Bruce Vladeck

Recent Articles

Unhealthy Rations

Oregon’s plan to ration care of the poor has won favorable reviews around the country. But take a closer look.

Policy makers, politicians, and editorialists seem so desperate for solutions to the problems of health care in America that they are now willing to consider, and are even hailing, proposals that ought to cause shame and disgust. How else can one explain the serious and respectful attention given in the past year to Oregon's proposed system for rationing medical care for the poor? Despite obvious and overwhelming flaws, Oregon's policy -- still in need of congressional approval -- has received widespread praise from leading members of Congress, health policy experts, and newspapers such as The New York Times . Every state struggles to balance budgetary pressures, the medical needs of the poor, and the demand of hospitals, physicians, and other providers to receive minimally adequate payment. Some states do it better than others; none does it perfectly. Striking the right balance is hard, especially because Medicaid is a joint federal-state program, for which the federal government...