Thursday, September 20, 2012

So It Begins: Rationing and Global Budgets in the U.S.

And so it begins.

Presently, kidney transplants are on a more-or-less first-come-first-serve basis. Those waiting the longest receive kidneys the quickest, as they come available.

The United Network for Organ Sharing (UNOS), a nonprofit organization that distributes organs, is now suggesting that a kidney with a potential life expectancy of 40 years shouldn't be given to someone with 5 years left to live (actuarially speaking—or, more accurately, guessing). In other words, young healthy kidneys should go to younger, otherwise healthy recipients--no matter how long they've been waiting.

UNOS is proposing that "20% of kidneys expected to last the longest would go to the 20% of recipients expected to get the most years out of each organ."

Bioethicists and others are justifiably concerned about this because, first and foremost, WHO decides WHO the lucky recipients will be?--not to mention, there are basic concerns about fairness and equitability.

In recent Facebook posts, I examined fallacies of Obamacare that have circulated the Internet—fallacies designed to do nothing but frighten people. I found many things about the Affordable Health Care Act that are good and necessary, and I admit I enjoyed digging into the legislation to find the facts that would put an end to fear-mongering lies. However, I also found many areas of concern in the legislation, and I also pointed out those.

One of the issues I discussed was rationing. What UNOS is proposing is the beginning of global-budget-centered rationing that will affect ALL Americans.

According to the UNOS website, more than 28,000 people receive organ transplants each year. Also according to their website, they receive most of their funding through “computer registration fees paid by members, charitable contributions, and project grants from foundations and corporations.” Only 7% of their funding comes from federal contracts, according to their site.

However, UNOS was awarded the national Organ Procurement and Transplantation Network (OPTN) contract in 1986 by the US Department of Health and Human Services. UNOS is still the only organization to operate under the OPTN.

Together, OPTN and UNOS have almost a dozen JOINT committees and have already established 11 “geographical regions” for “administrative purposes.” This is ripe territory for establishing global budgets, which is the cornerstone to rationing healthcare.

In case you didn’t read my posts about global budgets, they are regionally established budgets that assign a specific dollar amount to regions for the purpose of healthcare services/expense distribution. In other words, Region 1 will have X number of dollars to spend on healthcare and all of the people in Region 1 have to stay within that budget. This means that certain decisions will have to be made about who receives care—and how much—in order to stay within budget. A lot of people with high-cost medical expenses will inevitably be denied care. Quality will have to be sacrificed in order to serve the entire population of that region. That’s how global budgets work. That’s how socialized medicine works in other countries. That's how socialized medicine will work here in the United States. Denying care is the ONLY way budgets are achieved. It's simple math to bureaucrats.

There are many, many factors that go into the current system of deciding who receives transplants. But giving transplants to those in need on a first-come-first-serve basis is currently the fairest, most ethical means of distribution.

This subject hits close to home for me. My husband’s cousin, Philip, is facing this terrible situation right now. His wife, Brittney, is a beautiful, young mother of two small children. Her kidneys have been failing for quite some time. No suitable match was available for years, and her health deteriorated to the point of desperation. Finally, a decision was made for Phillip to donate one of his kidneys. It wasn’t a perfect match, but it was worth the risk to try. They both underwent the difficult and painful procedure a couple of weeks ago, and so far they are both doing well. We continue to pray for miraculous recoveries.

Under UNOS’s proposed system, however, even though Brittney has been waiting for several years, her health deteriorated to the point that her life expectancy wasn’t pleasant to consider and she wouldn't be a frontrunner candidate for a kidney transplant. Under UNOS’s proposed system, Brittney would be denied a kidney when it becomes available because a young healthy kidney might be wasted on her. Under UNOS’s system, her own husband may not be able to donate his kidney to her. Instead, his kidney could go to someone younger, healthier, who hasn’t been waiting as long. Would Phillip still want to donate an organ if he knows it wouldn't go to his wife? How many other potential donors will not give if they think their organs will be part of the cherry-picking process?

I don’t think it’s a coincidence that UNOS has made this call right now—this close to an election, and this soon after the Affordable Care Act was passed and found constitutionally viable. What kind of pressure is UNOS receiving from OPTN to make this change? Will they lose funding and their OPTN award if they do not comply? Are they offering this olive branch in return for their continued control over their own organization?

These are questions we need to ask NOW. We can sit in our easy chairs and watch the evening news and feel confident that the people we put in office are keeping an eye on this situation, BUT THE PEOPLE WHO SIGNED OBAMACARE INTO LAW STILL DO NOT KNOW WHAT IS IN IT—BY THEIR OWN ADMISSION.

We can’t wait for “someone else” to protect us. It’s a grave mistake to assume anyone in Washington is looking out for our best interests. And it doesn’t matter who our next president will be—the results will be the same if we do not demand answers and hold policymakers accountable.

If this is a subject near and dear to you, go to this site: and review federal and state legislation regarding organ and tissue donation. Write to your representatives and demand answers about how they plan to protect you and your community from healthcare rationing and global budgets.

It is clear that our Washington representatives have no interest in policing themselves on issues that don’t directly affect them. They don’t receive the same healthcare packages we do, and they never will under their current entitlements. Unless we FORCE change to take place, it will not happen.

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