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Is Oregon’s Health-Care Plan a Bold Experiment or Poor Man’s Burden? : Medicaid: Only by choosing which operations to pay for can the state beat the high costs of medical high-tech.

<i> William True is the retired executive director of the San Gabriel Valley Medical Center. </i>

Oregon is pioneering a rational method of rationing health care. The “costly miracles of modern medicine” are frequently cited as the main reasons for the experiment. But high-tech medical procedures are only one cause of runaway health-care inflation. Waste, abuse and misallocation of resources are major contributors as well.

The high cost of health insurance is already rationing care--irrationally. Essential and cost-effective preventive care, immunization of children and prenatal care for women, for example, is denied to 30 million--and counting--Americans who are locked out of the system because they lack insurance.

The Oregon plan’s initial thrust is to limit high-tech medical care. The larger problem of completely unnecessary health care--certain tests, treatments and surgeries--is bound to be next. Comparing costs and benefits inevitably leads to other means of discovering and eliminating waste.

Yet scrutinizing costly medicine makes sense for another reason. These are the tests, treatments and surgeries that produce the highest fees for the providers, and thus are most likely to be unnecessary.

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Critics of Oregon’s program maintain that “care limitation” judgments must be left to doctors, patients and health-care providers. But it is principally their “judgments” that are responsible for the chaotic dilemma in which we find ourselves.

Health-care providers, in general, are poorly prepared to say no to any medical treatment. Their training and work have one overriding goal: Do everything possible at all times for every patient. Doctors, nurses, technicians, even hospital administrators carry out this mission and are rewarded by the personal financial gain that results from doing more rather than less. Government regulation is the only answer; and since our health-care crisis is national, the federal government must play a role.

The misuse of resources is integral to our unregulated health-care system. I’ve seen new, entirely unnecessary hospitals being built in the San Gabriel Valley, causing occupancy rates at some established hospitals to plummet to the 50% to 60% range. Less efficiency and higher charges were the results.

Throughout Los Angeles County, duplicative technology has routinely been added without regard to need. In one instance, facilities for open-heart surgery were built at great capital cost, even though hospitals nearby were already performing too few of the operations to be either cost-effective or safe. An HMO proposal to use some of the vacant beds at my hospital was rejected because our fee-for-service doctors objected. The result: no efficiency improvements and increased capital and operating costs for the HMO.

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Implementing a system of controls, building on the Oregon approach, would reduce such waste of resources to a minimum. Rationing and associated controls would increase the value of our health-care dollar and, ironically, decrease the cases in which sophisticated medical care must be curtailed.

The cost of a bypass operation on an 80-year-old with chronic heart problems may--if he doesn’t die on the operating table--extend his life some months. But this money could provide prenatal care for many women now going without. The United States has slipped to 22nd among industrialized nations on the health indicator of infant mortality. Could there be a more telling statistic on the grossly inappropriate rationing of health care currently practiced by the wealthiest nation in history?


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