Rationing Care in Oregon: The New Accountability

Abstract

Prologue: Oregon's effort to explicitly ration the medical care resources it is prepared to allocate for the poor has triggered widespread interest in the United States. Essays that have dealt with it are rarely free of the opinions and values that authors bring to this controversial subject. For this article, Daniel Fox and Howard Leichter approached the topic with every intention of dealing with it in a balanced fashion. Readers can judge for themselves how well the authors achieved this objective. Fox is president of the Milbank Memorial Fund in New York City, Before his appointment to that post in January 1990, he was professor of social sciences in medicine and director of the Center for Assessing Health Services at the State University of New York, Stony Brook, Fox, who trained in history and public administration at Harvard University, characterizes his calling as that of a “contemporary historian” who works at the intersection of policy analysis, political science, and history. He is the author, coauthor, or editor of fifteen books. Because Fox has examined a wide variety of contemporary health policy issues in many milieux, Health Affairs asked whether anything about Oregon's proposal and processes surprised him. Fox responded: “What really astonished me and made me, if not a defender of the Oregon plan, respectful of its process, was the wide-open manner in which the rationing debate is being carried out there. If one was searching for a classic exercise of American democracy, in the sunlight, it is Oregon's debate,” Leichter, who holds a doctorate in political science from the University of Wisconsin, teaches at Linfield College in McMinnville, Oregon, He is also a clinical professor of public health and prevention at Oregon Health Sciences University, Leichter has conducted comparative studies of how health care systems, particularly in Europe, address the issues of containing expenditures.

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