Over the weekend, Vice President Dick Cheney received a new heart at Inova Fairfax Hospital in Falls Church, Va. The news raised eyebrows and questions about whether he was too old for the procedure. At age 71, Cheney was older than the average heart transplant patient; while there is no firm age limit for a heart transplant, most transplant surgeries are done on patients younger than 70 years old.
About 3,000 people in the United States are the heart transplant waiting list on any given day, although only about 2,000 donor hearts are available each year. Time spent on the waiting list does play a part in who receives a donor heart. For example, if two patients have equal need, the one who has been waiting longer will likely get the first available donor heart, according to the National Heart Lung and Blood Institute.
A heart transplant is considered a serious, life-saving surgery. In the procedure, a person’s damaged or diseased heart is replaced with a healthy heart from a deceased organ donor. Most heart transplants are done on patients who have end-stage heart failure which means that patient’s health is so severe that all treatments have failed. In Cheney’s case, he had suffered five separate heart attacks (the first at age 37) and had remained alive for the past two years or so with the use of a heart valve pump called a Left Ventricular Assist Device (LVAD).
I’m pretty familiar with the heart valve procedure. My mom, who is younger than Cheney – I’ll add much, much younger in case she’s reading – underwent a heart valve replacement surgery recently. It’s a pretty intense procedure. And it, like a transplant and many other medical advances, isn’t cheap. In fact, the average initial cost of a heart transplant, with drugs and post-surgery care, including catheterizations and scans, can be close to a million dollars.
Fortunately for Cheney, the cost of his health care was covered by taxpayers. In addition to health insurance provided through the government for Cheney’s years of service, Cheney, like millions of other Americans was eligible for Medicare benefits when he turned 65. In most cases, if you are retired and have Medicare, as well as health plan coverage from a former employer, Medicare pays first. The group health plan coverage pays second (booklet downloads as a pdf). Either way, it’s tax dollars at work.
It’s ironic, of course, that Cheney received his new heart just as the debate about Obamacare was being argued in front of the Supreme Court. The costs of getting better and staying healthy are controversial. Patients are living longer. Medical advances – like Cheney’s new heart and my mom’s new heart valve – can add years to a person’s life. But is it worth it? And who should pay for it? And should there be a test to decide who gets treatment and who doesn’t (specters of the so-called death panels)? In other words:
Should taxpayers foot the bill whenever a patient is too old/too fat/has smoked for too long/(fill in the blank)?
I was reminded, when I heard the comments about Cheney’s surgery, of an article which ran in the New York Times several months ago about young, obese people having weight-loss surgeries. The article highlighted a young woman, Shani Gofman, who was 160 pounds overweight, who underwent bariatic surgery. That surgery was funded by a state insurance plan for low-income families. The article went on to point out that Medicaid in almost every state and many private health plans now cover bariatric surgery, often more readily than diet or exercise plans (the same is true for tax breaks, by the way). Gofman’s story is not quite a success: she has since gained half of the weight back largely because she could not afford, she said, to go the gym, and had aged out of government-funded insurance.
As a mom – and a former fat girl – my heart hurts for Gofman. It sucks to be fat. It especially sucks to be fat when you’re young. In addition to teasing and self-esteem issues, obese children are vulnerable to other health problems like diabetes and heart disease. I was lucky because, despite some pretty awful genes in the gene pool which conspired against me (sorry, dear and respected deceased relatives), my health didn’t deteriorate when I was heavy. I was able to change my lifestyle to include lots more exercise and a better diet with no worries about diabetes, high blood pressure, or heart disease. But that’s the exception, not the rule. Statistically, most children and adults who pack on the pounds are at increased risk for health problems.
But do you, as a taxpayer, want to pay for Gofman to get better? What about Cheney? If you think taxpayers should pay for health care coverage, do we draw a line in the sand and say these are the folks who deserve saving? Does it matter if the health problems are genetic (like some heart disease and cancer), brought on by lifestyle (like some forms of diabetes and high blood pressure) or somewhere in between? Do we say you’re too old/too young/too fat/too skinny/too something… to receive care?
That’s part of what the Supreme Court is debating as we speak. Who should be covered? Who should pay? And who makes those decisions?
It’s a tough series of questions, ones that we’ve seen before. And it’s one we’ll likely see again and again as the debate over Obamacare – and whatever comes next – rages on.
