Proponents of California’s new assisted suicide law tout it as a way to ensure individual dignity in the final days of life. That may be their intention, but they’re overlooking the dangers that could result when a legalized suicide regime intersects with a cash-strapped state budget.
In his proclamation creating a special legislative session on health care financing earlier this year, Governor Jerry Brown was clear: He wanted the legislature to stabilize and restore funding for Medi-Cal, the state’s Medicaid program. But if that was the mandate, how did the session end up producing a bill allowing doctors to help Californians end their own lives?
It may sound like a non-sequitur, but the chilling reality is that – whether lawmakers intended it or not – there is a serious prospect that assisted suicide will come to be used as a cost-cutting measure for state government.
Take, for example, the very real possibility that Medi-Cal will offer assisted suicide as a covered treatment option for terminally ill enrollees. That’s what’s happened under Oregon’s Medicaid plan — and the state has already been caught informing a cancer patient that it would pay for assisted suicide drugs, but not for doctor-recommended chemotherapy. A report in the Los Angeles Times indicates why: “The barbiturates prescribed to patients to end their lives cost about $1,500,” it says. “Average healthcare spending in a patient’s last year of life is $33,486, according to federal data.”
This prospect is especially menacing for Medi-Cal enrollees who are eligible for hospice care. Qualifying for hospice requires a doctor to deem a person as having six months or less to live – the same timeframe that allows eligibility for assisted suicide. Even under the most conservative estimates (putting aside, for instance, the escalating costs associated with the final months of life), six months’ worth of hospice care would run to about $15,000 — 10 times the cost of life-ending drugs.
Since 2013, the year California expanded Medi-Cal eligibility under the Affordable Care Act, spending on the program has ballooned 74%, now reaching more than $91 billion annually. While Washington will cover 100% of the increased cost for the first few years, the federal government will begin scaling back its commitment in 2017, leaving states to figure out how to fill the gap. When California starts feeling that pinch, the state will be looking for savings wherever it can find them. In a world where taking your own life is just another medical decision, is it so outlandish to imagine that Medi-Cal will be unwilling to pay a premium to keep recipients alive?
Make no mistake; the fact that assisted suicide became law in a session ostensibly dedicated to shoring up Medicaid financing is a tacit admission that lawmakers see a connection between saving money and hastening death. That became even clearer when, only a week after signing assisted suicide into law, Governor Brown vetoed a so-called “right-to-try” bill allowing terminally ill patients access to experimental drugs that could potentially help them live longer. Going forward, California’s terminally ill have the right to die, but not the right to try.
A backlash is already forming. On October 20, a group opposing assisted suicide received permission from the California Secretary of State’s office to collect signatures for a ballot proposition to overturn the new law. In order to qualify the initiative for next year’s election they must submit 365,800 signatures by January 4. As Stephanie Packer, a terminally ill mother of four leading the effort, told the press, “Those confronting their most difficult days should be treated with compassion, understanding and support. Our medical response should not be to encourage them to end their lives prematurely.”
Ms. Packer is right. This is quite literally a matter of life and death. California lawmakers shouldn’t treat it as a matter of dollars and cents.