IN deciding how to spend limited public funds on health care for
the poor, should officials draw the line at the number of people
served - or the kinds of services provided?
This is the basic dilemma underlying Oregon's controversial and
unique health plan, which follows the second path. The state has
spent two years developing a program which now must be approved by
the federal government.
Congressional hearings on the plan, which began this week, are
being closely watched by other states searching for ways to address
the exploding costs of Medicaid as well as congressional lawmakers
groping toward a national system of health care.
Like all other states, Oregon has not been able to afford the
federally mandated medical procedures for all those eligible under
Medicaid. Tens of thousands of poor families have been turned away.
In response, the state drew up a list of 709 health services and
settled on a benefits package that covers what are seen to be the
587 most important.
These will be made available to all those eligible for Medicaid,
raising the number of people covered from 205,000 to 325,000.
Elderly and disabled Oregonians would be added to the program in
1993, as well as those requiring mental health or
chemical-dependency services. The plan also requires employers to
provide the benefits package to their workers by 1995, which would
bring 300,000 currently uninsured into the program.
In testimony before Congress this week, Gov. Barbara Roberts (D)
said those medical procedures not covered under the proposed plan
fall into three categories: "conditions where heroic efforts are
unlikely to change the outcome, conditions that get better on their
own or with a home remedy, and conditions that are cosmetic or
valuable only to the individual."
The Oregon health plan also provides some services not required
under Medicaid, such as dental care, hospice care, and physical and
State Senate president John Kitzhaber (a physician and chief
author of the Oregon health plan) calls it a "comprehensive benefit
package which covers the vast majority of those services needed by
persons seeking care." He says that providing preventative care or
early medical treatment will help avoid "the suffering and cost
associated with more serious illnesses."
What Oregon wants from the federal government (through the
Health Care Financing Administration) is a waiver of the Medicaid
requirements defining the amount, duration, and scope of benefits