Death Panels in Oregon

The WSJ editorial page is back today, with warnings of DEATH PANELS! in Oregon:

Liberal states often preview health-care central planning before the same regulations go national, which ought to make an Oregon cost-control commission especially scary. On Thursday a state board could change Oregon’s Medicaid program to deny costly care to poor patients who need it most.

Like most such panels, including the Affordable Care Act’s Independent Payment Advisory Board, the Oregon Health Evidence Review Commission, or HERC, claims to be merely concerned with what supposedly works and what doesn’t. Their real targets are usually advanced, costly treatments. That’s why HERC, for example, proposed in May that Medicaid should not cover “treatment with intent to prolong survival” for cancer patients who likely have fewer than two years left to live. HERC presents an example to show their reasoning for such a decision: “In no instance can it be justified to spend $100,000 in public resources to increase an individual’s expected survival by three months when hundreds of thousands of Oregonians are without any form of health insurance.”

The piece then goes on to rail against Medicaid, and HERC, for trying to limit what Medicaid will cover.

First of all, I’m always a bit confused by the fact that it’s often the same people, and organizations, who rail against rationing within Medicaid while simultaneously railing against the Medicaid expansion. Evidently, they are fine with completely denying Medicaid to many of the poorest among us, but against making Medicaid less robust once they get it. Odd.

But my larger concern is one of philosophy. We simply cannot afford to pay for everything. We must own that. And so, there will at some point have to be discussions as to what we might not pay for. Unlike the editorial, I will link to the actual HERC document that discussed this question. After laying out the proposal, the recommendations of the committee were as follows:

HERC Staff Recommendation:

Therapies prioritized lower include those with:

i. Marginal or subclinical benefit,
ii. Very high cost in which the cost does not justify the benefit, and
iii. Equivalent efficacy to a therapy prioritized higher, that are significantly more costly.

Additional specific therapies considered to be prioritized lower are those found by the Pharmacy and Therapeutics Committee to be of marginal benefit and/orpoor cost-effectiveness found in Table XX located at www… (e.g. as of October 1, 2013).

I wish we never had to have these discussions. I really do. But at some point, we probably should think in terms of prioritizing therapies. This isn’t the worst way to do it, and at least it’s in public.

I’d like to make a larger point. Although the editorial makes the case that this is the left’s one-size-fits all approach, that’s just not true. This is a discussion of Medicaid, not of Medicare, and not of private insurance (which also refuses to cover things, about which the WSJ doesn’t seem concerned). No one is prohibited from spending their own money on futile care. No one is prohibited from buying an insurance policy that will continue to cover futile care. What’s being discussed is how we will use taxpayer money to cover those at the lowest end of the socioeconomic spectrum. Recognize that anyone that qualifies for Medicaid will not be able to pay out of pocket for these services. Recognize that they will never be able to afford private insurance that covers these services. Recognize that we will never approve subsidies that will allow them to cover the services or private insurance that does. So either the government does, or no one does.

Have that debate. Have it in public. Have it civilly. But please don’t pretend to be outraged by that serious discussion while simultaneously being ok with denying much more to many more in the name of “fiscal responsibility”.


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