Norman Ornstein had a piece in the Washington Post railing against “death panels” in Indiana and Arizona, both of which involved Medicaid budget limits. He omitted the death panel in Oregon — perhaps because it is a liberal state? — which has explicitly rationed care under Medicaid since being allowed to conduct rationing under the Clinton administration. In Oregon, Medicaid has a list of over 700 procedures, and will cover only the number permitted by their budget, usually in the low- to mid-600s. All those procedures on the wrong side of the line are not paid for by Medicaid.
The point of Oregon’s experiment was to expand coverage at the expense of cutting off the sickest people. For example, double organ transplants have been refused. That hasn’t worked, but the state has kept its rationing scheme anyway. As a consequence, many poor Oregonians have, over the years, been denied potentially life-extending treatments. In 2008, two late-stage cancer patients were denied chemotherapy that could have extended their lives by Medicaid — but were offered payment for their assisted suicides!
What is the common thread that connects the death panels in these three states? Medicaid is a single-payer system in which budgets are limited. When the money runs out, people’s options shrink. See also, the U.K.’s NHS and, increasingly, Canada’s national health-care system, in which life-extending chemotherapy has also been restricted in some places.
Many Obamacare supporters see the ACA is a necessary step to the ultimate goal, a federal single-payer system. But those who are attracted to this option should learn from Indiana, Arizona, and Oregon: Government can get away with treatment restrictions that would never be countenanced within a market-based system in which regulators would be on the side of the patients, rather than the government funder. In other words, if you like death panels — as Norm Ornstein points out, although he probably missed his own message — single payer is the way to get them.
Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a legal consultant for the Patients Rights Council.