November/December, 1997 Volume XII Number 9

HMOs stand to gain big

In December of 1994, one month after Oregon voters passed Measure 16, "physician assisted death," into law, Health Maintenance Organizations (HMOs) responded.
Ethix Corp., an HMO, announced that they "welcomed broad coverage for assisted suicide in a medical economic system already burdened."
Ethix Corp's embrace of such a new "treatment" should have come as no surprise. Vice President Barbara Coombs-Lee, after all, was chief petitioner for the Measure which created Oregon's law legalizing physician assisted death. But media reports concerning Coombs-Lee failed to make much of her professional occupation within a health insurance group. She was portrayed as a passionate idealog who cared only for things like "patient autonomy," an end to "intolerable pain," and offering "death with dignity" to those who wished to die on their own time-line. Coombs-Lee's role as a financially motivated health industry hatchet woman was carefully buried throughout the 1994 campaign.
A representative for the Oregon Health Plan (OHP), a state funded health plan incorporating many of Hillary Clinton's proposals for national health care, announced in 1994 that the OHP would establish a protocol to pay for assisted suicide. The "service" would be carried under the unlikely category of "comfort care."
During the same press conference, tax-payer funded OHP announced cutbacks in reimbursement for other, standard, treatment options. Moreover, OHP has maintained exceptions to life-saving treatment, even when those treatments have been proven to be effective.
At the same time the state of Oregon was informing residents that tax dollars would be used to fund doctors who kill their patients, other HMOs joined in.
Blue Cross of Oregon and PACC (now QualMed Oregon Health Plan as the result of a recent merger) announced that they too were prepared to make the ultimate industry sacrifice. They would pay for "treatment" to end the life of a patient.
Under the guise of patient choice for a "service" which is legal under Oregon law, PacifiCare of Oregon too plans a benefit change aimed at paying doctors to administer death as a medical treatment.
Kaiser, which pays for doctors to kill the unborn in abortion procedures, artfully refused to make a statement.
Only one HMO, Good Health Plan of Oregon, announced that they would not offer coverage for physician abetted killing. The problem they have though, as with abortion, another procedure they have refused to reimburse for, is that doctors often disguise their work under other categories of care. For example, rather than bill the insurance group for an abortion, physicians have billed the selfsame procedure as a "therapuetic D&C." This is an operation not uncommon after a woman has experienced a miscarriage, and it is covered under the health plan.
The fear is that lethal treatments will be administered and then billed in the same deceptive way. Good Health Plan of Oregon might receive but never be able to identify a claim for reimbursement on assisted suicide.
In the midst of public statements embracing "assisted death" by several major HMOs, a representative for the American Association of Health Plans, a lobbying group representing over 1,000 managed care/HMO organizations, responded with assurances that none of the groups were motivated by the obvious financial gains to be had in offering lethal treatments.
However, while attempting to minimize the shock of establishing payment for doctors to kill their patients by labeling such as "treatment," HMOs are already making provisions in their allowable or reimbursed care guidelines. PACC (QualMED), for instance, has a scandalously inadequate $1,000 cap on in-home hospice care, including care given to alleviate pain.
Dr. Gregory Hamilton, a psychiatrist and opponent of physician assisted death, spoke on behalf of Physicians for Compassionate Care on a Town Hall show. He responded to PACC's cap on hospice care and payment for suicide plan saying, "What is the HMO going to do next," after your $1,000 benefit has been used up, "remind you that your benefit for assisted suicide hasn't been used yet?"
"Benefit conversion," it is proposed, is another way in which HMOs can make a financial killing off of assisted suicide. Under such a protocol the patient may opt for assisted suicide and the plan "pays death benefits if you do it by a certain point in time," according to Gerry Breshears, a theologian who has studied the issue.
When a patient has been diagnosed with a physically and/or financially catastrophic illness, instead of wasting money on what insurers define as "useless treatment," the patient can have a small portion, perhaps $10,000, of his medical benefits converted into death benefits. The bereaved can be comforted with a cash payoff.
If you think such a scheme sounds fantastic, something out of the overworked and religious mind of a man like Breshears, note that prestigious publications like the Journal of Health & Social Policy have given a great deal of space to such ideas. Volume 5(2) in 1993 offered just such a proposal. In fact, not only might HMOs be able to get in on the savings, so might society.
K.K. Fung, Professor of Economics at Memphis State University imagines that Government too can cash in. Entitlement programs such as Social Security, Medicare, and Medicaid can supplement the patient's estate by according survivors a death benefit as well.
The first and major problem with such a plan is that laws like Oregon's Measure 16--"Death with Dignity Act"--require patients to be terminal, within six months of death. But over time, once community sanctioned killing of the ill has been accepted, the "right" to end one's life may allow for a patient to opt for or be pressured into what is euphemistically called a "dignified passage" earlier. After all, why should one be "forced to live" and allocate their medical benefits toward other treatment options. Once suicide is legal, how can it be limited?
As Prof. K.K. Fung prophetically concluded in 1993 in the Journal of Health & Social Policy, "Additional pressure [to opt for physician assisted death] is likely to come from the insurer. It is their bottom lines that are going to be improved when dignified passage is chosen."

Copyright © 1997 AFLM