Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, May 12, 1990 TAG: 9005140202
SECTION: EDITORIAL PAGE: A9 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
Some soldiers are so badly hurt that it would take too much time and effort to save them - and most would be lost anyway. They'll be allowed to suffer and die. Others, more likely to respond to a moderate amount of care, will be treated and probably saved. The system is called triage.
Variations of battlefield triage are practiced every day in this country's hospitals. The demands for health care are greater than the resources. Physicians, nurses and other qualified people must decide which of the sick can benefit most from what's available.
Seldom can medical personnel deny care outright, nor do they want to. It's more a matter of doing what's possible with what is at hand.
Governments face such decisions as well. Only about 60 percent of the poor qualify for Medicaid, the federal- and state-supported program of medical services. But with the cost of health care steadily rising, the program doesn't have enough money to pay for all the care that's sought.
Oregon, meanwhile, is putting into effect its own kind of triage; it offers a glimpse of the future that many will find chilling. Others may find it reassuring.
Oregon's system is the culmination of nine months of preparation that included 50 public hearings across the state. A list of 1,600 medical procedures was established and ranked by computer according to a formula that compares their cost to how many people would benefit from treatment.
For example, such disorders as bacterial meningitis (an inflammation of the lining of the brain and central nervous system) and salmonella (a type of food poisoning) get a very favorable cost-benefit ratio.
A lot of benefit can be realized at relatively little expense from giving the generally accepted treatments for those ailments.
A low priority is given to expensive treatments for individuals, say a $100,000 organ transplant that would save one recipient's life.
The process is different in many respects from battlefield triage, of course; denial of care doesn't always consign people to death. But it could mean continued pain, as in cases of chronic ulcers, sleep disorders and impacted teeth.
Ranking the 1,600 procedures is only the first step. The second, to be taken by the Oregon legislature later this year, is to draw a line somewhere across the computer list. Ailments and injuries above the line will be fully covered by Medicaid; those below will not. (Ultimately, the federal government must approve the plan.)
What's chilling about this is its resort to a method that assures health care for some because they have the "right" ailments, while denying it for those who don't. Spending less to prolong the lives of terminally ill patients, for example, is a good thing generally - but perhaps less so if you or a family member are the affected patient.
What's reassuring is that the Oregon method would emphasize preventive care, such as regular tests for breast cancer. That common-sense approach is needed across the board in American health care. The nation shouldn't need a cost squeeze to bring it about.
In both good and bad aspects, the Oregon plan resembles what the nation's health-care system faces. "The miracle of medicine," says former Colorado Gov. Richard Lamm, "has outstripped our ability to pay for it."
The medical establishment, many social critics and some politicians argue against health-care rationing of the sort often associated with government health plans such as Britain's and Canada's.
But the United States already has rationing, much of it by default. We soon will have more.
by CNB