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Deciding who lives and who dies

When health care is rationed, the results can be heartrending. Such a story makes for one of the most compelling episodes in "Sicko," Michael Moore's documentary. But it conveys a totally inaccurate impression of what we need to fix health care in America, according to  NBC's Robert Bazell.

When health care is rationed, the results can be heartrending.

Such a story makes for one of the most compelling episodes in "Sicko," Michael Moore's documentary about the dysfunctional U.S. health care system. In the film a Kansas woman named Julie Pierce tells of the death of her husband, Tracy, after their insurance company refused to approve a bone marrow transplant to treat his advanced kidney cancer. 

While the tale is enormously sad, it conveys a totally inaccurate impression of what we need to fix health care in America.

Don’t get me wrong. As I’ve written before, I think America should have national health care just like every other industrialized nation. We are paying way too much for an irrational system that leaves huge parts of our society unprotected. Access to decent health care should be a right, not determined by whether a person has a certain job or a huge bank balance. So, I agree with the premise of Moore’s movie. I hope it provokes even more discussion about our health care crisis.

But Julie Pierce’s story does not help the argument. Her husband suffered kidney cancer that had spread throughout his body before his death at age 36 in 2004. In recent years a few experimental drugs have shown some promise for treating advanced kidney cancer, but even now the diagnosis is nearly a death sentence.

Tough choices
The bone marrow transplant that the Pierce family sought has never been shown to help. A few doctors have suggested it might. The National Institutes of Health is now running two clinical trials to try to find out. Still, it is an experimental concept with little scientific basis.

Pierce implies in the movie that her insurance company and the group that runs it — the board of directors of the hospital where she works — refused to pay for the treatment because she is white and her husband was black. Of course, we know nothing of the insurance company or board's motives. In the movie, neither speaks.

Almost any insurance plan would have turned down the request for an experimental treatment, with no proven value, costing tens or hundreds of thousands of dollars. It is critical to note that the national health plans in Canada, Great Britain, France and Cuba that are featured in "Sicko" would also have turned down such treatment. No matter where he was getting his care, Tracy Pierce almost certainly would have died at a young age.

Even in the wealthiest countries, health resources are limited. Everyone cannot get every treatment they believe might help them.

The problem is, the rationing we have now in the United States is immoral. It's based on job status, wealth, luck, and all too often, profit for doctors, hospitals or health insurance companies. We must ration health care, but we should do it morally.

Science vs. status
A big step toward moral rationing is to base treatment options on good science, not status.

A horrifying example of what happens when treatments are based on anecdotes rather than science occurred in the 1980s. A few oncologists became convinced, on the basis of a handful of cases, that the best treatment for advanced breast cancer was a combination of bone marrow transplants and very high doses of chemotherapy. Insurance companies at first refused to pay, saying correctly that the treatment was experimental, unproven. As a result, the oncologists encouraged their patients to sue. 

What jury could say no to a woman, often a young mother, when a doctor would testify that the treatment costing tens of thousands of dollars was her best chance for life?

When clinical trials of the bone marrow procedure were ultimately completed a decade later, they proved the procedure was actually killing the women faster than the breast cancer. More than 100,000 women underwent the marrow transplants involving untold suffering and billions of dollars in expenditures — money that could have been put to so many truly life-saving uses.

A sad story of a young person dying may make for a compelling scene before a jury or in a documentary, but it doesn’t help us know what needs to be done to fix our broken health care system.