 |
Please notify me via FReepmail if you would like to be added to or taken off the Oregon Ping List.
Posted on 07/26/2009 12:08:01 PM PDT by TenthAmendmentChampion
If you haven’t, read Erick’s post about an Oregon public health plan (”public option”) administrator responding to a cancer patient’s request for subsidized chemotherapy with a denial of treatment but an offer to fund a physician-assisted suicide.
Now, know this: over the course of this decade, the state of Oregon has put in place a formal procedure for rationing care to patients whose health coverage is subsidized by government (i.e., who are enrolled in some form of the state’s “public option”). To date, they are the only government in the world to have formally done this, though many — from Britain to Canada to states here in the U.S. — work “cost-effectiveness” into their official denials of medical treatment.
After beginning the process of determining the cost-effectiveness (to the state) of hundreds of medical treatments and procedures in 2002, the Oregon Health Services Commission narrowed down the number they were willing to entertain offering coverage for to 680, ranked in order of state priority. This year — 2009 — the state will only reimburse physicians for performing procedures and offering treatments ranked in the top 503, in ascending order of priority.
Recipe for Denial of Care WHAT THIS MEANS, of course, is that a patient enrolled in the “public option” who was in need of a treatment or procedure the commission decided to rank 503rd or below in priority would be ineligible for that procedure — period. Further, state bureaucrats balancing Oregon’s figurative checkbook could decide that the Beaver State only had enough health care dollars to fund some of the procedures on the list. This is where the prioritization comes in: under the state’s rationing procedure, a person in need of an emergency appendectomy (prioritized 84th by the the state of Oregon) would be denied that treatment before an individual in need of treatment for “tobacco dependence” (ranked 6th).
Does that sound a bit perverse to you? How about this: the state rationing board ranked abortion 41st overall in state-funding priority, meaning the bureaucrats who designed the priority structure in this “public option” program determined that the use of taxpayer funds for abortion is more important (and more medically necessary) than covering injuries to major blood vessels (ranked 86th), surgery to repair injured internal organs (88th), a “deep wound to the neck” or open fracture of the larynx or trachea (91st), or a ruptured aortic aneurysm (306th).
Also of note is the fact that treatment for esophogal, liver, and pancreatic cancers take up priority slots 337 through 339, with treatment for stroke at 340 — all over 300 places behind Obesity (8!), Depression (9), and Asthma (11).
That Pesky “Prolonging of Life Issue” In the “Intent” section of the state’s rationing guidelines, the bureaucrats responsible for the prioritization and denial of care make clear their view on end-of-life treatment and treatment for the chronically ill. It is, in a nutshell, “make them comfortable, but do not extend lives” — because these bureaucrats have determined, apparently, that the state’s “public option” health care dollars need to be saved for use on the healthy (or the tobacco-addicted), rather than on those who desperately need them.
From the report:
It is the intent of the Commission that comfort/palliative care treatments for patients with an illness with <5% expected 5 year survival be a covered service. Comfort/palliative care includes the provision of services or items that give comfort to and/or relieve symptoms for such patients. There is no intent to limit comfort/palliative care services according to the expected length of life (e.g., six months) for such patients, except as specified by Oregon Administrative Rules.
That all sounds fine and dandy — until you get to the fine print (page 97 of the 143-page rationing guide), where what is and isn’t covered is listed. What is covered includes:
1) Medication for symptom control and/or pain relief; 2) In-home, day care services, and hospice services as defined by DMAP; 3) Medical equipment (such as wheelchairs or walkers) determined to be medically appropriate for completion of basic activities of daily living; 4) Medical supplies (such as bandages and catheters) determined to be medically appropriate for management of symptomatic complications or as required for symptom control; and 5) Services under ORS 127.800-127.897 (Oregon Death with Dignity Act), to include but not be limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.
And, more importantly, what is not covered:
1) Chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression; and 2) Medical equipment or supplies which will not benefit the patient for a reasonable length of time.
