Continuity of Care or a Culture of Kickbacks?

Recently, I did something I almost never do…I went to the doctor for a physical.  Yes, yes, I work in the medical world and know how important it is to have regular checkups, but unless/until it becomes necessary I steer clear of the doctor’s office.  Unfortunately, this past April going to the doctor became necessary…

You see, about a year ago I had to switch from my cushy PPO plan to a less-than-satisfying HMO plan.  With this switch I now have to play the referral game.  This wouldn’t be an issue except that my glasses were disintegrating before my eyes.  Therefore, it was imperative that I brave the primary care physician’s (PCP) office for an Ophthalmology referral.

To do this I needed to find a new PCP, so I picked Dr. Mary Murphy on a recommendation.  She saw me as a new patient and I let her know about the referral I was seeking, she said that since her computers were currently down I should call the office in a few days for the referral, but it shouldn’t be a problem. 

When I called the office a few days later, I was told that I would be unable to go to my Beaumont doctor because of the “continuity of care” policy at St. John Health System.  The conversation went something like this:

Referral specialist (RS) – “You must see a St. John’s affiliated physician for continuity of care.  For instance if you were to be admitted to the hospital by this doctor, you would not be admitted to a St. John’s facility and the medical records would not be in our computer system.”

Me – “If I were to be admitted to the hospital directly from my Ophthalmology follow up visit???  And just how likely is that, do you think?  Besides, I could have the records sent to your office.  I understand that you are concerned about your continuity of care, but how about mine?  This physician has been treating my vision issues for the past 20 years.  I have a complicated history with my eyes and am not willing to switch specialists.  Can Dr. Murphy make an exception in this case for my continuity of care?”

RS – “Ma’am this is a policy of your Blue Care Network (BCN) insurance.”

Me – “I don’t believe it is, I looked up my Ophthalmologist’s office and it is within the BCN network.”

RS – “Ma’am I suggest you call your insurance company.”

Needless to say I hung up and promptly called BCN.  They informed me their policy states that the physician chooses where the patient will be referred and that BCN has no involvement in this choice.  So, I called Dr. Murphy’s office back and clarified the BCN policy for them, since they seemed confused, the response I got was unpleasant at best.

RS – “Ma’am I never said that it was BCN’s policy.”

Me – “Yes actually you did, you just told me to call them.”

RS – “Dr. Murphy will not give you that referral, we suggest you find another PCP.”

I took their recommendation.  I usually try not to use this blog as a venting platform, but feel this policy claiming “continuity of care” as a reason to trap patients in a certain health system is patently bad for the health of the patient and something should be said.

I think you should seek care from the best available specialist for your disease or condition.  I don’t live a life tied to one health system, in my opinion it isn’t wise.  Even though a health system may be “best in the area” at one thing it won’t be best for everything.  And if you are sick, don’t you want the best?

When Dad was sick we went to all three of the area ALS (Amyotrophic Lateral Sclerosis or Lou Gehrig’s Disease) specialists, they were in three separate health systems and we were able to maintain “continuity of care” for his PCP just fine.  In fact, going to the different specialists allowed us to have a more complete view of Dad’s disease and explore all treatment options.

So, is the quest of St. John’s Health System really for “continuity of care” or is it ultimately a treasure hunt?  For each patient kept in the system St. John’s makes more money, so it seems to me they are more concerned with the good of their pocket book than the good of their patients.

I single out St John and Dr. Murphy because I had this experience with them, but I don’t think this is an isolated problem.  Savvy patients beware, lest you become trapped in a mediocre health care system when you have a serious illness.

Home at Last: Justina Pelletier Gets her Happy Ending

On Tuesday afternoon Lou Pelletier’s cell phone rang, it was his wife’s name on the caller ID, when he answered the voice he heard was his baby girl, Justina.  “Daddy, Daddy, I am coming home.”  The 16 month battle between the Pelletier family and the state of Massachusetts has finally come to an end.  On Wednesday, June 18^th Justina was transferred back to her family home in Connecticut and the case between her and the Massachusetts Department of Children and Families (MaDCF) was closed.

On May 30^th the Pelletier family and MaDCF filed motions to have Justina reunited with her family stating that all four requirements of the reunification plan had been met.  Since May 30^th the motion has been on the desk and at the mercy of Judge Johnston.  He approved the plan on June 17^th and Linda Pelletier, Justina’s mother, was able to take her home the next morning.

