Is Oregon’s Health-Care Plan a Bold Experiment or Poor Man’s Burden? : The plan’s creators claim that rationing services will add about 77,000 uninsured people to its rolls. The disadvantaged get to pay the bill.

Imagine a health-care system in which only quadriplegics can get dentures and those in need of teeth to eat are issued a blender and the name of a nutritionist.

That’s precisely the sort of system that Oregon officials put in place for poor people several years ago. It demonstrates to what absurd lengths some have gone to deal with the effects of skyrocketing health-care costs.

Now the Oregon “innovators” are back at it. This time, they have come up with a scheme to ration health care for the state’s poorest women and children. The plan deserves close national attention, because it marks a critical juncture in the debate over the future of health care in America.

Americans will spend more than $600 billion on health care this year. Yet the frail elderly and AIDS victims will largely go begging. More than 30 million Americans, most of whom work full time, have no health insurance of any kind. We can no longer claim that our health system is the world’s best. Today, it’s only the world’s most expensive.

Tinkering cannot fix the system. Most experts agree that we must develop a new one if all Americans are to have access to appropriate health care.

But how to pay for it?

Oregon officials believe they have the answer: The weakest and most vulnerable groups in the state--poor women and children--should pay the bill.

The creators of Oregon’s scheme claim that it will add about 77,000 currently uninsured people to the state’s Medicaid rolls. To accomplish this, the benefits that poor women and children receive under Oregon’s Medicaid program will be scaled back. The elderly and disabled, however, will lose no benefits.

As unfair as this plan may seem, it is the law in Oregon and is being promoted in other states. In this year’s federal budget, the President praised it as “one of the most innovative.” Before the law can take effect, however, Oregon officials must persuade Congress to waive certain protections built into Medicaid.

Oregon has just released the first draft of a list ranking by cost-effectiveness the health services it currently provides and is putting pressure on Congress to decide the Medicaid-protection question.

The list will be divided into services covered and those not covered. Enough services must be cut to pay for the care of the 77,000 mostly poor adults whom Oregon wants to add to its Medicaid rolls. Dislocated elbows won’t be relocated, some broken legs won’t be set and cast, and most AIDS patients will go untreated, according to the list.

Oregon started work on this program in 1987, when it stopped paying for most organ and tissue transplants on the ground that the money could be better spent on prenatal care. Since California has not followed suit, it has taken a few cases involving transplants from Oregon. Should Oregon be allowed to carry out its more radical rationing plan, California might have to deal with many more medical migrants.

Oregon claims that the President and Congress have left it no choice. False. Despite an uninspired, do-nothing health-care policy from the President, Congress continues to add several billion dollars in Medicaid expansions. It also has funded a new aggressive research program to examine claims that as much as one-third of what we currently spend on health care pays for unnecessary and inappropriate treatment.

Oregon contends that rationing health care for the poor is the only way it can find the money to cover its uninsured population. Oregon is not a poor state, however, ranking about average in per capita income. It ranks far below average in percent of spending on Medicaid (46th). If Oregon simply spent as much on Medicaid as comparable states do, it could add more than 120,000 to its program without rationing anyone’s care.

Until recently, unequal access to health care was not tolerated. Oregon’s decision to ration care to its poorest women and children is a declaration of unconditional surrender just as the first battles are being fought over the future of our health-care system.