mentally prepared for the procedure, as well as life after the procedure. For the most part, patients who are unwilling to give up unhealthy drugs, including cigarettes and alcohol in many situations, will be automatically disqualified.

    If the transplant team feels that a patient is a good candidate for transplant, they will contact the UNOS Organ Center in Richmond, VA, in order to put the patient on the national waiting list. The Organ Center operators record all relevant information about the patient, including his or her physical condition, blood type, tissue type and age. This information is entered into the national database.

    When an organ becomes available (when an organ donor is pronounced brain dead at a hospital, typically), the local organ procurement organization (OPO) will gather all relevant information about the donor and enter this data into a program maintained by the UNOS Organ Center. Based on the criteria established by the UNOS board of directors, the program generates a ranked list of potential recipients. The criteria involves several factors, including the physical compatibility between the donor and the recipient, the health of the recipient and how long the recipient has been waiting for an organ. The purpose of the criteria is to choose a recipient who is a good match and stands a good chance of recovery, while also taking into account who has been "in line" longer.


    Discovery Health "Getting on the List"
  14. Real World

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    And Mrs.DB poster strikes again. Ah, the Dem party memo. Nice! I got mine from the OP's article.



    Read more: AHCCCS budget cuts cost Phoenix-area man his chance at liver transplant

    Arizona Budget Cuts Put Organ Transplants At Risk : NPR
  15. Real World

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    Ultimately it will be a bunch of suits who sit in a room, crunch a bunch of numbers (data), and then determine an arbitrary set of rules & cut offs for care. The term "death panel" basically refers to this process. It won't be strictly relegated to life and death treatments either. It will be things like knee surgeries, hip replacements, MRI's, etc. All types of treatments and conditions will be analyzed, so that dollar efficiency versus need is best maximized. They already do this overseas, and to an extent, here. It's the only way to keep costs managable. It's the part of the issue that no one likes to talk about. Understandably so.
  16. Mrs.PatsFanInVa

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    Yes, I know...and "some bone marrow transplants" are those which come from an unrelated donor, as the article I linked to explained.

    And bone marrow transplants from non-related donors have a 42% survival rate.

    From one of your own articles:

    The state's data also show the procedures have poor outcomes and that most patients die after the transplants. But critics say the data was cherry-picked, as it included only patients enrolled in AHCCCS and only for a two-year period.

    A coalition of Arizona transplant centers, including well-known programs at the University of Arizona and the Mayo Clinic, recently gave the state data for a broader patient group and a longer time period. It showed much better outcomes.

    State Rep. John Kavanagh, a member of the House Appropriations Committee in the Arizona Legislature, has looked at the new information.

    "It's a terrible situation," Kavanagh says, "but we don't want anybody to die because of a faulty data set. So if we made a mistake, we're [going to] reinstate those that require it."

    Kavanagh is promising a hearing when the Arizona Legislature convenes in January. He says the state can cut the money somewhere else.

    Meanwhile, one patient has found a private bone-marrow donor.

  17. Real World

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    Some, some, some, some, some, some, some, some.....
  18. Patters

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    That's terrible. If the cuts amount to about $4,000,000/year, as Michael's link shows, that means that the right wing is so awful that for 75 cents a person, they would not want to prolong the life of someone's dad or child. It's immoral. The the right wing could justify the early death of someone so they can keep an extra 3 quarters in their pocket, just shows how badly miserliness and avarice have corrupted their sense of responsibility and of human decency.
  19. lostjumper

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    you're right. It's certainly more moral to go the left wing way. Destroy our children's future by stealing their money and putting the coming generations into massive amounts of debt that they can never get out of. Patters, you can't pay everything for everyone. The government simply can't do that. Where do you draw the line? You have no sense of morality or decency in your twisted logic.
  20. Patters

    Patters Moderator Staff Member PatsFans.com Supporter

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    Yeah, you have really good evidence to support your point of view. Just think how your grandparents destroyed the future of your parents and your parents destroyed your future, all because of deficit spending. The country has really declined since the good old days when people worked longer hours, lived shorter lives, and had fewer rights.

