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practical significance. In addition, they found that patients were often able
to receive supposedly excluded services when physicians, for example,
treated an uncovered illness in conjunction with a covered one. During the
period of the study, the number of people covered by the plan expanded
substantially and yet rationing of services essentially did not occur. How
do they explain this seeming contradiction? Quite simply: state
government increased revenues from various sources to support the plan.
Indeed, they argue that, because treatments that might not be included
were explicitly stated, political pressure made excluding them even more
difficult and may have inadvertently increased the cost of the program.
In the early 2000s, Oregon, like many other states, confronted severe
budgetary pressures. To limit spending, it chose the perhaps less visible
strategy of reducing the number of people covered through the plan. Once
serving more than 100,000 people, budget cuts reduced the number
served to about 17,000. Whereas in 1996, 11% of Oregonians lacked
health insurance, in 2008 16% did.
Trailblazing again, in 2008 Oregon realized that its budget allowed room
for coverage for a few thousand additional people. But how to choose
among the 130,000 eligibles? The solution: to hold a lottery. More than
90,000 people queued up, hoping to be lucky winners.
Sources: Jonathan Oberlander, Theodore Marmor, and Lawrence Jacobs,
“Rationing Medical Care: Rhetoric and Reality in the Oregon Health
Plan,” Canadian Medical Association Journal164: 11 (May 29, 2001): 1583–
1587; William Yardley, “Drawing Lots for Health Care,” The New York
Times, March 13, 2008: p. A12.

Attributed to Libby Rittenberg and Timothy Tregarthen
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