Tuesday, July 28, 2009

Oregon: ObamaCare laboratory

Want a good preview for what health care would look like under ObamaCare? Well, Oregon is a pretty good petri dish. The Oregon Health Plan (OHP) is basically the equivalent of the "public option" envisioned by Obama.

To be sure, the OHP doesn't go near as far as ObamaCare portends to go. There isn't any mechanism in Oregon to force everyone onto either an "exchange participating" plan or the OHP. And there is no employer tax for companies that don't offer health coverage (despite Gov. Kitzhaber's wishes at the time for exactly such a tax.)

But if we look at how the OHP operates, we can envision the world of ObamaCare. The main difference would be that ObamaCare would eventually cover a far greater percentage of the population than does the OHP in Oregon.

The OHP, remember, has been in financial straits literally since it was started. The original idea was an overt rationing mechanism: the state bureaucrats would prioritize medical procedures in a ranking system, and then they would draw a line based on available resources. Depending on how much money the system has, procedures above the line (this year drawn at procedure #503) would be covered, and below the line, tough luck.

Even if your medical need is above that magic 503rd procedure, it will be paid for only if there is money left after everyone with a higher ranking priority has been served.

This is all decided by the Oregon Health Services Commission. They set the ranking - the most current version of which is this wonderful 143 page document. See any similarities between this commission and the ObamaCare idea of a "panel of experts" who will decide on the relative effectiveness of various health care treatments?

At the very least, one thing the OHP has been honest about from the start was in acknowledging that the publicly funded health services had to be explicity rationed. Obama has tried to deny this reality, even while openly discussing his"panel of expets."

The problem becomes, of course, when any commission, panel of experts, or bureaucrats are given the power to prioritize medical procedures. There are LOTS of perverse examples just in Oregon's list. For instance, as pointed out in a recent article:

"... a person in need of an emergency appendectomy (prioritized 84th by the the state of Oregon) would be denied that treatment before an individual in need of treatment for “tobacco dependence” (ranked 6th)."


"... 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 (88th), a “deep wound to the neck” or open fracture of the larynx or trachea (91st), or a ruptured aortic aneurysm (306th)."

It gets even worse when bureaucrats have to struggle with the ever-problematic end of life care issue. This is where health care dollars really get used up fast, and there really are no good answers to the problem, at least what I have seen.

But I am pretty sure the "Oregon way" is not the right thing to do. Which is, basically, refuse treatment for some terminal maladies but provide funding for services under the "Death with Dignity Act."

For patients with maladies the Commission has decided have a less than 5% 5-year survival rate, here is what IS covered:

1) Medication for symptom control and/or pain relief;
2) In-home, day care services, and hospice services as defined by DMAP;
3) Medical equipment (such as wheelchairs or walkers) determined to be medically appropriate for completion of basic activities of daily living;
4) Medical supplies (such as bandages and catheters) determined to be medically appropriate for management of symptomatic complications or as required for symptom control; and
5) Services under ORS 127.800-127.897 (Oregon Death with Dignity Act), to include but not be limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.

And here is what is NOT covered:

1) Chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression; and
2) Medical equipment or supplies which will not benefit the patient for a reasonable length of time.

Again - these decisions are being made by a Commission, not by doctors or families. You might say "Well, that's what you get when you are on publicly funded health care." Fair enough.

But then why would we want to make that kind of health care universal? Because make no mistake, what Obama is moving toward is precisely this kind of program. It is obvious with every single additional revelation of its details.

The uncomfortable fact of the matter is that one way or another, whether we are talking private insurance or some public program, health care has to be rationed. In a private market it is more or less rationed by price. In a public program, it will be rationed by bureaucrats.

Obama has tried to sell his plan by denying there will be the need for any rationing. He says he will find "cost efficiencies" in the current Medicare and Medicaid programs (which he can only do through rationing!) to pay for expanded coverage in the public option.

The veil is being pretty quickly lifted on ObamaCare, however. Pretty much everyone can see that his plan will necessitate Oregon style rationing. That is why support for it is falling apart.

As imperfect as our system now is, and as uncomfortable as we all are with price-rationing of health care and the skyrocketing costs of private plans, the people of the United States do NOT WANT federal bureaucrats deciding who does and who doesn't get health care.

That is why ObamaCare is going to go down in flames.


Anonymous said...

Very interesting. It figures that Oregon would lead the way to socialized medicine.

Tim Schlabach said...

To me it's simple; Name one federal program that operates efficiently and cost effectively. I'll give you a few that don't... Medicare, Medicade, Social Security, US Postal Service. Even if the government demonstrates its ability to manage anything effectively, I still wouldn't allow them any further control over the most important aspect of my life. My health.

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