OREGON PLAN COULD BE MODEL FOR HEALTH CARE

                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, February 21, 1993                   TAG: 9302210359
SECTION: HORIZON                    PAGE: F-5   EDITION: METRO 
SOURCE: By BARBARA J. COOMBS THE WASHINGTON POST
DATELINE: PORTLAND, ORE.                                LENGTH: Medium
OREGON PLAN COULD BE MODEL FOR HEALTH CARE
During the campaign, both Bill Clinton and Al Gore invoked themes of community values. "We need more than new laws," Clinton declared. "We need a new sense of community."
Gore asserted it was time for our rights as individual people to be justly balanced with our responsibilities as citizens. They talked about respect toward others and an attitude of restraint in human affairs.
One way they can put these ideas to work is by accepting the Oregon Plan for health care, a controversial proposal that was put aside by the Bush administration but is now back on the table. In the past, Gore has called discussion of the Oregon Plan the single most important health-care debate in the United States. It is important in part because it raises the question of what role community should play in individual health-care decisions.
The Oregon Plan stands for the infusion of community values into those decisions and into the processes of problem-solving and resource allocation. The new administration might look to Oregon to discover how the sense of community it seeks can guide the work of dedicated people to create health-care solutions.
I submit that the Oregon Plan, and specifically its process of ranking health services, embodies the first cure for a profound imbalance in American thinking about individual choice and the utilization of resources. It is a call to inject a sense of community obligation into decisions we make in our private lives. It would have us examine how we use medical resources - and by extension all resources - in the larger context of society's needs and priorities. It is a courageous and intelligent effort to achieve a more just balance between the needs of the community and the rights of the individual.
Oregon's list of health services, with its setting of priorities, crafted from societal ethics revealed in community meetings throughout the state, is based on the principle that effective treatment, offering the greatest good, should have the highest priority. It is the first open repudiation of the questionable assumption that all health-care services are equally valuable and desirable and that no expense should be spared if there is any chance a particular service could enhance the well-being of a patient. It weighs the value of a service by the magnitude of the good it will likely do. Does the treatment actually make a significant difference in the course of recovery? Is the cost of the treatment proportional to its effectiveness?
The plan emphasizes services that are valued by Oregonians, such as health education and relief of suffering during the process of dying. It deems less important those services that neither cure disease nor relieve suffering, such as treatment for the common cold and other self-limiting illnesses. The plan embodies the obligation we all have - insured, uninsured, rich and poor - to avoid squandering resources on ineffective, futile and unnecessary treatments.
By setting priorities, the plan accepts the fact that no service delivery takes place in a vacuum, that each dollar spent on ineffective or unnecessary treatment is one less dollar for care that would strengthen the community, build hope, effect a cure or relieve suffering. Under the Oregon Plan, businesses, taxpayers and other purchasers are not asked to provide every imaginable medical service with any possible benefit, but rather a basic benefit package of essential services.
Resources are finite, everyone dies, and disease is not fair. Those fortunate enough to live in community can accept these truths with courage and grace. It is the compassion in a human face that comforts us, the toil of human hands that brings us hope, and the sound of human voices raised in prayer and song that bears witness to the spiritual peace we seek.
But in order for the community to do all these things, it must be nurtured and honored and its limits respected. We cannot doggedly pursue only our self-interest and expect a compassionate community to sustain us when sickness, sorrow and pain come to us.

Barbara J. Coombs is an attorney, physician assistant and administrator of the Senate Committee on Health Care and Bioethics in Oregon.

by Archana Subramaniam by CNB