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Investor’s Business Daily has a powerful editorial deconstruction of health care rationing, using the dysfunctional Oregon Medicaid system as its archetype.  From the editorial:

Advocates of a nationalized single-payer arrangement, typically found on the political left, don’t like to admit it, but a government system eventually has to ration care. So it goes in Oregon. There, the state’s Health Services Commission has compiled a list of 680 treatments, only 503 of which will be paid for by the Oregon Health Plan, which provides services for the working poor. Got condition No. 504 on the list? Too bad. Treatment for lichen planus, a skin rash, is an out-of-pocket expense.

So is therapy for a cracked rib (No. 512), nasal polyps (No. 524), a broken big toe (No. 527) and liver cancer (No. 575). However, those who abuse or are dependent upon psychoactive substances or are dependent on tobacco (Nos. 5 and 6) are covered. Other conditions for which treatment is reimbursed include obesity (No. 8), major depression (No. 9), schizophrenic disorders (No. 27), termination of pregnancy (No. 41), sexually transmitted diseases (No. 56) and pathological gambling (No. 223).

So, I hasten to add, is assisted suicide—which in the Orwellian language of the Medicaid system is considered “comfort care.”

The point of the editorial is to illustrate how in a rationed system, who and what gets covered often depends directly on political clout; those diseases with a strong advocacy lobby generally do well, and visa versa for those on the political outs:
According to the Willamette Week, Oregon’s program was designed “to broaden eligibility to the working poor” but not as an open-ended system that could be exploited...As the program grew, those reasonable limits changed. “Between 2002 and 2009 there was a fairly radical reordering of priorities,” Linda Gorman wrote in the June 2009 issue of the Heartland Institute’s Health Care News. “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.” How did this happen? Gorman says that “various interest groups have spent the past seven years reordering the political priorities embodied in the list.”

Buyer beware: If we adopt a rationing system—whether in a single payer plan or due to a national utilitarian bioethics oversight board telling private companies what they must and don’t have to cover—it won’t take long for various disease and lifestyle advocacy groups to begin fighting each other to ensure their constituents are part of the “in crowd.” Or to put it another way, rationing creates a viscious caste system where, as in high school, the unpopular kids will find themselves on the outside looking in.

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