Human Exceptionalism

Health Care Rationing “Unraveling” in Oregon

One of my pet peeves about Oregon is that it rations health care to the poor in its Medicaid program. I believe that rationing is merely a polite term for discriminating against the people who need health care the most. Be that as it may, the way the program works is that a list of more than 700 treatments is listed with the number covered depending on available finances. Thus, if there are 740 possible treatments, one year the coverage might extend to the first 640.

In practice, this meant that politics become deeply enmeshed in the process (for example coverage of late stage AIDS but not some curative treatments for late stage cancers). And of course, assisted suicide was listed as palliative care and given such a low number that it would always be covered. This meant that a Medicaid patient who needed a double organ transplant a few years ago was not covered for the procedure, but if this had led to his wanting assisted suicide, it would have been paid for. (The man received private donations for the transplants, but died before he could have them.) Also, from the beginning the number of covered services has shrunk steadily.

This report claims that the great experiment in health care rationing is failing. From “the unraveling” in the abstract: “Only about 24,000 enrollees remain in the state’s Medicaid-expansion program, and it has been closed to new enrollment since 2004. Oregon’s uninsurance rate has climbed to 17 percent–virtually the same level that prevailed in Oregon before OHP began operation in 1994. Moreover, no state general funds are used to pay for OHP Standard (now financed entirely from provider taxes and beneficiary premiums), a staggering retreat for a state that had been a national leader in expanding coverage for the uninsured.”

We are frequently told that the states are the test tubes for the nation. That was why the Feds permitted Medicaid to be rationed in Oregon. The abstract tries mightily to avoid this aspect of the failure, but this facet was a primary reason why the rationing plan was allowed in the first place. I hope we learn the lesson and find other ways than health care rationing to expand access to health care.


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