“Reasonable length of time” is, of course, an arbitrary measure left entirely up to the bureaucrats counting the change in that year’s budget. In other words, if everybody in the state with all 503 conditions has been treated (in order of priority, of course) and there is money left over in the “public option” cookie jar, then a “reasonable length of time” that drugs or treatments would benefit a patient may be defined as a bit longer than it would be if there weren’t enough funds to go around for those whose illnesses and conditions qualify them for preferential treatment under the state’s official rationing policy.
Either way, folks’ health care — and, ultimately, length of life — is being left up to state bureaucrats.
Politics and Medicine Make Poor Bedfellows State administrators say they chose to focus on “less costly” preventive care (whose money-saving bona fides are dubious at best) when devising the state’s rationing program, rather than on medical conditions and emergencies in hopes of saving more money in the long run. However, much like the often-ridiculous mandated coverages on state health insurance policies that serve to drive up health insurance costs across the country, the determination of what will be covered and where it falls in the priority list was heavily influenced by special interest groups that have the ear of state government officials and cost-effectiveness-regulating bureaucrats.
In other words, this politician-run medicine has fallen victim to…politics. As the Pacific Research Institute’s indispensable John Graham posted yesterday on Twitter, “the best way to keep politics out of medical decisions is to keep politicians out of medical decisions.”
Oregon residents like Randy Stroup are finding that out the hardest way possible. Despite the President’s persistent push to remake America’s health care system in Oregon’s image, we as a nation can’t afford to learn the same lesson as Oregon the hard way.
http://www.heartland.org/publications/health%20care/article/25288/
Oregon Becomes First State to Officially Ration Health Care
Written By: Sarah McIntosh
Publication date: 06/01/2009
Publisher: The Heartland Institute
The Oregon Health Services Commission has drawn up a formal procedure for rationing health care services available to recipients of taxpayer-subsidized coverage.
The rationing policy may surprise low-income individuals on the state health care program, who could see treatments they need become unavailable due to changes in state-determined priorities.
Bureaucrats Making Treatment Decisions
The commission listed 680 common medical procedures and treatments and ranked them in order of priority. Beginning in 2009, the commission will reimburse physicians only for procedures and treatments ranking in the top 503 of 680.
This means a Medicaid recipient in need of a procedure the commission decided to rank 504th would be ineligible for that procedure.
Misplaced Emphasis
Linda Gorman, a health care economist with the Colorado-based Independence Institute, says the list demonstrates the danger of allowing government to determine medical priorities. (See article on page 14.)
“Politically powerful interest groups get more attention and funding than people who lack political power,” Gorman said. “As a result of powerful lobbyists’ ability to sway public policy, sick people will get less attention and funding than those who were well.”
The state-issued priority list appears to bear this out. For example, behavioral counseling for obesity is ranked above treatment for a ruptured spleen or appendicitis, and treatment for “tobacco dependence” is ranked 6th out of 680.
Interest Groups Rule
According to the commission, the state’s priorities emphasize preventive care because it is less expensive and more effective than treating those conditions later. But Gorman notes, “There is no evidence that preventive care will reduce expenditures for the general population.
“Various interest groups have spent the last seven years reordering the political priorities embodied in the list,” Gorman added. “When government is given control over medical decision-making, politics is going to play a role in deciding what is funded.”
Other states should learn from Oregon, Gorman said.
“Politically controlled medicine does different things than privately controlled medicine. It is important to preserve private benchmarks if one wants to preserve effective medical care,” Gorman said.
Sarah McIntosh (mcintosh.sarah@gmail.com) is a lecturer in constitutional law and American politics at Wichita State University in Kansas.
Oregon Plan Shows Dangers of Political Priorities
Written By: Linda Gorman
Publication date: 06/01/2009
Publisher: The Heartland Institute
In becoming the first government health care program in the world to draw up a formal procedure for rationing care to consumers (see article on page 1), the Oregon Health Plan has significantly shifted priorities away from lifesaving measures, instead favoring politically popular ones.
