The Nightmare of Rationing in Oregon

Two cases of “public option” administrators rejecting patient requests for lifesaving or life-extending drugs (and instead offering to fund those patients’ assisted suicides) reached the mainstream media in the last two weeks. This has caused critics of President Barack Obama’s health care overhaul proposal to look to Oregon for clues about what a national health system would bring.


The picture is not pretty. Oregon, the only state to allow assisted suicide (via the 1997 “Death With Dignity Law”), has used its public health care “option” as a pretext for enacting an official policy of trading lives that bureaucrats determine to be “expendable” for monetary savings by the government.

The problem does not end with the state government either condoning or encouraging suicide. Rather, it comes as a result of the public option’s bureaucratic masters, who have made Oregon’s government the first in the world to officially prioritize treatments for the express purpose of rationing care.

Bureaucrats crunching the “comparative effectiveness” numbers — a benign-sounding term that is government code for “rationing” — at Oregon Health Services Commission headquarters have come up with a master list of 503 treatments and conditions the “public option” will cover for its enrollees. They have ranked them in ascending order of priority.

Under this rationing program, a patient enrolled in the public option who was in need of a treatment or procedure the commission decided was not a top-503 priority would be out of luck; the procedure or treatment simply wouldn’t be covered. This is not terribly troubling; private insurers have a similar set of guidelines about what they will and will not cover


What is insidious is the fact that state bureaucrats balancing Oregon’s figurative checkbook could decide the public option’s budget only had enough cash left for a given fiscal year to fund some of the procedures on the list. This is where the prioritization comes in — to guide bureaucrats approving and denying treatments in the rationing of care.

The state’s prioritization database reads like a case study in medical prioritization turned on its head. Like those pushing preventive care in the current national debate, administrators say the rationing program’s foundational focus is on prevention rather than on actual medical conditions and emergencies. This was borne out of a desire to save the government more money in the long run.

However, as always happens when bureaucrats and elected officials are left to work out the nuts and bolts of a program, the determinations of what is covered under Oregon’s public option, and where those covered conditions fall on the rationing list, were heavily influenced by special interest groups and lobbyists who are paid handsome amounts for gaining access to the ears of state government officials and cost-effectiveness regulators.

A brief look at the state’s rationing policy demonstrates how out of whack the Oregon Health Services Commission’s medical priorities are. For example, under the OHSC directive, a person in need of an emergency appendectomy (prioritized 84th) would be denied that treatment before an individual in need of treatment for “tobacco dependence” (ranked 6th).


A closer look reveals still more examples of absurd prioritization. The state rationing board ranked abortion 41st overall in state-funding priority, meaning the bureaucrats who designed the priority structure in this “public option” program determined that the use of taxpayer funds for abortion is more important (and more medically necessary) than covering injuries to major blood vessels (ranked 86th), surgery to repair injured internal organs (88), a “deep wound to the neck” or open fracture of the larynx or trachea (91), or a ruptured aortic aneurysm (306).

Also of note is the fact that treatments for esophageal, liver, and pancreatic cancers take up priority slots 337 through 339, with treatment for stroke at 340 — all over 300 places behind obesity (8), depression (9), and asthma (11).

End-of-life care — both for the elderly and for those with terminal illnesses — has stolen attention from the state’s rationing program, and with good reason. As part of the Beaver State’s focus on prevention over treatment, and of monetary savings over care, the bureaucrats responsible for Oregon’s rationing regime adopted a policy of comfort over life extension in dealing with both end-of-life scenarios and chronic illnesses.

While coverage for “comfort/palliative care” — pain medication, wheelchair issues, in-home care, and “services under [the] Oregon Death With Dignity Act,” to name a few listed in the rationing guidelines —  is provided by the government-run public option, the OHSC expressly forbids patients from obtaining treatments that may actually improve their conditions. Under the rationing directive, chronic and presumed-terminal patients are barred from receiving “chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression” and “medical equipment or supplies which will not benefit the patient for a reasonable length of time.”


What the term “reasonable length of time” actually means is, of course, left entirely up to the bureaucrats counting the change in that year’s budget. This means the definition of the “reasonable length of time” treatments must benefit chronic or elderly patients in order for the state to consider them worthy of use. Further, it is dependent on how much money is left in the public option cookie jar after all enrolled Oregonians have their conditions treated (in order of priority, of course).

The bottom line on Oregon’s end-of-life policy is that the health care — and, ultimately, length of life — of Oregonians enrolled in the public option is left entirely up to state bureaucrats.

In other words, this politician-run medicine has fallen victim to … politics. As John Graham of the Pacific Research Institute recently said, “the best way to keep politics out of medical decisions is to keep politicians out of medical decisions.”

Oregonians are finding that out the hardest way possible. Despite the president’s persistent push to remake America’s health care system in Oregon’s image, we as a nation can’t afford to learn the same lesson that Oregon is learning the hard way.


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