Rationing in Oregon
Higgins, Thomas
HEALTH-CARE REFORM RATIONING IN OREGON NOT THIS WAY n August 3, when the Bush administration rejected Oregon's request for a waiver to change the state's medicaid program in order to implement a...
...Oregon wanted to rank order procedures for which it would pay, while at the same time extending coverage to more of the indigent population...
...For these and other reasons a number of health policy experts like Henry Aaron from the Brookings Institution, advocacy groups like The Children's Defense Fund, and progressive legislators like Congressman Henry Waxman (D-Calif...
...Regardless of almost any other variable concerning one's health status, reimbursement was based on whether or not a given procedure was on or off an approved list...
...As the proponents observe, we already ration health care in this country very badly, on the basis of access to insurance...
...They all deserve consideration because states should serve as "laboratories of democracy...
...At the same time, patients near the end of their lives were receiving nonessential care because those procedures were on the list...
...most of whom do not usually agree with the Bush administration—found the Oregon proposal untenable...
...Obviously, in any situation where there is inelastic demand and finite resources, such as health care, there has to be rationing...
...Others create voluntary purchasing approaches...
...The determining factor was political clout...
...There remains strong support, however, for states to take the initiative in devising more equitable approaches to improving access and controlling costs in our health-care system...
...And the process by which the list of covered benefits was determined was a violation of any clear reading of the Disabilities Act...
...They may even be expected to include some form of rationing, either direct or indirect...
...These recipients are disproportionately young, black, and female...
...2. The New York Times's editorial to the contrary, the proposal was, in fact, invidious discrimination on the basis of race, sex, class, age, and disability...
...HEALTH-CARE REFORM RATIONING IN OREGON NOT THIS WAY n August 3, when the Bush administration rejected Oregon's request for a waiver to change the state's medicaid program in order to implement a system of explicit rationing, a number of commentators protested the decision...
...This laudable goal ~~~~~~~~~ 25 September 1992: 5 would be achieved by "thinning the soup," e.g., only paying for those procedures that ranked high enough to be above the cutoff line...
...Upon closer examination, however, it appears that the White House was absolutely correct in rejecting Oregon's proposal...
...That is exactly what happened when Oregon tried to implement its program three years ago...
...One should note that this rationing scheme was not intended to cover any other publicly funded beneficiaries such as public employees, retirees, etc...
...Public employees and senior citizens do...
...and Senator Albert Gore (D-Tenn...
...He was also Deputy Secretary to the Cabinet of President Jimmy Carter...
...Even prior to the passage of the Americans with Disabilities Act, there was more than sufficient evidence of fatal flaws in the proposal...
...Along with state officials, they claimed the decision was the result of "election year politics...
...Oregon should be encouraged to come back with its own proposal, one which meets the test of good medical practice and fundamental fairness...
...The proposal applied only to Medicaid AFDC recipients...
...Contrary to what the proponents suggest, this debate is not about rationing, per se...
...A twelve-year-old boy with leukemia was denied a potentially life-saving bone marrow transplant because tissue transplants were not on the approved list...
...They are all poor...
...There were two overriding objections to the Oregon plan: 1. It was rationing by recipe...
...Some involve mandated insurance...
...Human beings are not, of course, so readily classified...
...The administration should not have taken as long as it did to make its decision...
...The poor don't vote, and they don't have political action commit6. 25 September 1992 tees...
...THOMAS H1GGINS Thomas Higgins, an insurance executive, is the former director of the Department of Human Services of Multnomah County, Oregon...
...But the Oregon plan would only have substituted an equally objectionable system without remedying the most glaring defects in our current one...
...Inspired by Hawaii's successful record providing near universal access to health care, states as diverse as Minnesota, Washington, Colorado, Iowa, Maryland, Oklahoma, and others are preparing waiver requests to the federal government for a variety of innovative and responsible approaches...
...That's why triage decisions take into account holistic judgments about individuals...
...The New York Times later editorialized that, "absent any showing of invidious discrimination," the denial should be overturned and Oregon's appeal granted...
...By following blindly the Oregon norms, any number of absurd outcomes were bound to result...
Vol. 119 • September 1992 • No. 16
