Because Uncle Sam doesn't want to pay what you'd pay for healthcare were you to pay out of pocket, he decided to set criteria. So unless criteria is met, your grandma cannot get the BiPAP or oxygen she needs.
A good example of this came up recently at my work. The patient is an end stage COPD/ pulmonary fibrosis patient. She benefits greatly at night with BIPAP. It keeps here CO2 from rising and it helps her oxygenate.
However, Uncle Sam doesn't care about this patient as much as he cares about his wallet. So he set a criteria where the only way he will pay for BiPAP before a sleep study is done is if the patient meets the following criteria.
1. A sleeping SpO2 of 88 percent over five minutes
2. An ABG on whatever oxygen the patient will be wearing at home (or on room air) that shows a CO2 of 52 or greater.
Yet this patient has a sleeping SpO2 of 85% and her ABG showed a CO2 of only 50.5. Based on the government criteria she doesn't get BiPAP. She, thus, is on the losing end of the government ration. Uncle Sam cares not about this wonderful old lady that I've grown to love.
So many politicians say there are no such things as death panels. Yet is this not the same thing? It's rationing to decide who lives and who dies because Uncle Sam is frivolous with his money.
The lady lived another 2 months, and never received the BiPAP that may have preserved her life a while longer, and made breathing more comfortable for her while she was still here. Thanks Uncle Sam.