2023 – Feinwachs, D., Medical Aid in Dying, StarTribune.com


I read with great interest Hoffman’s opinion piece on aid in dying.

Hoffman said that “HMOs’ health care decision making introduces another layer of complexity. When profit-driven entities are entrusted with determining the allocation of resources and medical care, the risk of neglecting the needs of individuals with disabilities becomes pronounced. Ethical guidelines and oversight mechanisms must be in place to ensure that financial considerations do not override the commitment to the well-being of all individuals, regardless of ability.”

I could not help being struck by the irony of this statement. Last year a bill in the Minnesota Legislature would have given Medical Assistance enrollees the ability to choose fee-for-service health care as opposed to managed care in the Medical Assistance program. The proposal was killed just before it was scheduled to pass because certain interests wanted medical assistance patients trapped in managed care. Why? Because they make more money using the managed care model.

The irony here is twofold. First, the Medical Assistance program exempts disabled people from being forced into managed care. Very likely for exactly the reasons that concern Hoffman, who fears that economics will play no small part in shaping health care treatment decisions.

The second part of the irony involves the fact that while the Legislature rightfully protects the disabled, it throws the rest of the Medical Assistance population to the managed-care wolves. The measure that was killed would have saved the state and the taxpayers money while granting people the right to choose their health care. It was killed so certain hospitals could continue to make more money. Not long after the measure was killed, the U.S. Office of Inspector General released a study raising concerns about the dangers of managed care and health care access in the Medicaid program. Perhaps we should ask which hospitals and which legislators were responsible for euthanizing freedom to choose in Minnesota’s Medical Assistance program.

Unlike patients seeking medically assisted suicide, patients in Medicaid managed care have no choice. If you want to worry about someone, worry about them.

David Feinwachs, St. Paul
The writer is an attorney and former general counsel for the Minnesota Hospital Association and former assistant professor at the University of Minnesota.