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Putting a price on prolonging a doomed life

Doctors, not health insurers, should decide how much can and should be done to extend the lives of the terminally ill.

September 01, 2011|David Lazarus
  • Karen Iritano gives her husband, Bob, a kiss on his 50th birthday last year while cooking dinner. Facing terminal cancer, his life was extended by a year and a half after his health insurer, Health Net, reversed an earlier decision not to cover what it deemed an experimental procedure. Bob Iritano died Thursday morning at age 51.
Karen Iritano gives her husband, Bob, a kiss on his 50th birthday last year… (Anne Cusack, Los Angeles…)

Bob Iritano died Thursday morning. He was 51.

Iritano wasn't a celebrity. He wasn't a captain of industry or a mover and shaker.

Iritano was just a guy who worked his job as an insurance broker every day. He was a husband. He was the father of four kids.

Iritano also had terminal cancer. He knew he was going to die. The only question was when.

His insurer, Health Net, decided last year not to cover a life-extending procedure that had worked just a few months earlier. This left Iritano fighting for time — time to share with his wife, Karen; time to teach his son to throw a football; time to attend a father-daughter school dance with his little girl.

Iritano faced a situation that many others with terminal illnesses or chronic diseases face: What price do you put on a life? How much money and medical resources are too much when it comes to prolonging a doomed existence? Who decides when your time is up?

Iritano gained an extra year and a half after I wrote about his case in February 2010 and reported a TV segment for KCET's "SoCal Connected." As a result of the publicity, Health Net said it would approve what it still deemed an experimental procedure as "a one-time benefit exception."

In fact, the insurer covered two additional rounds of the treatment, known as a radio frequency ablation, in which microwaves zap malignant tumors. A Health Net spokesman declined to comment on the company's newfound flexibility.

"It wasn't a cure," Karen Iritano told me a few hours after her husband's death at their home in Thousand Oaks. "But it worked. It gave him more time."

And it was time well spent. The Iritanos took a family vacation to Hawaii. They went boating at Clear Lake in Northern California. They went camping near San Diego. They attended a family reunion in Connecticut.

Iritano saw his 8-year-old son play football.

He attended the father-daughter dance in May.

And he served as an inspiration to his many friends who marveled at his cheerful attitude and complete lack of self-pity.

"Every day was a good day," Karen said. "We were a family, and the kids got to be with their father. You can't put a price on that."

Well, you can, obviously. And it can be argued that you should. The United States already spends about twice per person on healthcare compared with most other developed nations — $7,538 a year on average, according to the Organization for Economic Cooperation and Development.

That translates to healthcare accounting for about 16% of the overall U.S. economy. That compares with 11.2% in France, 10.5% in Germany, 9.4% in Sweden and 8.7% in Britain.

In the harsh light of pure statistics, it's clear that we have to do more to bring down healthcare costs and expenditures. One way to do that would be through the efficiencies of extending Medicare to all Americans and more strictly regulating how much can be charged for medical procedures and insurance.

Another would be to limit how much of our healthcare resources should be devoted to, for lack of a more artful term, lost causes.

More to the point, do we really want to spend hundreds of thousands of dollars extending the life of a person with a terminal illness?

For me, Bob Iritano provides a resounding "yes" to that question. And the reason is a simple one: What if it were me? What if it were you?

Iritano, who was diagnosed with Stage IV metastatic sarcoma in February 2007, knew full well that the clock was ticking. But he also knew that he wanted to spend as much time with his family as possible.

His doctor believed the radio frequency ablation would help. Indeed, studies at the University of Texas and Royal Marsden Hospital in London found this to be an effective treatment for conditions like Iritano's.

Clearly there are limits to how much can and should be done to prolong the lives of the terminally ill. But this is a matter for medical experts, not insurance bean counters, to address. A doctor is in the best position to determine what's most appropriate for his or her patient.

Health insurers have no business denying coverage just to save a buck. It's not their call to make.

Nor should they put patients and their families through the grueling process of challenging insurance decisions and battling a corporate bureaucracy. That's just cruel.

But it's what we'll keep getting as long as health insurance is run as a for-profit industry. Under such circumstances, a Bob Iritano isn't a living, breathing person. He's a financial liability. And for-profit companies have a fiduciary duty to eliminate financial liabilities.

Iritano wasn't famous. He didn't do anything earth-shattering or history-making.

He just lived his life, and he lived it well, right up to the very last minute, when he passed away wearing a Boston Red Sox T-shirt and warmed by a New England Patriots blanket.

"I always knew this day would come," Karen said. "But at least we had more time with him. Every day was special."

That's all that counts.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com

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