I believe this is in no small part due to the public outcry, phone calls to the Massachusetts powers-that-be, and extensive media coverage of this case.  Thank you to all of my readers who joined the fight for this little girl.

Her journey, in a sense, is just beginning.  She is confined to a wheelchair, it is unclear if she received adequate schooling during her time in the custody of MaDCF, and her forced separation from family will certainly leave scars.  Her family plans to find her appropriate physical therapy, assess her schooling needs, and start the journey to emotional healing.  They are under no delusion that their world will return to the normal they used to know, but are determined to help Justina heal and create a new normal for the family.

Lou Pelletier is overjoyed to have his daughter home and said his main focus at this time is her health and safety.  However, he plans, with the help of Liberty Counsel, to pursue legal action against MaDCF in the future. His goal is to ensure this never happens to another family and create a “Justina Law” to protect the families of children with rare diseases against flagrant charges of medical child abuse and secure parental rights in medical dispute cases.  A noble goal and I wish him well on his journey.

Thank you again to all of my devoted readers for helping get the word out about this case and indulging my obsession.  For the foreseeable future I think I am done writing about the Pelletier family.  I will however be watching as Liberty Counsel and Lou Pelletier pursue legal action against MaDCF.  Hopefully the next time the name Justina Pelletier appears on this blog it will be under the headline “Justina’s Law Takes Effect.”

A Less-Than-Sweet 16: The Justina Pelletier Saga Continues

Justina Pelletier turned 16 over Memorial Day weekend.  She was only 14 when the Massachusetts Department of Children and Families (MA DCF) took custody of her.  She has been hospitalized or institutionalized ever since.  Many of you will be aware that this is a story I have been following closely. If you are new to this tale and need further background on this family please see When Being Wrong is Unacceptable and When Doctors Disagree.

Earlier this month Justina Pelletier was transferred to a facility in Connecticut.  Though her parents still feel she should be home, they have said that this new facility seems to be taking better care of their daughter.  They are allowed more frequent visitation with her and are hopeful that she will soon be home.  Some friends were even allowed to visit and celebrate with her on her birthday. 

Even though these are positive developments, the case as a whole is still very concerning.

In March of this year "permanent" custody of Justina Pelletier was awarded to the state of Massachusetts.  Prior to this, Justina’s care was ordered back to her original physicians at Tufts.  Since this case is a diagnostic dispute between the physicians at Boston Children's Hospital (BCH) and Tufts, wouldn’t this transfer signify that the Tufts diagnosis of Mitochondrial Disorder was being upheld?  And, since the parents had been upheld on which doctors should treat their daughter, why did custody go to the state?  The logic in these decisions is not clear to me.

 Shortly after the custody ruling in March the judge's decision was leaked, trying to gain some additional perspective on the case I of course read it.  The full text can be found here.  My interpretation is as follows:

He made three main points:

1.       Disappointment that Connecticut Department of Children and Families (CT DCF) was unwilling to accept a transfer.

2.       Justina’s diagnosis

3.       Parental bad behavior

Let’s break down what Judge Johnston had to say about each of these issues.

First, the better part of his decision talked about his disappointment in CT DCF for refusing to accept a transfer of Justina.  He noted in his decision that CT DCF had investigated the Pelletiers and found that the home was an unsuitable environment for Justina (the Pelletier family claims the opposite).  Personally, I found the incessant mention of the CT DCF denial by Johnston to be (for lack of a better word) whiny to the point of ridiculousness and redundancy.  To be frank, I expect legal documents to be more professional and less petulant. 

However, all that being said, I don’t understand why Connecticut is refusing the transfer.  I assume it is to avoid media attention and responsibility.  If they were to accept her, she would be closer to home and if (as the Pelletier family states) CT DCF in fact found no problem with the home, why not accept the transfer and release her to the custody of her parents?

Regarding the diagnosis, Judge Johnston states that there is a large amount of psychological and medical evidence to prove that Justina suffers from Somatoform disorder.  However, as mentioned above, his order to transfer her care back to her original physicians at Tufts is contradictory to this statement.  The Tufts physicians diagnosed Justina with Mitochondrial Disorder and will certainly treat her in accordance with their diagnosis.

The last belabored point in the decision, was a discussion of the parents’ poor behavior.  Interestingly, everything noted as poor behavior and the reasoning for removal of custody happened after Justina was initially placed in state custody.  The document states that the Pelletiers were:

-          Verbally abusive to BCH staff

-          Approaching other families at BCH and telling them that the hospital was kidnapping children

-          Threatening institutions that were planning to accept Justina as a patient

-          Contacting the media

-          Changing their minds about accepting a transfer to CT DCF upon the advice of new legal counsel.

