Health Care Critic Lamm: Heart Transplants Were Wrong

Orange County’s first two heart transplants, performed last month, are the kinds of costly artificial means to prolong life that Americans should do without, a nationally recognized health care critic said Friday at a conference in Newport Beach.

Former Colorado Gov. Richard K. Lamm, who created a national stir four years ago when he said patients who are terminally ill have a “duty to die,”’ told a meeting of the California Assn. of Health Maintenance Organizations that heart transplants should not be performed because they are expensive and extraordinary ways of artificially prolonging life.

Reliance on such techniques has caused the United States to spend $500 billion annually for the most costly medical care program in the Western industrial world and still rank only 17th in infant mortality and measurements of quality of care, Lamm said.

The roughly $150,000 that was spent on each transplant could be better used to provide prenatal care for the estimated 2,000 women in Orange County who went without prenatal care last year, Lamm said in an interview.

“What kind of terrible health care system do we have where we have 2,000 women going without something as basic as prenatal care while two other people can get costly, experimental surgeries like heart transplants?” Lamm asked the 150 people, mostly officials of 40 prepaid group health care plans in the state.

Lamm acknowledged that the heart transplants appeared to have been life-saving measures for Scott Headding, 26, who got a new heart April 8 at UCI Medical Center in Orange, and Dr. Norton Humphreys, 58, who received a new heart April 20 at Hoag Memorial Hospital Presbyterian in Newport Beach.

But “though these two heart transplant patients would be dead, think of how many kids would be living if their mothers had gotten proper prenatal care,” Lamm said. “Why should the scarce health resources we have be provided to two men who would live for just a few more years, while infants would have a whole lifetime to look forward to?”

The average life expectancy for heart transplant patients is five years, according to medical experts, although some patients have lived much longer.

Lamm served as governor of Colorado for 12 years before deciding not to seek election to a fourth term in 1986. He gained national prominence in 1984 when he said that the terminally ill have a “duty to die and get out the way, with all of our machines and artificial hearts and everything else like that, and let the other society, our kids, build a reasonable life.”

Lamm, 52, who earned the nickname “Governor Gloom” for his warnings about the problems facing health care, is now director of the Center for Public Policy and Contemporary Issues at the University of Denver.

During his talk and a question-and-answer session, Lamm reiterated that too much money is spent to prolong the lives of the desperately ill and not enough on routine and preventive care for those who cannot afford it.

During his speech, Lamm noted that the United States, which spends 11% of its gross national product on health care, spends more in this area than any other industrial nation. If this rise is not checked, it will reach 17% in the year 2,000 and 100% in 2050, Lamm said.

Though such industrial nations as West Germany, Japan and Britain spend a smaller proportion of their national wealth on providing their citizens with health care, they rank ahead of the United States in lower infant mortality rates, longevity and other key health indicators.

Polls indicate that people are not willing to pay higher taxes to get increased health care, Lamm said, and because only a limited amount of a national budget can be spent providing medical care, Lamm said, health care policy-makers should “prioritize” medical care so that all people are provided with basic medical care.

“We’re already rationing health care, with 35 million, or one out of eight American families being denied a basic level of health care,” Lamm said.

Under the “rational” rationing of health care proposed by Lamm, all such basic services as doctor visits, vaccinations and prenatal care would be provided by cutting spending for costly, experimental treatments that artificially prolong life.

“I want to live a long life,” Lamm said, “but I should not be able to do so by stealing it from women and the indigent.”

Thomas Higgins, editor of HealthWeek, a national newspaper based in San Francisco that covers the health industry, said at the meeting that more money for medical care could be found by reallocating money from national defense and such programs as Social Security and Medicare.

“I am opposed to this country saying that it is all right to discriminate on the basis of income when I think this country can readily afford to pay for basic medical care benefits,” Higgins said.

The United States could afford to increase its spending on medical care by 4% to 15% of its gross national product, Higgins said.

But he said he agreed with Lamm that government money should not be spent to pay for heart transplants “because there is no evidence so far that they prolong lives for more than about five years.”

Larry K. Ainsworth, Hoag’s executive vice president, declined to comment on Lamm’s heart transplant criticism.

Leon M. Schwartz, director of UCI Medical Center, said the Orange hospital provided full care to pregnant women and heart transplant patients.

Schwartz acknowledged that an estimated 2,000 women in the county went without prenatal care last year but said he had fought for additional funding to provide them with more care.

“But we here at UCIMC don’t make that kind of decision,” Schwartz said. “We’re responsible to government decision-makers.”

The bill for Headding, the hospital’s first heart transplant recipient, is $165,000. Headding, an unemployed roofer who lives with his grandparents, has said he is indigent, and Schwartz said the hospital has met with Medi-Cal to find out if Headding qualifies for the program.

Hoag officials have said the $145,000 cost of Humphreys’ transplant will be paid by his insurance.