OREGON PLAN SHOWS DANGERS OF POLITICAL PRIORITIES
June 8, 2009
In becoming the first government health care program in the world to draw up a formal procedure for rationing care to consumers, the Oregon Health Plan has significantly shifted priorities away from lifesaving measures, instead favoring politically popular ones, says Linda Gorman, a senior fellow with the Independence Institute.
After comment from interested parties, the state health program for low-income people ranked treatments for various diseases and conditions in order of priority. The health care dollars available determine which priorities are met, and as program costs have grown, the list of covered procedures has become shorter, says Gorman:
- In 2009 the state will pay for only the first 503 procedures; it won't pay to remove ear wax, treat vocal cord paralysis or repair deformities of one's upper body and limbs.
- It will fund therapy for conduct disorder, selective mutism in childhood (a prolonged refusal to talk in social situations where talking is normal), pathological gambling and mild depression and other mood disorders.
- The list emphasizes preventive care and chronic disease management because these services are less expensive and often more effective than treatment later in the course of a disease.
- However, there is no evidence preventive care will reduce expenditures; good evidence for the cost-effectiveness of disease management programs beyond those currently offered by physicians, individuals, insurers, and patient groups also remains elusive.
So what is driving the move away from procedures to save lives in immediate danger? Oregon's list increases expenditures for politically popular care, meaning preventive care for the healthy and treatment of diseases with active political constituencies, says Gorman. This drift in rationing appears to be unavoidable when political processes are given control over medical decision making.
The decisions in Oregon show the results of ceding health care rationing to political bodies, concludes Gorman.
Source: Linda Gorman, "Oregon Plan Shows Dangers of Political Priorities," Health Care News (Heartland Institute), June 2009.
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