To me, much of this seems like behavior that is par for the course when someone has been unnecessarily stripped of their parental rights and are grasping at straws to have their child returned.  I don’t deny that the behavior is rude, but being rude is not a reason to lose your parental rights.

Consider these parents: their daughter has been taken by the state of Massachusetts, they are extraordinarily limited in when they visit her and what can be discussed, they see her health declining and can do absolutely nothing to help her.  How calm and pleasant would you be if it were your child?  

Mandatory Organ Donation: Ethical or Outrageous

Organ donation is the gift of life.  By donating organs after we die we can literally bring someone back from the brink.  Pretty awesome right?

So awesome in fact, that it could be argued, and has been, that everyone should want to donate their organs when they die, and consent for donation should be presumed.

What would this mean? Presumed consent for organ donation means that viable organs would be harvested from anyone who dies and consent from the patient or family would be unnecessary.  Every person would need to opt-out of the donation program rather than the current “opt-in” plan we have now.

As with everything in life there are pros and cons with an opt-out plan.  Let’s start with an obvious pro: with more available organs, more sick patients can get the transplant they need.  This is a definite good, but is it worth the cost.

One of the arguments I have heard for mandatory organ donation is: you don’t own your body once you die.  The assumption is that once I have died neither I, nor those who love me, have a vested interest in my body and until it is released to my family for funeral arrangements it in essence belongs to the government and my organs can be taken for donation without any ethical issue.

I adamantly disagree with the idea that I have no vested interest in my body once I have died.  My interest extends from the values I have lived during my life.  Furthermore, ownership and all decisions therein, should belong to my next of kin.  This ownership is crucial for many families.  For me, the final act I can perform for my loved one is ensuring the safe passage of their remains.  It is vital for me to have ownership of this task as part of my grieving process.  To remove personhood and its intrinsic value because life has left the body is illogical and disrespectful to the person as well as the loved ones they leave behind.

Another issue with presumed consent is that it expects an educated populous.  At this point in our society we need to recognize that this cannot be expected.  The vast majority of Americans live very uninformed lives for a variety of reasons.  If you don’t believe me watch some of Jimmy Kimmel’s Lie Witness News, they will make you cringe.

Finally, I think that making organ donation mandatory changes the psychology of the act.  Right now to donate you organs is altruistic and selfless.  If it becomes mandatory it changes the dynamic, instead of an altruistic giving of your organs, you become a renter of those organs until your death.  This may sound like a small thing, but changing this changes the way we view donors entirely.

In the end, organ donation saves lives, which is an important and wonderful thing.  However, making donation mandatory comes at a cost.  Are the lives saved worth possibly violating a person’s body?  Or upsetting their family? 

Treating everyone with respect and dignity is the most important thing we can do.  We should not place one patient at a higher priority while neglecting the other patient or their family.

As you have likely gathered I am strongly against mandatory organ donation.  That being said, organ donation is crucial and we should educate all citizens on the great gift they can give at the end of their life.  As we see with Lie Witness News, this will be an uphill battle, but if you agree with organ donation tell a friend and tell them to tell a friend.  With passionate advocates making the case to individuals we can raise the number of willing organ donors without compromising the donation process.

When Being Wrong is Unacceptable: More on the Department of Children and Families and Justina Pelletier

Alright, as many of you certainly know I have developed an addiction to the Justina Pelletier case.  I promise someday I will write on another topic, but today is not that day.  If you haven’t been privy to my latest obsession please see: When Doctor’s Disagree.

An opinion I hear for too often is that this is a “conservative” story, driven by “conservative” groups and media.  I don’t understand this claim, how is a story about parental rights only a conservative issue?  What if Boston Children’s Hospital (BCH) did overreach on this family, the Massachusetts Department of Children and Families (MA DCF) rubber stamped this case, and the court showed bias toward MA DCF in their decision, wouldn’t that be important to parents of all political beliefs? 

As I have said in every article about Justina, we need to remember that we are only seeing half of the story.  Because of this we do need to be a bit skeptical and cautious in forming an opinion.  Though, it seems that there is enough of a question to keep watching this story.  The best thing to do is investigate with an open mind and a calm nature.