    As far as where you draw the line, you draw it where it makes sense. It's expensive to run a great nation and the fact is that taxpayer dollars are returned to the investors, who invest in those companies that directly or indirectly receive taxpayer dollars. So, you implement a more progressive income tax like we used to have under the good economies of Eisenhower (93% top income tax bracket), Kennedy (70% top bracket), and so on. We can and should pay for a lot more than we do. For instance, we should have much more job training and paid job programs for the poor and disabled, but welfare is a lot cheaper.
  21. Patsfanin Philly

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    Absolutely and one of the reasons that the centers are so selective is the allocation of a scarce resource. Currently there are 16,000 people waiting for livers, 80,000 waiting for kidneys and 3000 for hearts. Forget about left/right or death panels, decisions are currently being made on what is he best use of a donated organ so that it doesn't go to waste.
    You have to be sick enough to need an organ and get on the list but not so sick that the organ will fail. You need a tissue match so it is likely to succeed and you have to hope that some family in your geographic area, in their darkest hour of a tragedy chose to give the gift of life to others.......
    Been there, done that..........

    SRTR -- Fast Facts About Transplant, Scientific Registry of Transplant Recipients
  22. Patters

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    With transplants there is a legitimate need for a lot of selectivity, but it's a shame that now some poor people will be excluded, and to think some of those poor people may be people who made enormous sacrifices in their lives to do good works. But, that's Arizona, and perhaps there people are more avaricious than elsewhere. Perhaps there, there are fewer brave and compassionate families willing to give someone the gift of life, especially if that person only has Medicaid.
  23. Mrs.PatsFanInVa

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    Thing is.....just because a person is on Medicaid doesn't mean he/she is a life long deadbeat as so many here seem to think. Chances are a person waiting for a transplant is/was very much just like "we" are.....a working man or woman, the child of a working man or woman. A homeowner, taxpayer, church-goer.

    People don't usually just one day wake up and need a transplant. They've usually been sick for a very long time and it takes years or longer of being chronically, catastrophically ill before you actually reach the need for a transplant. Long enough and sick enough to have lost their job and their insurance - hence the need to go on Medicaid in the first place.

    Truthfully, cardiomyopathy because you had rheumatic fever as a child, liver failure due to an adverse reaction to a prescribed drug, kidney failure due to diabetes, leukemia from just plain bad luck, lung failure due to pulmonary hypertension - any of these things could happen to each and every one of us here - at any time.

    Do you think you don't deserve a transplant, either?
  24. Real World

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    Most people are still going to get transplants. It's some of those who have extremely low rates of success that now won't. That's absolutely tragic, and I do wish they'd cut the money from somewhere else. Maybe they cut money everywhere (they have a $1.5 Billion deficit), and this is a must. I'm not from there so I don't know.

    How about deporting the illegals, so that Americans in need can have these transplants? I'm sure illegals in that state use up more than the $5 million annually this cut is supposed to save.
  25. scout

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    As everyone knows, but not all will admit, somewhere in this dilemma politics is playing its ugly game. Arizona has a $1.5 Billion deficit, yet, I bet some individuals or corporations are enjoying perks or subsidies at the expense of those individuals on their death watch. Illegals may be costing Arizona millions. Want to bet that there's plenty of businesses employing those illegals and heads are looking the other way.
  26. Wolfpack

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    The number one problem with the health care debate is you always have people, such as the writer of the OP's article, doing everything they can to make it an emotional issue instead of a logical one - which includes throwing in a few grossly misleading "facts".

    The number two problem with the health care debate is all the liberals who think we have a bottomless supply of funds and resources.
  27. PatsFanInVa

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    LMAO... let's see, WP, you can't handle logic, and you don't like emotions. I dunno what's left...

    Moving on to the subject it's ownself, vis., is it good or bad to kill people for 52K a head, or is it good to charge 75 cents to each taxpayer to not kill them? I would say the latter. I would say that if we all had a veil dropped over our personal situation, so we didn't know how the lottery would turn out (as in fact we don't, but so we don't mistakenly believe we know how the lottery will turn out,) we cough up the 75 cents.

    But that's not how it works. We have emotional appeals, my rightie friends, to putting on three cornered hats, because hating the poor is patriotic if you filter it through silly signs about the constitution and about how the real reason for the American Revolution was taxation (without regard to the issue of representation.) We have demonization of the populations that get these transplants, despite the fact that it can (in the Real Real World,) be any of our fates.

    It's grotesque. It's third-world thinking.

    Pay. Your. Share. Stop bleating slogans about deficits at precisely the wrong historical moment to bleat those slogans. Stop bleating about tax cuts incessently -- they are good temporarily but are killing us long-term, and have been for at least thirty years. MY GOD, yes, I did include the Dems in that. They can get elected giving the children candy too.

    There are, in Washington, a variety of values-of-human-life. We shouldn't be surprised such valuations are made.

