Distorted priorities of Oregon Health Plan (Medicaid)

Posted on March 2, 2009 by Brian Schwartz

When politicians decide how to spend taxpayers’ money on health care, they spend it on what is most politically popular.   Linda Gorman writes that this means less emphasis on “procedures to save lives in immediate danger” and more “preventive care for the healthy and treatment of diseases with active political constituencies”

Writes Linda Gorman:

To our knowledge, the Oregon Health Plan is the first government health care program anywhere in the world that has drawn up a formal procedure for rationing.  After comment from interested parties, this state health program for low-income people ranks treatment for various diseases and conditions, currently from 1 to 680, in order of priority.  The health care dollars available determine which priorities are met.  As program costs have grown, the list of covered procedures has become shorter.  …

… between 2002 and 2009 there was a fairly radical reordering of the plain language priorities. A great many life-saving procedures that ranked high in 2002 have been relegated to a much lower position in 2009, while procedures that are only tangentially related to life and death have climbed to the top. …

What is driving the move away from procedures to save lives in immediate danger?  Oregon’s prioritized list is drifting toward increasing expenditures for politically popular care.  This means preventive care for the healthy and treatment of diseases with active political constituencies.  This drift in rationing appears to be unavoidable when political processes are given control over medical decision making.

(via FIRM)

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  • http://patientpower Michele Peterson

    Hello – as a parent of a disabled son with a brain injury I am concerned that you are not understanding the importance of caring for the disabled. I believe that his rights should be protected and the needs of others in his position upheld. There are laws in Washington DC to protect Medicade for the disabled. You cannot start adjusting things after spending mass quantities of money for stadiums and other non essential things you diem necessary.
    The social security- Medicare also is something that I have paid into all my working years (34 years) and it seems that even as Medicare stands now it is inadequate. How about you help protect those of us that are legal citizens who have worked and paid into the system.
    Let’s make sure to “Save the Oregon Health Plan”

    Michelle: I am truly sorry about your son. This post, however, does not question the importance of caring for the disabled. Its point was to show that government-run care, the kind of care that gets priority ends up being what is politically profitable for politicians. Whether or not this type of care is important to you is secondary.

    A relevant question is “Who decides?” Who gets to decide how one spends money on medical care and insurance, be it for yourself, your loved ones, or through charitable motivations? Shall it be you, or a politician?

    As for Medicare and Social Security, my understanding is that these are like Ponzi schemes. Or perhaps a “Bernie Madoff” scheme. You pay in, and the government takes they money to fund those who paid in years before. Chances are you’ll end up with little of what you paid in, and these programs could bankrupt the country. The difference is Madoff goes to jail for this, but politicians who support such arrangements have buildings, airports, and streets named after then.

    For comparison, if government merely forced you to deposit the amount you pay in taxes for Social Security and Medicare into a savings account that only you can access, you’d be much better off. Or more “secure” as it were.

    Putting policy and politics aside, I hope your son does as well as possible.

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    [...] Linda Gorman, Health Care Policy Center Director at the Independence Institute in Colorado, states, “…the Oregon Health Plan is the first government health care program anywhere in the wor… She goes on to explain something all of us should already know – when the choices are dictated by [...]

  • S. Fitzgibbons, MD, FACP

    If the government doesn't pay for aggressive care of people whose own neglect of their health caused their problems (like the guy who ran out of his blood pressure meds and had a massive bleed into his brain), do you think they won't get the care their families demand? Of COURSE they will, because the family will sue the hospital and doctors for every dime they can get. So both doctors and hospitals work for free, with bills averaging $5000 a day in intensive care. How much longer do you think there will be hospitals for you to choose from? And how will you find a doctor when they are all being paid less per patient than it takes to keep from being evicted from their offices?

  • S. Fitzgibbons, MD, FACP

    If the government doesn't pay for aggressive care of people whose own neglect of their health caused their problems (like the guy who ran out of his blood pressure meds and had a massive bleed into his brain), do you think they won't get the care their families demand? Of COURSE they will, because the family will sue the hospital and doctors for every dime they can get. So both doctors and hospitals work for free, with bills averaging $5000 a day in intensive care. How much longer do you think there will be hospitals for you to choose from? And how will you find a doctor when they are all being paid less per patient than it takes to keep from being evicted from their offices?