There are two main opinions on DCF swirling around this case.  The first comes from those who side with BCH and believe that the hospital and MA DCF are justified and must certainly have evidence against the family that they are unable to share due to privacy laws.  This opinion is represented well here.  The article reminds us to not lose all faith in the medical community because of this story and that the vast majority of providers are appropriate at BCH, even if this story is true.   Pediatric providers have a deep love for their profession and a passion to help the children in their care.  Cases like Justina’s can make us lose sight of this and develop an irrational fear of pediatric medical professionals.   We must not allow our concern in this case to shape our judgment of all pediatric clinicians.

The second opinion is one that is very critical of child protection departments throughout the country.  An article explaining this case and the inadequacies of child protection services in general can be found here.  The author explains how child protective services employees often develop the idea that most parents will abuse their children and even a whisper of possible abuse should be acted on with the removal of the child. 

At this point I want to clarify a part of my opinion that I realize may not yet be clear.  Though I feel that there may have been overreach by the state of Massachusetts in Justina’s case, I do not believe the goal of MA DCF, BCH, or their employees has been to harm this girl.  I believe every person in this case is working for what he/she feels is in Justina Pelletier’s best interest. 

I work in pediatrics currently and frequently disagree with choices parents make for their children, but my respect for the institution of parenthood reminds me that people are entitled to make choices for their children that I consider wrong.  It is only in the direst of circumstances that anyone is entitled to intervene.  It is not always easy, but I remember that my view is merely a snapshot and that parents have the right to raise their children as they see fit.  Even if their home isn’t perfect (keep in mind that no home is), we must consider the harm done by removal versus the harm (or potential harm) done in the home.

Unfortunately, it doesn’t appear that this evaluation is always done appropriately.  The reality is that there is always harm done to a child when removed from their parent’s custody.  Sometimes, it is warranted, but should be a last resort because of the psychological turmoil removal has on the child.  When removing parental custody, it is absolutely and ALWAYS unacceptable for DCF to be wrong! 

Anyone who works for child protective services should work under a constant fear of being wrong, as deeply as or even more deeply than the medical community fears mistakes.  The responsibility given to those who work for DCF is intense and workers should feel the weight of that responsibility.  It is unacceptable for these agencies to become reactionary, ie remove a child too quickly and find proof for the removal later.  I am not saying that this happened here, though we must admit it as a possibility.  I am trying to make the broader point that DCF should be under the strictest regulation, and that the burden of proof should be on their side for removal of a child.  The bar should be set high, weighted always on leaving the child with their natural family unless serious and imminent harm is certain.

Since we have said that a harm comparison should be done, let’s use the information we have in the Justina Pelletier case to compare her life with Mom and Dad vs. her life in DCF care:

Life with Mom and Dad

-          Participated in social activities (figure skating)

-          Attended and enjoyed school

-          Frequent medical appointments (possibly unnecessary)

-          Frequent medical procedures (possibly unnecessary)

-          Many medications (possibly unnecessary)

-          Family structure intact

Life in MA DCF Care

-          Over a year in institutions

-          No schooling (alleged by the family)

-          Deterioration of overall health and physical appearance (assessed by pictures and family report)

-          Less medical procedures (that were possibly unnecessary)

-          Fewer medications (that were possibly unnecessary)

-          Family unit and child’s normal support system fractured

It has also been alleged that Justina has not been allowed to participate in elements of her faith that are important to her.  If the parents are medically abusing their daughter this certainly needs to be dealt with, but to add intellectual, emotional, physical, and psychological harm to this child under DCF care is not the way to handle it. 

Remember that there are respected physicians who have cared for this child for years and feel she has Mitochondrial Disease and that the family has appropriately dealt with this diagnosis.  This case is not cut and dry, one respected physician’s opinion is in direct opposition to another and a child’s care and wellbeing hangs in the balance. 

I have said it before and will say it again: It is unacceptable to be wrong.  In any DCF case there should be a harm analysis and abuse, willingly or unwillingly inflicted by the government agency on the child needs to be addressed and appropriately handled.  It does no good to move a child from a potentially harmful environment into a definitely harmful one.

When Doctor’s Disagree

What happens when doctors disagree on a pediatric diagnosis?  What are the parents’ rights in a diagnosis dispute?  Do they have any?

