Who we let die, and who we get a court order to keep alive - By Linnea L.

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We’ll chase a white middle class teenage boy across the country to make sure he receives expensive chemo that he doesn’t even want, but we can’t even cover basic dental care for children on Medicaid?

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In light of the current debate about health care rationing, as well some recent conversations I’ve had about race, the following comparison struck me as somewhat painful:

Earlier this year Daniel Hauser and his mother ran away rather than continue chemotherapy for Daniel. You can read about the story here: http://abcnews.go.com/US/Story?id=7674820&page=1. I don’t intend to get into any sort of debate here about parental rights or the right to choose alternative medicine over conventional Western medicine. What struck me about this was the fact that there was a court order put in place for Daniel to continue chemo and some amount of police resources put into finding the two after they ran away. Clearly the state of Minnesota deems Daniel a valuable life that needs protecting and that is worth public resources.

Contrast this to the case of Deamonte Driver, a twelve year old boy from Maryland who died in 2007 from a dental infection that spread to his brain (full story here: http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR200702...).

An $80 extraction could have saved his life if done in a timely fashion. But his mother was in and out of Medicaid, and even when they had Medicaid they had exceptional difficulty in finding a dentist that would actually accept their coverage. According to the Washington Post article mentioned above, only 900 or so of the state’s 5,500 dentists accept Medicaid patients. Now admittedly once it became apparent how ill he was after a visit to the emergency room he received a great deal of care. About $250,000 worth of care based on reported estimates (although no one seems to be mentioning how much of this bill Medicaid will actually be picking up and how much Deamonte’s mother was stuck with).

The point here is that as a society we absolutely have drawn some sort of line about what lives we deem “worthy” and “unworthy.” We’ll chase a white middle class teenage boy across the country to make sure he receives expensive chemo that he doesn’t even want, but we can’t even cover basic dental care for children on Medicaid? This seems a horrible injustice to me. It speaks both the importance of rationing (we need to cover basic services for everyone before we cover extensive procedures for those of us society deems desirable) as well as to the implicit sense of worth that we assign people in our health care system. These two scenarios just seem to indicate such a complete mis-allocation of resources to me.

Elijah Cummings, a Democratic member of the House from Maryland, introduced the Medicaid-SCHIP Dental Benefits Improvement Act of 2009 in January of this year and as best I can tell the CHIPRA provisions include some better coverage along the lines of what he was hoping for. But still, if reimbursement rates are too low, it really doesn’t matter if coverage is better because they’ll never actually be seen by that ever elusive dentist.

You can follow the progress of this bill here (although it's currently stalled): http://www.govtrack.us/congress/bill.xpd?bill=h111-462

This article was originally posted on the blog Soylent Green is People: http://soylentgreenispeople.wordpress.com/