Saturday, August 10, 2013

WSJ on Oregon Health Plan

The Wall Street Journal ran an op-ed this week critical of Oregon's Health Evidence Review Commission (HERC).
Some parts of it were misleading and some outright false*, but on a fundamental level the concern it expresses is correct. To the extent we turn over health insurance to government we have to live with what government gives us.

What government gives us isn't arbitrary, it's a product of a public process which because we're a democracy is ours to control. But it's for all of us to control, and what we collectively decide may not coincide with what some of us individually might prefer. That's the case with education, the law, and everything else achieved through a political process. Health care is no exception.

If that sounds scary, chew on the alternative. How effectively could we act on our preferences in the pre-ACA system?
 *Factual issues:
WSJOn Thursday a state board could change Oregon's Medicaid program to deny costly care to poor patients who need it most...    
 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.
Reality:  The current guideline, adopted in 2009, restricts coverage of certain treatments for cancer patients expected to live 24 months or less.  The policy WSJ claims was proposed in May was four years old, and was preceded by even tighter restrictions.  Whatever changes HERC adopts, these kinds of coverage restrictions aren't new.
As for "costly care to poor patients who need it most," HERC is considering changing the guideline so that restrictions aren't based on expected life but instead on clinical circumstances (such as multi-system organ failure).  Such restrictions are sought precisely because those treatments are unlikely to help anyone in those circumstances.  The guideline isn't about denying care to patients who need it most, it's about avoiding care that isn't needed.  Ignoring the probability of benefit as the WSJ does is like claiming buying a lottery ticket is the same thing as getting rich.

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