A Needlessly Harsh Rebuff : Pioneering Oregon health plan deserved better treatment than it got in Washington

The Bush Administration refused last week to issue a federal waiver so than a health program with proposed health care rationing could go forward.

The objection, said Secretary of Health and Human Services Louis W. Sullivan, was that the plan would wind up discriminating against Americans with disabilities, certainly something no government should countenance. That’s the easy part. But what the Administration failed to do was deal with the hard part. If not the type of rationing that Oregon proposes, then what?

Anyone who has ever worked in, or even visited, a hospital emergency room knows full well that the silent rationing of health care services goes on daily.

The current hodgepodge health care system works very well for those who are insured, works worse for those who are underinsured and poorly and sometimes not at all for the uninsured.

As one emergency room physician put it in the Op-Ed pages of this paper recently, the besieged public health care system can lead only to more “uneducated, unimmunized, malnourished, homeless children, not likely to acquire acceptable family values. Our mentally ill will act out even more bizarrely when they can’t get medications at their clinics. Our county hospitals will be overwhelmed. . . . AIDS and tuberculosis patients will die for lack of medication, and hospital, nursing or hospice care. People with acute curable illnesses will suffer and die for lack of services.” The physician, Dr. Brian D. Johnston, likened this state’s health care system to “a very sick horse”--that, if it were a horse, would be shot to humanely end its misery.

Oregon proposes to expand Medicaid, the largest government program financing health care for the poor. An additional 120,000 working poor would have been covered by the plan. But in order to afford it Oregon would have cut back on the variety of medical services covered, giving high priority to preventive care and treating illnesses that respond well to treatment and giving low or no coverage to procedures deemed medically useless or extraordinarily costly for the benefits produced. That formal priority list and a “quality of life” assessment are what got it in trouble with advocates for the disabled and others who said the plan would discriminate against them.

The Oregon plan, watched closely across the nation, no doubt needs some revisions. But credit that state with doing more than the federal government to face up to the existing unfairness and haphazard rationing that already occur as physicians, nurses and counselors scramble to try to decide who gets health care quickly, , who waits and who, by default, gets none at all.