Many of my faithful readers will be familiar with the story of Justina Pelletier.  I have been following the case of this 15 year old girl for several months.  For new readers I will give a quick recap here:

Justina is a 15 year old Connecticut girl, she had been diagnosed with Mitochondrial Disease at Tuft’s Medical Center by Dr. Mark Korson.  In February of 2013 Justina developed the flu, Dr. Korson suggested that the family take Justina to Boston Children’s Hospital (BCH) to see her gastroenterologist who had recently moved to BCH.

When the family arrived at BCH they were told they would not be allowed to see the gastroenterologist, the staff at BCH quickly changed Justina’s diagnosis from Mitochondrial Disease to Somatoform Disorder, a psychological condition that manifests in physical symptoms.  They stopped all of her medications and moved her to the psychiatric ward of the hospital.  When the parents objected and said they were going to return their daughter to her doctors at Tufts the hospital made allegations of medical child abuse and the Massachusetts Department of Children and Families (DCF) took temporary custody of Justina.  The parents have been fighting to regain custody ever since.

The theme of the many, many court dates has been postponement, but a decision was finally made last week.  Judge Johnston granted “permanent” custody to DCF.  This ruling cannot be reviewed by the court for 6 months, the judge backdated the decision to December, so the family’s next court date is May 25^th, 2014.

In January, Justina was moved to a non-medical psychiatric facility.  The average stay at this facility is 2 weeks or less, she has now been there over 2 months.  Her family feels that this is a dangerous environment for Justina.  According to her father, Lou Pelletier, before developing the flu last year his daughter was a typical active teenager, she handled her chronic illness well and enjoyed activities such as figure skating.  By the time she was moved to this non-medical facility in January 2014, she was confined to a wheelchair barely able to walk.

The family’s position is that Boston Children’s Hospital and Massachusetts DCF have kidnapped their daughter and are neglecting her medical needs to a point that her life is in imminent danger.

Lou Pelletier has been on a media campaign to raise awareness of his daughter's condition and situation.  The family’s last big media appearance was on the Dr. Phil show about two weeks ago.  The episode was well done and featured opinions from many experts on custody battles.  The overarching theme was that any custody case involving the state should focus on creating a safe environment at home so the child could return to the family.  This is done through investigation of the home and family life, counseling, education, etc. basically whatever is necessary to reunite the child with his/her family.  According to the Pelletier family no investigation has been done and they do not feel that Massachusetts DCF has any intention of working to return custody of their daughter.

The trouble with this story is that we only have the Pelletier family’s side, DCF has remained extremely tight lipped, making very few statements regarding the case, none that have been particularly informative or helpful.  From all appearances the family is calm, together, medically literate, and rational.  I recognize that their side of the story is certainly biased and we must keep that in mind, however with the silence from DCF, lack of criminal charges toward the parents, and drastic difference in this girl through photos from this year and last, the family’s story appears to be credible.

A few weeks ago Judge Johnston ruled that Justina’s medical care be transferred from Boston’s Children’s Hospital back to Tufts.  This was considered a win for Justina’s family, and the parent’s called to help facilitate Justina’s appointment with Dr. Korson.  Massachusetts DCF refused to take Justina to Tufts prior to this most recent decision, it remains to be seen what they will do now that they have been granted custody.

One of the things I fail to understand in this case is how BCH could override the diagnosis from Tufts and because they make a new diagnosis have grounds to remove this child from the custody of her parents.  What are a parent’s rights in healthcare situations?  Do they have the right to decide: who treats their child, which doctors to trust, or whether to seek a second opinion? 

A key player in the new diagnosis of Somatoform Disorder was Simona Bujoreanu PhD.  Somatoform Disorder takes a very long time to diagnose, before a diagnosis can be confirmed, the physician must rule out any possible medical cause.  Physicians at Boston Children’s Hospital allegedly diagnosed Justina with Somatoform disorder in just 12 hours.

 I think it is important to focus on Dr. Bujoreanu because of an article she wrote a few years ago.  The article is titled: “Approach to Psychosomatic Illness in Adolescents.”  Dr. Bujoreanu claims in this article that “20-50% of all patients complaining of physical symptoms can be categorized as having medically unexplained symptoms.”  As the article goes on she seems to claim that psychosomatic diagnoses are a catch-all for these patients with symptoms that cannot be immediately medically explained.  She makes broad strokes about what can be considered psychosomatic and does not focus on how time consuming a diagnosis like this should be.  She talked about how families may react badly to a psychosomatic diagnosis, but did not stress how careful a psychologist should be in making the diagnosis. 

