Charles Camosy is assistant professor of Christian ethics at Fordham University and the author of his recent release, Too Expensive to Treat? Camosy serves on the ethics committee of the Children’s Hospital of New York and as an advisory board member of the New Evangelical Partnership for the Common Good. Here he asks us to wrestle with the difficult issue of health care rationing and illustrates why we must.
For six-month old Seth Petreikis, expensive treatment was his only hope.
Without a very rare “thymus transplant” Seth would die within a few months, but his family couldn’t afford the $500,000 price tag. At first Indiana Medicaid called the treatment “experimental” and denied their claim. But perhaps because of media and other social pressure, and also because the treatment (though not yet formally approved by the FDA) could hardly be called experimental given its 73 percent success rate, the procedure was eventually approved. Obviously, the family was overjoyed:
“I got the call and when I heard her say it was approved, I just fell down on the floor crying,” said his mother Becky Petreikis, a Dyer resident. She called her husband, Tim, who was driving home from his job in Chicago, and shared the news with their three-year-old daughter, Julia. “The phone’s been ringing off the hook,” she said.
Great, right? Cold, unfeeling government defeated in favor of the vulnerable and desperate child.
Well, maybe from an ethical point of view it is more complicated.
Medicaid works from fixed budgets, and the hundreds of thousands of dollars needed to perform this transplant are resources that now cannot be used to serve other Medicaid patients, because Indiana has a budget crisis caused in large part by medical costs. Their need to cut Medicaid is such that they are even telling parents of disabled children that Medicaid is no longer an option — and that perhaps they should leave their children at a homeless shelter if they cannot care for them at home.
Like Indiana, states all over the country are scrambling to cut Medicaid costs — including Arizona, which recently made headlines by refusing to fund life-saving transplants. Physicians’ flight from Medicaid patients, already problematic because of poor reimbursement rates, will only get worse with the new health care plan. The situation is so bad that Republicans like Paul Ryan have proposed serious plans which would replace Medicaid “with a new system of health care tax credits and debit cards that could be applied to health insurance premiums, as well as deductibles, coinsurance, and co-payments for low-income families.” Ryan’s plan is honest, but it will leave tens of millions of the most vulnerable without access to needed health care.
But what’s the alternative?
In my new book, Too Expensive to Treat?, I argue another kind of honest response to admit two truths about human existence:
- We have virtually unlimited health care needs. (We will all die some day.)
- We have limited health care resources. (There is a finite amount of “stuff” out there.)
Attempting to escape rationing health care is like attempting to escape the finite nature of our resources and, indeed, of our very being. Sadly, many Christians seem be leading the charge against rationing — as if we could somehow overcome this situation. But we need to push back against a polarized, political response (something I try to do in my blog) and instead try to bring the substantial resources of the ancient Christian tradition to bear on this problem.
In the book I argue that, instead of attempting to run away from this tragic, fallen state of affairs, Christians should be among the best at bravely attempting to face its reality. We should be able recognize the false idol present in the consumerist mantra that we can have as much as we want of whatever we want. Acknowledgment of this fact is admittedly difficult. How could one look into the eyes of Seth’s parents and explain that his procedure was denied? But what about those who will have to look into the eyes of the parents who will be forced to drop their disabled children off at the local homeless shelter?
We live in a fallen world — one riddled with tragedy. But in the interests of justice we must have the courage to make the difficult and even heart-breaking choices such a world requires.