Rationing health care

March 01, 1991

In a time when 37 million Americans do not have health insurance, and as a consequence often get no health care at all, the state of Oregon has embarked on an innovative, albeit radical, course of action: It wants to ration health care for the poor.

Oregon, like most other states, faces the daunting problem of escalating health care costs for its Medicaid program, the joint state-federal health insurance program for the poor. For years Medicaid has been so underfunded that only a portion of eligible people are served. Now, as the recession swells public assistance rolls, Oregon lawmakers have confronted the grim choices: Either limit further the number of people Medicaid can serve, or limit the services it covers. On the presumption that every poor person is entitled to medical care, Oregon chose the latter.

Now, if the federal government approves the plan, Oregon will begin rationing health care for the poor -- that is, paying only for the most cost-effective services. Last week, a state commission released the results of a study which ranked 800 common disorders. High on the priority list of services for which the state might pay were preventive care and treatable illnesses like pneumonia and appendicitis. Low on the roster were minor health problems and -- for similar reasons -- fatal diseases for which no treatment will help. Oregon lawmakers now must decide how many of the disorders the Medicaid program can afford.

Oregon's approach is basically a copy of the British system which, while it assures the poor more health care than many of them have now, also brings a host of moral problems -- not the least of which is that it creates a system where the quality of health care is determined by how much money a person has.

Given that, and all the other predictable ethical dilemmas, the Oregon plan is a Band-Aid, a statement far more of the depth of the problem than it is a permanent solution. The proposal, however, ought to be a flashing red light to federal lawmakers who have dawdled far too long in making the kinds of long-term structural reforms to the health care system that are needed to assure both access and quality of care to all Americans.

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