Death and Public Money in Oregon

Obama care poster

The Wall Street Journal’s opinion section decided Friday is a good day to go full-derp on the Oregon Health Evidence Review Commission (HERC):

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.”

As I said; derp. In a health policy world of finite money HERC is an attempt to, above all else, prioritize payments where treatments that cost a ton of public money while simultaneously offering little to no benefit is emphasized less. You can find that and more from Dr. Aaron Carroll here, but what he writes here is especially important:

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.

If not for the fact that evidence-based treatment prioritization and end-of-life counseling policies are so important, I’d consider this debate over so-called ‘death-panels’ the least illuminating macro-discussion of healthcare reform. That’s because it’s such an uncomfortable subject to talk about even in private. Anything above the level of discussing with your close family or doctor invites so much hysteria as to become almost unproductive. Almost. There should be public provisions (i.e., funds) for doctors to have these ‘talks’ with patients if they want them, and overall something like “the government should be smart with taxpayer money” shouldn’t be a controversial subject. Yet given the current climate surrounding healthcare reform it is, unfortunately, just another excuse to reaffirm one’s priors on the Affordable Care Act and the left in general.


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