After comment from interested parties, the state health program for low-income people ranked treatments for various diseases and conditions in order of priority. The health care dollars available determine which priorities are met, and as program costs have grown, the list of covered procedures has become shorter.
In 2009 the state will pay for only the first 503 procedures. It won’t pay to remove ear wax, treat vocal cord paralysis, or repair deformities of one’s upper body and limbs. It will fund therapy for conduct disorder (age 18 and under), selective mutism in childhood (a prolonged refusal to talk in social situations where talking is normal), pathological gambling, and mild depression and other mood disorders.
Reordering Priorities
Between 2002 and 2009 there was a fairly radical reordering of priorities. A great many lifesaving procedures that ranked high in 2002 have been relegated to much lower positions in 2009, while procedures only tangentially related to life and death have climbed to the top.
In 2002 there was far more emphasis on actual medical care and measurable interventions that save lives and improve individual functioning. Various interest groups have spent the past seven years reordering the political priorities embodied in the list.
For example, medical treatment for Type I diabetes, which ranked second in 2002, was demoted to 10th place in 2009, even though not providing treatment for it is a death sentence. And this is not an isolated case.
Routine, Preventive Care First
Now the rapid and complete treatment of medically correctable problems and diseases has taken a back seat to routine and preventive care. For instance, bariatric surgery for people with Type II diabetes and a 35 or greater Body Mass Index number is ranked 33rd, with the rationing board judging it more important than surgery to repair injured internal organs (88), closed hip fractures (89), and hernias indicating obstruction or strangulation (176).
Similarly, abortions now rank 41st, showing the state considers using public money for abortions more important than treating an ectopic pregnancy (43), gonococcal infections and other sexually transmitted diseases (56), and infections or hemorrhages resulting from miscarriage (68).
U.K. Lesson
The Oregon Health Services Commission’s Web site explains the 2009 list emphasizes preventive care and chronic disease management because these services are less expensive and often more effective than treatment later in the course of a disease. However, there is no evidence preventive care will reduce expenditures. Good evidence for the cost-effectiveness of disease management programs beyond those currently offered by physicians, individuals, insurers, and patient groups also remains elusive.
So what is driving the move away from procedures to save lives in immediate danger? Oregon’s list increases expenditures for politically popular care, meaning preventive care for the healthy and treatment of diseases with active political constituencies. This drift in rationing appears to be unavoidable when political processes are given control over medical decision making.
Britain’s National Health Service uses utilitarian analyses of cost effectiveness that often conflict with the “rule of rescue,” the presumption that saving a life in imminent danger is more important than improving the quality of life of someone who is not in immediate danger, or of saving hypothetical future lives through prevention efforts. In 2008 the rule of rescue was officially removed from any status in decisions about health care rationing.
The decisions in Oregon and Britain show the results of ceding health care rationing to political bodies.
Linda Gorman is a senior fellow with the Independence Institute. An earlier version of this article was published by the National Center for Policy Analysis. Reprinted with permission.
If this isn’t a wake up call for those who want government control of health care, then nothing will be. It is profane and speaks of a state (Oregon) which is far removed from caring for its people. I can bet that obamanation won big in this place... cut from the same fabric, so to speak.
As God is my witness; when Obama-Care leaves me for dead I swear I will take as many of these bastards with me as possible! I mean, what are they going to do…kill me?
This has some inaccuracies due to omission. To start with, the list was made with extensive input from the medical community and the public, and is not what you would typically think of as a priorities list.
The list has two criteria. The first criteria is how *effective* the medical procedure is. The second criteria is the *price* of the procedure. The idea was that at the top of the list would be things like an infant hairlip.
Hairlip is easy to treat with simple, safe, common and inexpensive surgery, and it improves the patient quality of life enormously. So basically anybody who needs hairlip surgery can get it, any time.
