Kimbell’s comments spark concern in elder and disabled communities

By Rob Roper

Those opposed to Physician Assisted Suicide (or Doctor Prescribed Death) in Vermont worry that healthcare cost cutting is the real objective behind the initiative, and they see BISHCA Commissioner Steve Kimbell’s words to that effect in a recent interview with the Addison Independent as a case of a politician committing candor.

 There is evidence to support that theory out of Oregon, where Physician Assisted Suicide is legal and has been since the mid-1990’s. One case opponents of the policy bring up frequently is that of Barbara Wagner.

In 2008, Barbara Wagner was 64 years old and suffering from lung cancer. She had insurance through the state-run Oregon Health Plan, which was designed to provide coverage to low-income people. But, since its implementation in 1994, Oregon Health experienced major cost problems, even though “rationing” was an explicit part of its mission. By 1995, the price of the program had jumped from $1.33 billion to $2.36 billion. Over the ensuing years, the state government had resort to a number of strategies — cutting budgets, closing enrolment, and finally resorting to a lottery system — in order to get the program’s finances under control.

So, when Barbara Wagner’s doctors recommended a $4000 per month treatment that represented her last hope for a prolonged life, Oregon Heath said no. What they said yes to was the $50 cost of a lethal prescription – Physician Assisted Suicide.

In an interview with ABC News, Wagner said, “It was horrible. I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won’t give you the medication to live.”

Writing about Physician Assisted Suicide in his book, Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare, Ira Rosofsky, Ph.D, describes what’s going on here: “‘Open up, Mom. Here are your last meds.’ Something about me loves the fact that the [Oregon state government web page] asks you to check with your health insurer to see whether this is a covered procedure. Covered procedure? You bet. Suicide is the ultimate medical utilization cost saver.”

This reality has many in Vermont’s elderly and disability communities worried as our state considers moving to an all-government-controlled, single payer healthcare system, where government will be the only insurer, and for which Governor Shumlin has repeatedly said cost containment will be the primary goal.

It doesn’t help that questions about how Green Mountain Care will be paid for, what the benefits package will look like, and how care will be allocated are going purposefully unanswered, and the politicians pushing the program want to keep it that way until after the next election in November 2012. Were Kimbell’s comments a peek behind the curtain that we weren’t meant to see?

As a state senator, Peter Shumlin was a sponsor of legislation that would have legalized Physician Assisted Suicide in Vermont. During his general election campaign for governor in 2010, Patient Choices Vermont, an organization dedicated to passage of a Physician Assisted Suicide law, donated $3000 to Shumlin, the maximum amount allowed. As governor, he has pledged his support for the policy.

Although Shumlin insists that he does not view Physician Assisted Suicide as a cost-cutting measure, the possibility that top members of his administration do – and the fact that the success of his signature policy initiative, a single payer healthcare system that controls health care costs hinges on containing those costs – raises serious questions.

Although the Oregon law specifically says that requests for Physician Assisted Suicide must originate with the patient, in Wagner’s case the idea certainly didn’t start with her. At what point does government cross the line from informing patients about an “option” to actually pushing that option onto patients?

Since Governor Shumlin expects that both a single payer healthcare system and Physician Assisted Suicide will at some point both be the law of the land in Vermont, he owes Vermonters a detailed explanation of how he expects the two policies to coexist.

Add this to the very long list of things Vermonters would like to know about Green Mountain Care.

Angela Chagnon contributed research to this article.