Imposing title for a blog post. It may sound kind of boring, but before we die each of us -- more than likely -- is going to face the bioethical question, "What kind of life is worth living, and at what cost?"
Back in the 1980s I lived and breathed health policy issues. That was my job. Also, my passion.
Recently I got to reminiscing about the days when I worked with Portland psychiatrist Ralph Crawshaw and Senate president John Kitzhaber (who later became Oregon's governor) on a project that laid the foundation for the Oregon Health Plan.
Getting into spring cleaning, at my wife's urging I started going through some boxes in the garage that held old memories. Out popped some Oregon Health Decisions publications -- an organization that I helped found, and was executive director of for several years.
It had been a long time since I'd seen "Quality of Life in Allocating Health Care Resources," which I wrote in 1988 on behalf of a Citizens Health Care Parliament. Reading it with fresh eyes, I was amazed at how the issues Oregon and the nation wrestled with then are the same issues being debated now.
Read the 23 page report and see for yourself. (It's a 1.4 MB PDF file.)
Download Quality of Life in Allocating Health Care Resources
Illustrating how the more things change in health care, the more they stay the same, here's how the report starts off.
Health care in Oregon and the nation faces critical choices. Many attempts have been made to cut health care costs, but spending in this area by both government and the private sector continues to increase much faster than growth in the general economy.
Left unchecked, the burden of rising expenditures for private health insurance and public programs such as Medicare and Medicaid will lead to a growing inability of low- and middle- income Americans to receive health care, and siphon off tax dollars that could be used for other pressing social needs.
The real tragedy is that even though this country spends a far greater percentage of its gross national product for health services than does any other nation, this had not brought us either markedly improved access to health services or better health. The United States infant mortality rate ranks 19th among industrialized nations, and 37 million people do not have private or public health insurance.
Even though I wrote the report, the passage of more than twenty years caused me to read it today as if I'd never seen it before. Here's a few lines that struck me.
The goal of priority-setting is not to limit health care benefits, but to assure that as many of those benefits as possible are made available to people. Resource allocation becomes a concern only when there is a societal obligation to provide the services to be allocated. There is no public outcry about the maldistribution of diamond rings in homes across America, since this is not considered to be a basic human need.
...Rescuers will spend vast amounts of money to save a person trapped in a well when logic argues that more lives could have been saved if that same money were spent differently. The point seems to be that whatever our minds decide, our hearts must be able to live with.
Like most Americans, I'm hoping that a viable national health care plan is going to emerge from Congress and the Obama administration soon -- looks like it could be this year. Whatever that plan looks like, it is going to have to deal with quality of life and resource allocation issues.
I'm proud that Oregon helped lead the way in finding solutions to our health care problems. And pleased that I was able to contribute to that effort.
I'm also happy to learn, via a Wikipedia article, that Portlander Dr. Ralph Crawshaw was still very much alive and kicking in 2005. It was great to work with Ralph back in my state health planning and Oregon Health Decisions days. He was a great guy and a marvelously energetic activist.