Kathleen Sebelius and Organ Transplants

I am most likely not going to make many friends with this post, but oh well, here it goes anyway.

I have been somewhat following the story of  Sarah Murnaghan, the ten-year CF patient, that is dying due to her lungs being in such bad shape due to her illness.  Absolutely tragic story.  One of the guidelines of the transplant lists UNOS is that children receiving adult organs must be 12 or older.  Of course that number is for the most part arbitrary, the data shows that children don't always do well with adult organs.  Although it seems that is less common with lungs.

Sarah's parents are talking to every media outlet they can to raise awareness to this issue.  I would hope that any parent would do the same.  As a parent, part of your responsibility is to be an advocate for your child.  This mom is trying to save her daughter's life.  I can't imagine being in her position.  I couldn't hate someone enough to wish this on anyone.

A congressman from Pennsylvania has asked Kathleen Sebelius to waive this requirement and allow her to be put on the adult waiting list.  Sebelius has declined that request.

“I would suggest, sir, that, again, this is an incredibly agonizing situation where someone lives and someone dies,” Sebelius replied. “The medical evidence and the transplant doctors who are making the rule — and have had the rule in place since 2005 making a delineation between pediatric and adult lungs, because lungs are different that other organs — that it’s based on the survivability [chances].”

While this is a very hard thing to do when the life of a ten-year old is hanging in the balance, these decisions must be made without emotion.  What she said is 100% true.  When making decisions about who gets the organ and who doesn't is a life and death decision.  Many people die every year while waiting for an organ to become available.

Dr. Stuart Sweet, director of the pediatric lung transplant program at Washington University School of Medicine in St. Louis says this:

When asked about concerns over whether adult candidates who are less sick are getting transplants instead of sick children, Sweet said, “There’s no way to really answer that question.” He said the number of adults who die waiting for an organ transplant greatly exceeds the number of children.

"The reality is ... the numbers suggest that there are lots of patients who are running out of time on the waiting list and many more patients run out of time ... in the older age group than the younger group,"

The question also becomes does she even have the legal authority to waive this rule?  The UNOS list is not a federal list.  It is done by a private organization that has government oversight, but operates independently.   This is one of the few things in our country that are still done by need.  The only exception being that before being put on the list you must be able to prove that you can pay for the medications that are mandatory for all transplant patients after surgery.  In most cases that will be done through medical insurance.

We have to look at outcomes when these decisions are made.  There are only so many organs to go around.  This from The Mayo Clinic on lung transplants on CF patients:

• Lung transplant. If you have severe breathing problems, life-threatening lung complications or increasing resistance to antibiotics used to treat lung infections, lung transplantation may be an option. Because both lungs are affected by cystic fibrosis, both need to be replaced. Lung transplants for people with cystic fibrosis are controversial because studies indicate the procedure is associated with many complications, and may not prolong life or enhance quality of life.

We also have to remember that is said to be "end stage".  CF affects more than just the lungs.  It also damages the liver, causes intestinal damage and quite a few other problems.  What are her other health issues?  Like it or not in cases such as these survivability rates must be taken into consideration.  Doesn't it make more sense to give the limited amount of organs to people who have the most likelihood to survive?  Now, I am not saying that Sarah is not one of these people, she may well be.  But the truth is we aren't hearing that side of the story.  We are hearing the pleas from a family who is facing the loss of a child.  

It is very possible that we need to look at these rules again.  As medical advances are made it may be very possible that putting adult organs into children has gotten to be an easier procedure than in the past and that number can be lowered or even done away with.  But looking at that data is going to take more time than she has.  As an update to this story, her family has filed a lawsuit this afternoon asking a judge to waive the rule while the regulations are being studied again.  

This sounds cruel and looks nothing less than wicked in writing, but these decisions must be made by medical need, not emotion.  Again, I wouldn't do anything different if Sarah was my child.  I would do everything possible to save the life of my child.  But we have to step away from the emotion of this and look at the medicine of the situation.  This has nothing to do with Obamacare, as I have heard ballied about today and yesterday.  These rules were in place long before he even took office let alone before Obamacare became law, current regulations came into place in 05.  

The amount of available organs in this country are few and become even fewer for young children.  The organs must go to the people who are the most likely to have a positive outcome.  We cannot run an organ donor list based on giving to the squeaky wheel, who has more money, more prestige, or any thing other than medical need and survivability rates. The science at the time when these rules were put into place said that a young child taking an adult lung wasn't that person.  

A very sad truth is that someone has to die in order for this child to live.  Another sad truth is that an adult who likely is just as ill will not get the organs if she does.  There are no good outcomes in this situation.  47 people in her state are on the adult list waiting for the same organ.  We should take a step back and realize that not everything is political.  This tragic story isn't about politics, it is about a family facing the loss of their child and being helpless, and an organ list that will always make a choice about who gets a second chance of life and who doesn't.  Sad, but true.  

Kathleen Sebelius did exactly the right thing, she left these choices up to medical professionals instead of getting the government involved. This is exactly what conservatives say they want.  

