Not content, apparently, with Oregon's pioneering status as the first state to legalize physician-assisted suicide, the Oregon state government has decided to be the first in the country to offer financially assisted suicide as well. Last year the state agency in charge of determining Medicaid assistance for the poor included assisted suicide among the approved uses of the state's health-care dollars.
So, how much does it cost to kill yourself, anyway? Under the Oregon Death With Dignity Act you must consult with a physician and a psychiatric counselor before imbibing the $45 cup of hemlock (actually Phenobarbital D). It turns out to be quite hard to get a price quote for this service over the phone. Medical academics I talked to said you would probably need at least five professional visits at $60 each, for a total bill of $350 or more. But the two individuals for whom claims have been made so far cost the state a total of only $99, which suggests that not a lot of handholding was going on.
Since death itself costs $45, the two-for-$99 figure suggests that the poor of Oregon who claim this benefit are getting only $4.50 worth of dignity. On the other hand, how many people are there in Oregon who would like to die but have to go on living because they can't scrape together $49.50?
But here's the killer. Before expanding the definition of "health services" to include intentional death by overdose, Oregon was known for another kind of health-policy sang-froid. A few years ago the state expanded medical benefits to cover more people but fewer ailments. A Health Services Commission was set up to consider all illnesses and the treatments available and to prioritize them on a cost-benefit basis. This year's list identifies 743 different conditions and treatments. There was only enough money to treat the top 574 conditions. Venereal warts just made the cut. Uninsured sufferers from condition No. 575--anal fissures--are out of luck. Ditto Nos. 576 through 743.
After hearings last year, the commission decided that, since Oregon voters had approved of physician-assisted suicide in not one but two referendums, it was appropriate to include this service under the category of "comfort care" for the terminally ill. "Comfort care" entered the chart at No. 263 with a bullet, just below acute ischemic heart disease and delirium tremens, nosing ahead of various mental disorders, Tourette's syndrome, and rectal polyps.
T he Oregon legislature is reconsidering all this. People afflicted with illnesses that have not made the funding cut (particularly a group with the Monty Pythonesque name of Not Dead Yet) are irate that a lifesaving operation in the territory around No. 570 can depend on the annual appropriating whims of the legislature, while a free barbiturate consolation prize is safely ensconced at No. 263. Defenders of the commission counter that it would be unconscionable to deny poor people a right as fundamental as death.
It sounds like classic big-spending liberalism. But is that what is really at work here? Aiding and abetting a suicide--even at $350 per--is cheaper than just about any other serious medical treatment. Anyone dying in a modern hospital will quickly cost more by staying alive than by exercising the right to die, dignity and all. The commission declined to estimate the cost impact of fatal "comfort care." It could easily be positive, a money saver. If I were an Oregon Health Plan member who suffered from anal fissures (No. 575), my first reaction would be bitterness that by putting assisted suicide at No. 263, the commission had bumped me and my suffering off the list. But my second reaction would be that the more people who take advantage of No. 263, the more likely it is that there will be money enough for No. 575 after all.
Given the harrumphing by legislators that Oregon voters never intended to fund suicide when they approved the 1994 referendum, the era of government-subsidized death will probably soon be over. A federal bill sponsored by Sen. Orrin Hatch, R-Utah, would forbid the prescription of drugs for assisted suicide, presumably taking doctors out of the death-assistance business for all patients.
This is too bad. Oregon led the country in facing the health-care rationing issue head-on. And now, perhaps unintentionally, it has taken the next logical step: bribing people to go early and save the system a bit of money. To the agonizing issue of health-care costs for the terminally ill, Oregon has stumbled onto a kind of answer, heartless though it may be. Those who attack it will have to come up with something better.
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