CHICAGO. LTC — Chicago -- This is what health-care rationing looks like -- a least in Oregon, where the nation's first open, deliberate rationing system is scheduled to start for Medicaid recipients this summer:
It's a list of 709 medical conditions, coupled with treatment, arranged in a rough and arbitrary order of priority. Between numbers 587 and 588, there's a cutoff line. Medicaid money will pay for the health services above the line, but not for all the rest.
The cutoff is open, public, the result of long debate, consensus building and legislation in Oregon. Like it or not, the plan could be a model for widespread rationing of health care elsewhere in the United States.
High priority on the Oregon list goes to preventive care -- prenatal services, immunizations, medical and surgical care for treatable cancers, mammograms, dental services. Also near the top are repair of deep, open wounds, appendectomy, treatment for burns and services that could prevent death, restore health or improve the quality of life.
Below the cutoff, too far down to be paid for, are treatment for infertility, restorative breast surgery, medical treatment for diaper rash, stripping of varicose veins, health services that may have uncertain or limited value. Newborn care will be covered; intensive neonatal treatment for extremely premature babies (23 weeks' gestation, 500 grams in weight) will not. Drug therapy for HIV infection goes above the line. But only comfort and hospice care -- not aggressive treatment -- are included for those in the last stages of AIDS or cancer.
This first, specific proposal to ration health care drew criticism in Washington last month when a draft of a report being prepared by the congressional Office of Technology Assessment was leaked. The document purportedly criticizes the Oregon plan for making subjective decisions in drawing up its priority list and for intending to deprive Medicaid recipients of some forms of care.
But that, of course, is what rationing really means.
Rationing is also what is implied in those health-care plans circulating around Washington that promise ''basic health care for everyone.'' But, unlike the Oregon planners, their promoters don't get around to explaining what won't be included in their ''basic'' care packages.
Oregon's Medicaid rationing plan, which can't go into effect until the Health Care Financing Administration grants the state a waiver, is the most controversial part of a major effort to provide ,, health care for all Oregon residents.
