Arizona spends too much time in the headlines (see: Arizona Tragedy: Only Fools Make Sense of Crazy). Saturday’s shootings came after a year of negative media coverage over the state’s landmark immigration enforcement bill, and the resulting condemnation and federal lawsuit. More recently, Arizona ran afoul of critics for discontinuing funding for certain types of transplant procedures because they are too costly for the state’s depleted budget.
A widely quoted remark by a state legislator suggested that Arizona was killing people to save money. While the sentiment could have been expressed with a bit more tact, and it is impossible to know whether the ineligible individuals would have found compatible organs, or survived the procedures, the state was permitting the demise of those on the receiving end of the cuts.
This is a hard pill to swallow when we recall highly publicized accounts of organ transplants performed for illegal immigrants on a goodwill basis, such as the failed gratis transplant performed on a Mexican girl in 2003. That situation was resolved with a settlement between Duke University and the girl’s illegal immigrant parents, a reminder that even the best intentions carry substantial risk.
The recession placed tremendous demand on the federal government to increase Medicaid funding for states. As of September 2010, $107 billion in Medicaid grants and assistance were paid out with Recovery Act funds in addition to the $453 billion spent since early 2009.¹ While we parted with those billions, Congress passed a health care bill that adds 18 million low-income Americans to the Medicaid rolls.² Over one-half of the $828 billion spending increase created by the health care bill is owed to Medicaid’s expansion. The increase is tempered with assurances that reforms will reduce net total spending to $251 billion, still a massive amount. Whether the savings will be realized remains to be seen.
The bleak financial condition of the states, the burgeoning debt of the federal government, and the increased demand for subsidized services created by the health care bill will further strain the system, as noted in an April 2010 Health & Human Services report:
Total national health expenditures in the U.S. during 2010-2019 would increase by about 0.9 percent. The additional demand for health services could be difficult to meet initially with existing health provider resources and could lead to price increases, cost-shifting, and/or changes in providers’ willingness to treat patients with low-reimbursement health coverage.³
America is proud of its health care system, or at least the system we had until President Obama and his Congressional supporters decided to fix it. We are fond of shaking our heads in disbelief over countries that ration health care services out of financial necessity. Now we have become one of those countries. Our states are too broke to pay for the benefits citizens take for granted, so payments for the most costly procedures will be cut. Get used to it. Years of unfettered spending put us where we are now. The health care bill created a costly two-tiered health care system, and despite government assurances to the contrary, for those on the bottom tier we will likely be rationing a lot more than transplants in the years to come.