A market driven success story of participatory medicine

The United States does not have enough money to give all medical and healthcare products and services to everyone who wants them, whether or not they need them, right now, especially at the prices that those in the medical-industrial complex wish to be paid.

Thus, we now have, and have always had, rationing.

Anyone who does not agree is in some zone of ignorance or delusion.

A couple of decades ago, eminent Portland psychiatrist Ralph Crawshaw and famed emergency physician John Kitzhaber pioneered “the Oregon Health Plan.”

The idea that they brought to fruition was that all medical and surgical products and services should be stratified by their proven effectiveness and benefit/cost ratios, and that Oregon Medicaid recipient needs would be best managed by applying this prioritized list in expending the total money available.

The most bang for the buck. How sensible.

Town meetings were held all over the state to collect real beliefs, obtain public buy-in, and turn the concept into action.

As the JAMA editor, I published a good bit about this creative adventure. I always called it eminently ethical rationing according to evidence-based value of care and funds available. I also called it immoral, since it only dealt with Medicaid patients and not all Oregonians.

The success of this plan was helped by Kitzhaber becoming the governor.

The Oregon plan still exists in an altered form, but was not the panacea hoped for. Money was scarce; costs for some treatments became astronomical; and the lawyers and courts then mucked it up.

In 2011, two new points are worth noting. John Kitzhaber is again the governor, so watch out.

Second, a whole new grass roots “Oregon health plan” has begun in Eugene.

Family physician Dr. Pamela Wible decided to hold town meetings to ask what patients wanted from their doctor. She listened and learned, responded, and acted.

The result is a market-driven success story of participatory medicine. Same day appointments; all insurance taken; no one turned away; complementary therapies available; happy patients and a happy physician.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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