In Justina’s case her physical symptoms had been explained by a diagnosis of Mitochondrial Disorder, the doctors at Boston Children’s Hospital simply rejected this diagnosis.  I think doctors need to be extremely careful when countering the diagnosis of another physician and if the new diagnosis is psychosomatic even more time and evidence will be needed.

The decision of the judge this week was very disappointing.  The family has been investigated by Connecticut Department of Children and Families and nothing was found.  Connecticut Department of Children and Families has repeatedly turned down a transfer of Justina to their custody, presumably because they have previously cleared this family.  I also feel very strongly that before a child is placed in “permanent” foster care against the express wishes of the family, some sort of criminal charges should need to be filed against the parents.  I am frankly appalled that something like this could happen in America.

Parents should be allowed to disagree with a diagnosis and to have their child treated by the medical professional of their choice.  If the child is in danger of abuse or neglect by a family member criminal charges should be filed along with the request for custody by the hospital or state.  I am a very strong advocate for parental rights, and believe that excepting extreme cases custody of and decisions for children should remain with the parents.  Parents need to have defined rights in medical situations, perhaps this case can motivate us to more plainly secure parental rights when a child is ill.  I have said it before, but will stress it again, I am shocked and saddened that removal of a child from her family like this does not have to be associated with criminal charges against the parents.

I have so much to say about this case and I am sure I have not typed my last on this story.  I was glad to hear that the family plans to continue the fight at the appellate court level.  I will be following this closely as it develops, I hope you will as well.  More to come…

Barbie Dream Body

 When you were a kid did you ever want to look like Barbie?  No?  Me neither…her breasts were too big and her waist too small.  I always figured she would break in half in real life, or at least have chronic back pain.

Blondie Bennett though, has always dreamed of becoming a real life Barbie doll.  She says that she was obsessed with Barbie as a kid and has modeled her life after the doll.

photo credit: <a href="http://www.flickr.com/photos/dollobserver/5499591092/">The Doll Observer</a> via <a href="http://photopin.com">photopin</a> <a href="http://creativecommons.org/licenses/by-nc-nd/2.0/">cc</a>

Now 38, she has had five breast enhancement surgeries and at this point makes Dolly Parton look “natural”.  She also has regular Botox injections and lip fillers to make her appear plastic and doll like.  Believing that “natural is boring,” she has gone to extremes to make herself into a living doll.

The most extreme of her actions is to participate in hypnotherapy sessions multiple times a week.  The goal of this hypnotherapy is to lower her IQ.  Her ultimate desire is not only to resemble Barbie in looks, but also to become brainless like the doll as well.  To hear Blondie in her own words, please watch this video.

In my humble opinion, it appears that this desire to become Barbie even to the point of brainlessness masks a deep psychological pain in this woman.  To purposefully work to forget your life and become ignorant of the world seems to me a red flag to deeper issues. 

However, we aren’t here to judge or fix this woman.  I chose to write about her story for two reasons: 1, I found it fascinating and 2, I think it is an interesting way to highlight an important issue in our country.  The current trend in laws and policies makes us increasingly financially responsible for and beholden to one another.

Take the healthcare law for instance.  With health insurance being subsidized by tax payers, we have a financial interest in our fellow citizens staying healthy.  Right now Blondie’s rent is paid by a “special guy” and some of her procedures funded by other gentlemen in her life.  I presume that one day, as she ages, these gravy trains will cease to run.  Where then will her money come from?  What if she suffers back problems from the weight of her super enhanced bosom?  What if her treatments to become brainless work so well that she is unable to enter the workforce or even care for herself because of her forgetfulness?  Since she chose to put herself in that position, should American tax payers foot the bill for her future care?

If the answer is yes, doesn’t that give us a vested interest in her behavior now?  We see this idea play out in campaigns against: smoking, drinking in excess, eating junk food, not exercising, using recreational drugs, etc.  I am not saying that we should encourage these behaviors by any means, but since we are now financially tied together through healthcare, whether or not people stop the high risk behavior has a direct effect on the wallet of every tax payer.

Blondie Bennett may have a contingency plan for her future and continue to live a self-sufficient life.  However, her eccentric life choices are an interesting case study for how involved we should be in the choices of others when the future cost of those choices could fall on our shoulders.  Whether or not you agree with the changing healthcare system it will inevitably lead to new discussions and decisions regarding healthcare rationing as it relates to risky health behaviors. 

Mulling over interesting and quirky stories like this one, could give us good practice for the deeper and more complicated questions we are sure to face in the future.