Oregon’s Medicaid plan Notes for November 17

Main points

During the 1990s, Oregon tried to reformulate its Medicaid program. They would cover fewer medical services but offer coverage to everyone under the poverty line. We talked about some of the technical and ethical problems that their effort faced.

Notes on our discussion

We had a very interesting discussion of the advantages and disadvantages of democratic decision making compared with relying on technocrats.

Ben noted that when calculating the value of services, we shouldn’t talk about “saving” a life. We all die, after all. The correct question concerns how long life would be extended. And, presumably, what quality the extended life would have.

We often came back to the question of why we are adverse to intentional rationing. Any system of financing health care involves rationing of some sort. Oregon wanted to move from a system that rationed according to how close you are to the poverty line to one that rationed according to the cost effectiveness of health procedures. Even if we leave aside the technical details of how they measured “cost” and “effectiveness,” there’s considerable reluctance about the whole effort. Why is this so? For answers, I would go back to Arrow’s article.

I see that Arizona is going to end state-financing of some organ transplants. That sounds like another Oregon.

And the “rule of rescue” isn’t Daniels’s invention. Apparently someone named Jonsen coined the term.

This page was written by Michael Green for Freedom, Markets, and Well-being, PPE 160, Fall 2010. It was posted December 6, 2010.
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