Montana Viewpoint

December 9, 2002

There are no easy choices ahead for the state legislature this January.

In a state budget crisis, you get the biggest cost savings by cutting the biggest programs. Health care and human services are major programs in any state budget. In Montana it will account for 24% of the total General Fund budget in 2003. (When you hear that the state budget is going kablooey, it’s the General Fund that’s having the problem.) There are three options: cut spending, raise taxes, do both. We are looking at about a 10% General Fund deficit. In dollar terms that’s $250 million for the two–year budget period.

Governor Martz has chosen, nay, vowed, to correct the deficit by cutting spending. In the preface to the budget the Governor states: “The reductions will mean some people will no longer receive some services. Care has been taken to try to ensure that services are continued to those most in need,” (my italics). It’s apparent that there must be different definitions of “most in need.”

One of the programs slated for elimination is the program to treat End Stage Renal Disease. Renal disease means kidney failure, and End Stage means that the kidneys are working at less than 10% of normal. If the kidneys are functioning less than OK but above 10%, it’s called Chronic (or continuous) Kidney Disease.

Diabetes and hypertension are the most common causes of Chronic Renal Failure, and affects two out of every 1000 individuals --about 2000 Montanans. When kidneys don’t function properly the waste products that are normally removed by the kidneys accumulate in the blood and have to be removed artificially. This is done using a process called dialysis by physically hooking the patient up to a blood cleansing machine for 3 or 4 hours at a time. Without dialysis or a kidney transplant, End Stage Renal Disease is fatal. Are these folks not “in need”?

Montana hasn’t always offered an End Stage Renal Disease program. I remember vividly when it was included in the 1991 budget. The 1989 legislature voted to not fund an End Stage Renal Disease program, but between 1989 and 1991, Tom Hager, a member of the Montana Senate, was diagnosed with it. It can sneak up on you. He was a nice man, and apparently couldn’t afford the expensive and intense dialysis treatment he needed to live. He needed Government assistance. That year, the legislature put the program in the budget.

I have never really been able to decide how I felt about that vote by the legislature. I supported the program in 1989, and in 1991, so I was glad to see it pass, but dismayed that it didn’t pass until “one of our own” needed the treatment. I surely didn’t begrudge Tom the few months more of life it treated him to, but I often feel that if he had not been in the Legislature that he wouldn’t have had the program to give him that gift.

To be charitable, I’ve come to believe that until legislators can put a face to a problem, they’re not as likely to be understanding or sympathetic. Otherwise, it’s just another statistic that costs money. There are thousands of statistics whose future will be altered by the next legislature. Some will die, some will go insane, some won’t get the education they might have, and some will survive and do just fine.

Individually, I know legislators are all caring people, but we look at the bottom line more than we look to the individual needs of Montana’s citizens. It’s important to look people in the face when you’re deciding their future.

Voting to eliminate the End Stage Renal Disease program is just one of the choices we’ll get to make when we go to Helena. Another one will be about whether or not to raise taxes. What would you do if somebody’s life were in your hands?

Jim Elliott
Phone: 406-444-1556
Mail: State Senate Helena, MT 59620