Importantly, it is not a life saving procedure, so saying it has a higher priority than a life saving procedure for a different problem is not true. It just has a very high success rate at a very low cost.
But at the bottom of the list was multiple internal organ replacement for very premature infants. Such surgery could cost a half a million dollars, and *still* doesn’t work. A half a million dollars and the baby still dies. Why bother?
With a limited amount of government money to pay for health care for the poor, if that single surgery that didn’t work was eliminated, the cost savings were such that prenatal care could be given to hundreds of women—care that very ironically would prevent very premature birth of infants needing multiple organ transplants.
And that is the cut offs at the bottom of the list. Realistically, is sees that if you have metastasized pancreatic cancer, chemotherapy isn’t going to help, and it will likely make you sicker and miserable.
Importantly, however, and this is critical, this health care list should only be for those who cannot afford health care. It can instantly become villainous if government says that “Even if you have the money, you can’t have that procedure.”
This is the acid test of evil. If they try to ration *paid* health care, then they are willing to ration life itself. Which of course means euthanasia. And not just willing suicide, but murdering people.
What about the procedures that were dropped from the protocol?
What about the prostate cancer patient Erick who was referred to end of life counseling instead of getting chemotherapy?
Do you think this is an acceptable model for national implementation, to allow bureaucrats to manipulate payment for procedures via lobbying and political influence peddling?
With the Waxman bill, do you think the government will “allow” fee for service medical practice? I don’t.
Read all the material again. The authors assert that this “preventative” medicine isn’t all it’s cracked up to be.
What about this:
From the report:
It is the intent of the Commission that comfort/palliative care treatments for patients with an illness with <5% expected 5 year survival be a covered service. Comfort/palliative care includes the provision of services or items that give comfort to and/or relieve symptoms for such patients. There is no intent to limit comfort/palliative care services according to the expected length of life (e.g., six months) for such patients, except as specified by Oregon Administrative Rules.
That all sounds fine and dandy — until you get to the fine print (page 97 of the 143-page rationing guide), where what is and isn’t covered is listed. What is covered includes:
1) Medication for symptom control and/or pain relief;
2) In-home, day care services, and hospice services as defined by DMAP;
3) Medical equipment (such as wheelchairs or walkers) determined to be medically appropriate for completion of basic activities of daily living;
4) Medical supplies (such as bandages and catheters) determined to be medically appropriate for management of symptomatic complications or as required for symptom control; and
5) Services under ORS 127.800-127.897 (Oregon Death with Dignity Act), to include but not be limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.
And, more importantly, what is not covered:
1) Chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression; and
2) Medical equipment or supplies which will not benefit the patient for a reasonable length of time.
I was diagnosed with advance multiple myeloma last year. It had already destroyed my kidneys (I am currently on dialysis twice weekly). My doctor had told me repeatedly I won’t live five years. No chemotherapy for me under this protocol. Even though Velcade stopped the damage to my kidneys and probably my bones and alleviated months or years of excruciating suffering from crumbling bones, I wouldn’t get it because statistically, no one lives five years with MM that progresses as far as mine had. And I didn’t even know I was sick until it was too late. I was only 55 and had never had a serious illness and had no symptoms. Thank God, I am now in remission. I worked hard to recover, I followed a strict diet and took supplements to fight off the disease, along with the Velcade which blocked the poisonous Bence-Jones proteins.
What do you want to do next, unplug the dialysis machine and send me off to hospice? I would like to keep my insurance and possibly see a grandchild or two, or at least see my son turn 21. His father already died a few years ago.
Get the government out of health care entirely!!
Gee, being obese is quicker to get treatement than having a stroke. Duh, if I have a stroke and don’t get treated, I’ll probably die...thus won’t need any more medical care or social security payments.
Oregon Ping!
Government bureaucrats will have the power of life and death, and letting patients die is high on their list of priorities. This is how Obamacare will solve the financial problems of Medicare and Social Security, plus military and civil service retirement plans.
