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One Nation… Without Healthcare Justice For All

Though every state in this nation struggles with escalating and unmanageable healthcare costs, only Oregon has established a rationing policy for the care needs of those on Medicaid.

Oregon’s overt rationing plan has suffered the bumps and bruises of being a pioneer, but it set the stage for other states to follow.

Oregon’s Medicaid costs were so high, it proved impossible to cover the needs of the poor. So in 1990, the state calculated what it could afford to spend collectively, and it then developed a list of diseases and disorders to rank the cost-of-treatment against the benefit. A red line was drawn. If treatments were above the line, they were covered. If a treatment fell below, it was not. So far, no other state has followed suit. Neither has the federal government when it comes to another taxpayer responsibility, Medicare.

Our country faces a moral dilemma. How do taxpayers picking up the tab for Medicare and Medicaid equitably support those most vulnerable? First and foremost, the government and providers have a moral responsibility to be efficient. In his essay, “Setting Priorities for a Basic Minimum of Accessible Healthcare,” Paul T. Menzel, Professor of Philosophy Emeritus, Pacific Lutheran University argues that “efficiency is not a moral luxury, it is a moral obligation.”

Rather than looking inward at its mushrooming inefficiencies, the government has shifted the burden to the individual citizen- with the likes of greater premium sharing, higher deductibles and larger co-pays. When bloated bureaucracies fail to self-adjust, and financial resources are so strained- they move into the category of extreme scarcity. There is another way to allocate financial resources: rationing.

Oregon’s Medicaid program is the nation’s bellwether. Individual states are grappling with how to address cradle-to-grave healthcare demands, but not one has taken the controversial step that Oregon did long ago. The common good is not served when Medicare spends more than 128 billion dollars annually on end of life care, or when Medicaid spends 45 thousand dollars for each neonatal intensive care unit admission. The basic minimum of healthcare needs for the poor and elderly go unmet in this broken system. Overt rationing decides systematically in proportion to the common good. With rationing, limited resources are more equitably distributed to all.

Our country faces a moral dilemma. How do taxpayers picking up the tab for Medicare and Medicaid equitably support those most vulnerable?

As Charles Camosy offers in his book, Too Expensive to Treat, “All one is entitled to [in society] is equal consideration with others in proportion with the common good of all…this may mean that lifesaving treatment may be justifiably withheld from some persons.” With billions of dollars collectively spent on the art of rescue at both the beginning of life and life’s end, the principle of equal consideration is lost.

This lack of rationing seems grossly unfair. Social justice exists when all share a common humanity and a right to equitable treatment. Assuming we are in solidarity, why are the poor in Oregon the only individuals afforded a policy of rationing?

As Pope Francis explained, “solidarity…is a firm and persevering determination to commit oneself to the common good; that is to say to the good of all and of each individual, because we are all really responsible for all.”

We say we are “one nation, under God, with liberty and justice for all,” but such justice is not reflected in our public health care policies. Rationing is unjust when only one small subset of Oregon’s population bears the consequences of a ubiquitous societal crisis. If we are truly one nation and delivering on our Pledge, we should all be sharing in the fair allocation of extremely scarce resources and rationing for the common good.

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