    Basically, for various purposes, you make a regulation if the cost to commerce is less than $X per life saved. I worked for an agency where that number was in the single-digit millions (I believe around 4). That agency dealt with safety. These numbers are not state secrets, though I don't know what wonky website you go to to find them.

    In any event, what that means is that if I inconvenience CorporateCo for $100 million worth of accomodation to regulations, I damn well better save 25 lives by doing so.

    If you are shocked by the math of safety regulations, I suppose I can understand that point of view. Hell, I might even support it. I don't know how I'd make public policy without said numbers - not that I make policy now, please understand; I am a mere ink-stained wretch - but that's how it's done. That's how it's probably done most places.

    So if I inconvenience a corporation for $4 million, statistically, that's got to save 1 life.

    Seems to me that saving 98 lives for $5 million is a bargain.

    So even if you don't mind that governments put a price on human life, the question is why they are putting such a low price on human life in Arizona.

    To the comment on "death panels" (oh btw, there's a nice emotionally neutral term,) these individuals had already been condemned to death by the private-pay system.

    So, the answers are either that:

    A) they are condemned to death by the private-pay system, so they should die, because it costs too much for people to live, or

    B) They are condemned to death by the private-pay system, and you support government-paid health solutions, i.e., you don't allow the system to let them die for monetary reasons.

    If you are really against "death panels," in other words, your stance is that the state should pay any amount of money to save a human life (or of course, that the medical establishment should work for free.)

    You can't simultaneously support a requirement that nobody die (i.e., eliminate "death panels,") and support letting someone die (i.e., support the outcome in Arizona.)

    The only way around "death panels" is uncapitated costs, ad infinitum, born by the state, and funded by the taxpayers, extending every life for the maximum length of time.

    Regrettably, I am more fiscally conservative than that, ultimately. Realistically, one has to be at some point. Is that point 52K per life, in such low-probability outcomes? I don't think so.

    So what do you guys support -- higher taxes and deficits, or death panels?

    PFnV
    Last edited: Nov 24, 2010
  28. scout

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    Let them eat cake.
  29. Wolfpack

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    Just because you and your wife can't think logically doesn't mean the rest of us can't. Heck, I don't think either of you would recognize logic if Mr. Spock himself prepared your bacon and eggs breakfast tomorrow.
    Ya, it's ridculous, moronic hyperbole like this that make the subject so difficult to discuss for the rest of us who want to have a serious and intelligent conversation on the topic.
  30. PatsFanInVa

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    Yeah, "we can discuss these issues without being uncivilized". - Robert Gibbs

    YouTube - Townhall Fights - What Are They So Angry About?

    Leaving aside the absolute hilarity of righties lecturing about "moronic hyperbole" after calling health care reform "death panels," how's about you square the circle, Captain Logic?

    1. If there's no government health care, state, federal, etc., death panel by income is in effect. I understand some utter idiots here think insurance itself is immoral. In that case, pretty much everybody but the super-rich goes without health care at this (transplant) level.

    2. If there are government pays for health care, someone gets the government health care pay for service. When we are talking life or death, we mean somebody gets to live who would otherwise die.

    In other words, from the set of those who will otherwise die: Someone picks who lives. Otherwise everybody dies.

    Now, we have a case where a suitably Republican state is deciding that 75 cents per Arizonan is too much to save 98 lives.

    Now then, Mr.Spock, it would seem that Arizona has capitated its costs, and declared the 5M to keep 98 people alive to be too much. They have convened a death panel, by the right's rhetoric, and sentenced these people to death, by the right's rhetoric. They pulled the plug on grandma, by the right's rhetoric.

    So, wolfie, the man who puts the "silly" back in sylogism, how is it emotional to state the fact of the matter, that we are talking about precisely the same case as was shouted about at length in 09, with the righties diametrically opposed to the very position Arizona is presently taking -- when, in fact, their betes noire in the government were in fact not doing it?

    And exactly what was your attitude about the shouting down of all reasoned debate by the lathered-up mobs in Summer 09? Were you on here decrying emotional responses to health care reform?

    You guys don't look transparent to each other, do you?

    And because of that, you think the rest of us, who actually function outside your cone of denial, don't notice the hypocrisy, don't you?

    I mean, is that even the case at all? Or do you actually know you're full of sh1t and just go through the motions of typing here, because you think it's funny to be self-contradictory?

    It would actually be my first read of most of your posts, WP, had I not been here so long.

    One other question: why set the value of human life so low in Arizona, when in fact comparison figures are so much higher?

    Rightist credo: Life before birth. Life after death. Actual living people? Meh.

    PFnV

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