You have set up a paradoxical situation. That is, I was careful to point out that health care “for the poor” is, and always has been limited, even right now with “County health care.”
This will not change with any government system, and though private medical care can save lives, it cannot necessarily do so inexpensively.
So this leaves the choice, either the government cannot afford expensive care, or individuals cannot afford expensive private care. The only difference is that with private care, a person if they are able, can raise the funds they need.
But the government can deny treatment even to those that can afford it. So private care can offer a slim chance, and government care offers no chance, unless you can escape from their control.
|
Please notify me via FReepmail if you would like to be added to or taken off the Oregon Ping List.
I agree with you there. But private care need not be expensive. I don’t understand why insurance is needed for doctor visits or anything below $5,000. I’d have everyone create for themselves a medical savings account and a catastrophic policy. Whatever money they didn’t use in a year could be carried over to the next year. When people are spending their own money they will apply common sense to medical bills, and ask why a certain test is necessary. That, plus “loser pays” tort reform, would fix the whole situation.
I pretty much agree with everything you wrote to the point of tort reform.
Tort reform is messy, in several ways. On one hand, there should be strong limits on recovery, but they should be based on unusual loss minus typical loss, active error vs. passive error, and if the medical error was truly accidental, or prejudicial, i.e., the doctor was angry or fraudulently scheming. The courts need an objective analysis, not just hired gun expert opinion. And contingency payment should be strictly limited. (As well as loser pays.)
However, that being said, there are many instances of physicians and surgeons who are not mentally or physically competent to practice, and repeat offenders who move from State to State when caught out.
In your extreme example of multiple organ transplant on a premature infant you are overlooking one important aspect.
Those types of extreme treatments are most often done at teaching or research hospitals on a charity or reduced cost basis because of they are valuable to the hospitals in and of themselves as practice, training and research opportunities.
I have a 24 year old nephew who was affectionately called the 6 million dollar baby because he was the recipient of amazing experimental open heart procedures. Many of the procedures and experimental materials are now standards in many more applications across the medical landscape as a result.
This is why medical care in the US is the best in the world, because we don’t have officious bureaucrats shuttering operating theatres while surgical skills atrophy in order to control costs.
They’ll put a stop to this in the name of cost effectiveness and that will be the end of medical innovation.
This is all well and good when it is done in the name of research, but less so when it is done as health care policy. Did you note the paradox of this procedure?
That is, by not performing this procedure, in which the infant will die anyway, enough money will be saved to provide prenatal care to hundreds of women who otherwise wouldn’t get that care, and in doing so, the vast majority of extremely premature infants needing multiple organ transplants wouldn’t be created in the first place—they would instead be full term and healthy at birth.
Add to that when you are talking about reduced cost, that makes little sense. Reduced cost paid for by whom? The inherent cost of obtaining infant transplant organs, the medical equipment, the surgical skill, you implied that the hospitals pay for this. But this is still paid for with public money, so it is taking money from Peter to pay Paul.
If it was itemized as research, and paid for with research funds, it would be one thing; but in a limited budget public health system, the money has to come from other procedures.
Importantly, this does not support the idea of public health care, beyond what already exists, “County health care” for the poor. But innovation comes from free enterprise. It shouldn’t come from money meant for health care for the poor.
All I’m saying is that in a single payer system, innovation is pretty much going to come to a halt because decisions will be made by bean counters and not Dr’s and patients making decisions together.
Prenatal care’s ability to prevent birth defects and prematurity is vastly overstated, btw. Under Obamacare they are simply going to encourage abortion of potential high risk fetuses to save costs.
And there are no studies showing the preventative care is a cost saver over time since doing millions of inexpensive screenings and follow-ups costs more than dealing with the fewer but more expensive “treating it when it presents itself”. So then they start rationing the screenings and follow-ups via long wait times.
Their primary goal is simply to destroy as much life as possible.
I hope that Oregon Democrat voters learn to enjoy it when they watch their children die from preventable diseases.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.