Looking south for health-care lessons: Gov'ts study Oregon plan; critics call it two-tiered
Edmonton Journal
Thu Nov 16 2000
Page: A17
Section: Insight
Byline: Shawn Ohler
Dateline: Edmonton
Source: The Edmonton Journal
Series: HEALTH CARE: What's the prognosis?
In poll after poll, Canadians rate health care as their top concern. It has become a hot election issue as politicians bicker over who betrayed medicare. But alarmed health-care experts are looking beyond the politics to ask some tough questions: Is our ailing health-care system doomed? Can it be cured? What are the best solutions? Journal reporter Shawn Ohler tackles those questions in an eight-day series.
The Series
NOV. 12: How sick is medicare? Canadian health care is imperilled by an aging population and exploding costs.
NOV. 13: Future health-care models. From Bill 11 to controversial national studies -- a look at what's being done to shape medicare's future.
NOV. 14: Behind the times. Is Canada a Third-World nation when it comes to state-of-the-art medical technology?
NOV. 15: Options and obstacles. Champions of alternative medicine face massive government roadblocks.
TODAY: Looking south for lessons. Oregon may have something to teach cost-conscious Canadians about public health care.
FRIDAY: The doctor deficit. The keys to solving Canada's growing physician shortage.
SATURDAY: Tracking `spare parts.' Can a novel new database end the suffering of patients who need replacement knees and hips?
SUNDAY: Radical remedies. User fees, medical savings accounts and medicare taxes are among the aggressive prescriptions for health care's ills. Political parties, too, are pitching cures.
- - -
It has the same population as Alberta, a river-bound city the size of Edmonton and a revolutionary health-care system that may have something to teach Canadian health hawks desperate for ways to contain costs.
It's Oregon, the Pacific Northwest state whose ground-breaking Oregon Health Plan continues to draw international notice -- including some from Alberta Health Minister Gary Mar -- seven years after it was introduced. (Insert: While this was being printed, Capital Health was drawing up their list of services to be taken off Alberta Health care. Conservative dogma had already decided a person should sell their homes to pay for medical treatment before the Government chipped in)
As Canadian politicians, doctors and health-care experts tread carefully around the explosive political ramifications of limiting publicly funded medical services, Oregon has already done it.
``We wanted to identify those services which are effective and beneficial to society as a whole, so we did it,'' said Hersh Crawford, the program's director.
In the early '90s, Oregon faced some of the same pressures that now imperil Canada's medicare system -- an aging population, exploding drug costs and expensive advances in medical technology.
The state of 3.2 million was having problems funding its Medicaid program, which makes state-funded medical coverage available to all Oregonians living below the poverty line.
Oregon responded by compiling a list of ``diagnosis-treatment pairs'' that link medical conditions with their appropriate remedies. About 350,000 Oregonians who are enrolled in the public plan -- the majority of whom can't afford private health insurance -- are treated for 574 priority pairs, and the bill goes to the state.
For example, the state plan covers bone-marrow transplants for leukemia, cancer surgery, and therapy for insulin-dependent diabetics, but not minor head injuries, doctor visits for the common cold, or fractured ribs.
Since implementing its plan, Oregon boasts its ranks of uninsured have dropped to 10 per cent from 14 per cent, and more than one million Oregonians have gained access to health care.
Meanwhile, the priority list -- drafted by a state-appointed commission and meticulously costed out by actuaries -- has kept costs manageable.
``I think we've shown it is possible to provide good health care for people without covering a sprained wrist or a simple cold,'' Crawford said.
``We knew we needed reform but we didn't want to dump a whole lot more money into the system, because we assumed that would be inflationary and costs would just go up.''
But the plan has generated controversy about its perceived failure to control those medical costs while providing fair access to technology advancements.
This spring, Oregon teen Brandy Stroeder, a plan member, was denied a potentially life-saving lung-and-liver transplant because it's not on the priority list. The rarely attempted simultaneous transplant was deemed too experimental and, at $250,000, too costly.
``I think if you're going to have a medical plan, as soon as the medical technology advances, so should your plan,'' said Stroeder, before firing a shot at Oregon Gov. John Kitzhaber, a Democrat who drafted the plan in the early '90s.
``I guess Kitzhaber thinks he knows what he's doing. I just hope that later on down the road one of his relatives doesn't need a double transplant.''
The 18-year-old Stroeder, who has cystic fibrosis, is trying to raise the money privately to pay for the operation. Without it, she'll likely die before her 20th birthday.
``I cough a lot during the day. It's like running a marathon and then trying to walk. From my liver disease, I feel really bloated, like I've just eaten a big turkey dinner.
``But I'm not going to spend the rest of my days being mad at the Oregon Health Plan people. They're not worth my time. We'll try to work it out.''
Other critics of the plan say Stroeder's case, while sad, isn't indicative of the plan's failures. Even the state's richest private health-insurance companies likely wouldn't cover the rare double transplant either.
The critics say the plan's real failure is the same general failure of the American system, in that it creates different levels of care and access for the rich and poor.
``When it comes down to a list that says, `OK, this is the baseline but anybody who wants more care has to pay out of pocket' -- that's dangerous,'' said Ellen Pinney, who heads an Oregon consumer advocates' group. ``It's two-tiered medicine, the same thing folks in Canada have done their darndest to guard against.''
Pinney said Canadians shouldn't rush to emulate Oregon's plan. ``It's the reverse. Canada -- the single-payer, publicly administered system -- that's what we should be emulating.''
Still, the Oregon plan appears attractive to Canadian governments looking for innovative ways to sustain the country's most cherished social program.
Mar, Alberta's health minister said it warrants a closer look.
``We have to be open-minded to the experiences of all jurisdictions and look at innovations in the delivery of health care,'' Mar said.
``Some say a user fee should be put in. You go to the doctor, it costs you $10. Others have said you should take some things off the list like they do in Oregon. We're not planning on a user fee, but those kinds of other solutions should be raised. It may lead to something that's a constructive change and palatable to the public.''
Illustration:
• Photo: AP / Brandy Stroeder, right, of McMinnville, Ore., with her mother, Karen, at Doernbecher Children's Hospital in Portland.
Edition: Final
Story Type: Special Report; Series
Note: HEALTH CARE: What's the prognosis?
Length: 1064 words
Idnumber: 200011160123
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