The Oregon Health Services Commission has drawn up a formal procedure for rationing health care services available to recipients of taxpayer-subsidized coverage.
The rationing policy may surprise low-income individuals on the state health care program, who could see treatments they need become unavailable due to changes in state-determined priorities.
Bureaucrats Making Treatment Decisions
The commission listed 680 common medical procedures and treatments and ranked them in order of priority. Beginning in 2009, the commission will reimburse physicians only for procedures and treatments ranking in the top 503 of 680.
This means a Medicaid recipient in need of a procedure the commission decided to rank 504th would be ineligible for that procedure.
Linda Gorman, a health care economist with the Colorado-based Independence Institute, says the list demonstrates the danger of allowing government to determine medical priorities. (See article on page 14.)
“Politically powerful interest groups get more attention and funding than people who lack political power,” Gorman said. “As a result of powerful lobbyists’ ability to sway public policy, sick people will get less attention and funding than those who were well.”
The state-issued priority list appears to bear this out. For example, behavioral counseling for obesity is ranked above treatment for a ruptured spleen or appendicitis, and treatment for “tobacco dependence” is ranked 6th out of 680.
Interest Groups Rule
According to the commission, the state’s priorities emphasize preventive care because it is less expensive and more effective than treating those conditions later. But Gorman notes, “There is no evidence that preventive care will reduce expenditures for the general population.
“Various interest groups have spent the last seven years reordering the political priorities embodied in the list,” Gorman added. “When government is given control over medical decision-making, politics is going to play a role in deciding what is funded.”
Other states should learn from Oregon, Gorman said.
“Politically controlled medicine does different things than privately controlled medicine. It is important to preserve private benchmarks if one wants to preserve effective medical care,” Gorman said.
Sarah McIntosh ([email protected]) is a lecturer in constitutional law and American politics at Wichita State University in Kansas.
For more information …
Oregon Health Services Commission Current Prioritized List: http://www.oregon.gov/OHPPR/HSC/current_prior.shtml