Equitable isn’t always ethical or compassionate

If more medical professionals shared with the public what it’s like to care for patients covered by managed care plans, the reason most doctors find it incompatible with medical ethics would be more widely understood. By controlling what care is available, managed care rations care and decides which lives are worth expending money to save. But government rationing is quiet, behind the scenes and often invisible to the public. It isn’t to doctors who understand how it works.

Dr. Zane F. Pollard, M.D., who’s at the only pediatric ophthalmology practice left in Atlanta, Georgia, that still accepts Medicaid patients, explained why most doctors oppose government-managed care. Dr. Pollard wrote:

For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye. Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list. Get the point — rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind…

Read the full article here.

People who need medical care beyond the basic benefit coverage — like premature babies, elderly, disabled and those with chronic diseases — find their special care needs an uncovered benefit. Under healthcare reform, managed care is to be focused on “wellness” not sick care. Medical care for those with special needs will be even less attainable. Such people are already being described as burdens on the system, costing everyone else and not cost effective to spend money on under the comparative analysis formula being used to prioritize healthcare spending.

That’s what actual, active rationing of care means.

With Medicare already paying doctors and hospitals 20-30% less than comparable plans, and Medicaid 30-40% less, growing numbers of doctors and hospitals can't afford to care for the poor and those with special needs. Out of necessity, care for them is increasingly restricted to what the government will cover. Those needing care beyond the government’s basic “equitable for all” coverage, have to find a way to pay for it themselves or suffer. Discrimination can be disguised as equitable and fairness. Equitable isn’t always ethical or compassionate.

© 2009 Sandy Szwarc