years.They’rethinkingthey’regettingatleastthatlottery
ticket’s chance that their disease might not even be a
problemanymore.Moreover,ifthere’sanythingwewant
tobuyinthefreemarketorobtainfromourgovernment
taxes,itisassurancethat,whenwefindourselvesinneed
of these options, we won’t have to worry about the costs.
This iswhy theRword—“rationing”—remainssuch a
potent charge. There is broad unease with the
circumstances we’ve found ourselves in but fear of
discussingthespecifics.Fortheonlyseemingalternative
toamarketsolutionisoutrightrationing—deathpanels,
assomehavecharged.Inthe1990s,insurancecompanies
attemptedtochallengethetreatmentdecisionsofdoctors
andpatientsincasesofterminalillness,buttheattempts
backfiredandonecaseinparticularprettymuchputan
end to strategy—the case of Nelene Fox.
FoxwasfromTemecula,California,andwasdiagnosed
with metastatic breast cancer in 1991, when she was
thirty-eight years old. Surgery and conventional
chemotherapyfailed,andthecancerspread toherbone
marrow. The disease was terminal. Doctors at the
Universityof Southern Californiaofferedher aradical
but seemingly promising new treatment—high-dose
chemotherapywithbonemarrowtransplantation.ToFox,
it was her one chance of cure.
Herinsurer,HealthNet,deniedherrequestforcoverage
ofthecosts,arguingthatitwasanexperimentaltreatment
whosebenefitswereunprovenandthatitwastherefore
excluded under the terms of her policy. The insurer
pressedhertogetasecondopinionfromanindependent
medicalcenter.Foxrefused—whoweretheytotellherto