AMERICA COPES WITH COSTS OF LIFE AND DEATH CHOICES

For cancer patient Mike Carlton of Cape Girardeau, health care is a life and death matter.

For months, he and his family have fought to get his insurance company, Blue Cross and Blue Shield of Missouri, to pay for a costly bone marrow transplant.

His story reflects America's health care dilemma.

In a three-part series of articles beginning today, the Southeast Missourian looks at Carlton's situation, bone marrow transplants and explores the underlying question: Can society afford to pay for experimental, often risky, medical treatments?

It's a question that has no easy answers, insurers, doctors and medical ethicists agree.

High-priced medical technology, costly drugs, government regulations and malpractice lawsuits drive up health care costs, those involved in the health field say.

The health care issue is particularly acute when it comes to individuals with life-threatening diseases such as cancer, where doctors propose treatment that insurers consider experimental and risky.

Such treatments, such as bone marrow transplants, have little chance of success in many cases, insurers say.

Such procedures are also expensive, costing hundreds of thousands of dollars.

Without insurance coverage, the burden on patients and their families is enormous.

Faced with more than $400,000 in medical bills, Donald McQuay of Jackson Route 2 ended up filing for bankruptcy.

McQuay had to face not only the financial burden but also the emotional strain of the death in 1990 of his wife, Patty, from breast cancer.

A large portion of the medical bills resulted from a bone marrow transplant for Patty McQuay, a treatment that her health insurance company refused to pay on the grounds that it was experimental.

The McQuay family didn't resort to litigation against the insurance company, Blue Cross.

But a St. Louis woman, who was dying from cancer, did. A federal court ordered Blue Cross to pay for a costly bone marrow transplant despite the treatment's slim chance of success. The 41-year-old woman died in July, only a few months after undergoing the $240,000 treatment.

Some people point to such cases as an argument for rationing health care on a national basis.

Medical ethicists say the cost of medical treatment today serves to ration health care, leaving millions without access to adequate care.

Some 37 million Americans don't qualify for government assistance and can't afford health insurance.

Modern medicine seemingly can perform miracles, but there's a real question if society can afford the cost, medical ethicists, insurers and health professionals admit.

And when it comes to health care, Americans have conflicting emotions. They want to have the best health care in the world, but they don't want to pay higher taxes to provide that care to everybody.

Americans talk of health care cost containment. But when it comes to their own families, they want the best care possible regardless of the cost, say those involved in the continuing health care debate.

At its very core, the issue comes down to matters of life and death.