  

Holder's Defense of Obamacare

Eric Holder and Kathleen Sebelius took to the Op-Ed pages of the Washington Post today to counter the ruling that Obamacare's mandate is unconstitutional. Not that this should surprise anyone, but they feel that Obamacare will eventually be called constitutional when all is said and done. What else are they supposed to say? What is interesting is not what they said, but how they said it. They trotted out the car insurance analogy that the left always seems to go to. Not that these pesky little facts should have to be pointed out again, but we will explain to you one more time just so you can be clear.

1. There is no federal law requiring anyone to purchase car insurance.
2. States require insurance for the damage you cause to someone else's vehicle, not what you do to your own.
3. There is no requirement to purchase a car.
4. If you do not drive on publicly funded roads, you do not need insurance. If you never remove your car from your property, it does not need to be insured.

In the case of health care all you must do is breathe. There is no comparison between the two. But, my very favorite part of the piece was the perfunctory victim that they have trotted out yet again. This time her name is Gail O'Brien. Sadly, Ms. O'Brien has been diagnosed with an aggressive form of cancer and her job as a pre-school teacher doesn't offer insurance. She was delaying the timing of her chemotherapy because of the costs and her savings wouldn't last. A very sad story, indeed. According to the piece due to Obamacare, she is now able to obtain health insurance that will cover her treatments.

 I don't think you find people who will say that she shouldn't be treated and her life saved. But, read the sentence again carefully:

 In March, New Hampshire preschool teacher Gail O'Brien, who was unable to obtain health insurance through her employer, was diagnosed with an aggressive form of lymphoma. Her subsequent applications for health insurance were rejected because of her condition. With each round of chemotherapy costing $16,000, she delayed treatment because she knew her savings wouldn't last.

They themselves are admitting that she had enough money to purchase insurance before she was ill and chose not to. Which completely contradicts what they say later in the piece:

 If we want to prevent insurers from denying coverage to people with preexisting conditions, it's essential that everyone have coverage. Imagine what would happen if everyone waited to buy car insurance until after they got in an accident. Premiums would skyrocket, coverage would be unaffordable, and responsible drivers would be priced out of the market.

So the person that they are setting up of why the mandate is necessary is the person who causes the costs for people who carry insurance all the time to increase? It seems to me that she is not the best example to be highlighting. This woman took the chance of going without insurance and now is complaining that the costs are high for the medical care that she needs. Again, I am not saying that she shouldn't get care, but I don't think she has the right to complain about the risk she voluntarily took. I pay my health insurance bill every three months, even though I rarely use it. It isn't that I have so much money, but since I have had health problems in the past, I know how expensive the costs can be and I do it to protect myself. As my regular readers know, my insurance for the year 2011 has increased by more than 80% because the policy that I have used for the past five years is now illegal. So, because this woman took a risk my payments must go up?

  

If you read the entire piece no where is the answer to the breakdown of the arguments that the judge yesterday very clearly laid out. This is the attorney that is in charge over the federal court system in this country and he can't articulate where in the constitution it says that congress has the right to force us to purchase something? I am no lawyer, but I will tell you that decision yesterday was very easy to understand and well-reasoned. I don't think it is too much to ask that the Attorney General do the same instead of the playing the emotion card and basically just say that it is for the common good. He of all people should understand that we are a nation of laws, not a nation of emotions. I also would like to ask if Holder is so sure that this will pass the muster with the high court, why is he so opposed to a quick ruling? Could it be so that the groundwork for the law will be harder to dismantle the longer this drags on?

Cross Posted at PotLuck

Hope and Change - HHS and White House Were Aware of Actuary Report Before Healthcare Vote

Initially we were lead to believe that the actuary report of the true costs of the healthcare "reform" bill was not available until after the vote had taken place.  Well, not so fast.  The report was given to both the Health and Human Services Secretary and was passed onto to the White House.  Kathleen Sebelius received the report that gives the more accurate costs of the then legislation one week before the vote.  This report shows that 14 million people lose their current coverage, the costs will rise at a rate of $38.9 per year over the next ten years, and it will dump more people into the medicaid system. 

This is bad news on so many levels.  One being that finding a doctor that will take medicaid is difficult at best.  So while the "leadership" in this country were touting the amount of people who will now have access to healthcare knew that they were lying.  This bill does nothing but give people access to insurance; insurance that they will not be able to afford.  This will force millions of Americans to pay the fine instead of getting insurance.  There will be people who currently have insurance losing the coverage they have as they will no longer be able to afford it; paying the fine will be less expensive.  Another unintended consequence will be the already taxed emergency rooms will become more so as people will not be able to find a doctor who will accept their mediciad insurance. 

We can then move onto all the President's (wo)men who hid this information from the public and more than likely from some of the house members who voted on this bill.  While this is unlikely to be illegal, it certainly is unethical.  The President who ran on transparency and change is nothing more than a liar and a cheat.  The by hook or by crook way that this law was passed is a shining example of why the founders designed the system to move slowly.  When a law that is going to have an effect on every American the people of this country has the right to demand that it be done carefully and out in the open so everyone understands the implications of how our lives are going to be changed and what it is going to cost.

Where the heck is the media in reporting this?  This is a violation of the trust of the people who voted for this man.  This is not the hope and change that people were expecting, but sadly it is what the conservatives saw coming. 

read the report here.