Rationing of Health Care: Oregon Comes Out of the Closet
Howard M. Leichter
In 1989 Oregon became the first state in the nation to adopt legislation that would explicitly ration health care for the poor. The Oregon Basic Health Services Act (OBHSA) guarantees health care to all those who fall below the federal poverty level but limits that care to what expert opinion, community sentiment, legislative judgment, and fiscal reality deem a "basic level of services." In the words of the law's chief architect, "Everyone will be in the health care lifeboat. Not everyone will eat steak, but at least everyone will eat." The fact that it will be primarily the poor who will be deprived of "steak" in the Oregon health care lifeboat is just one of many facets of the plan that troubles its opponents.
The Oregon rationing plan has left few observers neutral. It has been characterized as "bold," "pioneering," "rational," a "brave medical experiment," and "fundamentally flawed," "unfair," and "unethical." 1 What proponents and opponents of the Oregon law agree on is that the current "system" is seriously, and probably irreparably, flawed. Something must be done to control spiralling health care costs and to expand access to an estimated 32 to 37 million uninsured Americans. Where observers and participants disagree is over the question of whether or not the Oregon plan offers a fair, workable, and responsible solution. This chapter examines the origin, content, criticism, and implications