The Right to Be Covered

This chapter explores the paradoxical assertion of freedom of therapeutic choice in the context of reimbursed health care. Cries of “rationing!” and “death panel!” are directed at every suggestion of a limitation on government insurance coverage. This chapter traces the history of the notion of a “right to be reimbursed” for one’s therapeutic choices since the 1930s. It explores the persistent public insistence on “a right to choose one’s doctor” in insurance plans. It describes the history of drug formularies and patients’ resistance to them. The chapter focuses most intensively on the controversy surrounding the FDA’s November 2011 withdrawal of provisional approval of Avastin for the treatment of breast cancer. Conservatives and patient groups used the language of rights to attack this decision even though it did not remove the drug from the market; the protesters’ real fear was that insurance plans would stop reimbursing patients for this use.