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July 14, 1989

Oregon Pioneers `More Ethical' Medicaid Coverage With Priority-Setting Project

JAMA. 1989;262(2):176-177. doi:10.1001/jama.1989.03430020014003

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ETHICS AND LEGISLATORS often figure in the news, usually because the latter have abused the former. But in two western states, elected officials attempting to solve the tough problem of guaranteed access to medical care are coming to grips with ethics in its root meaning: moral duty and obligation.

Enthusiastically supported by the Oregon Medical Association, the state has enacted legislation aimed at using Oregon's health care resources more justly. It will provide services considered basic for a greater number of people on Medicaid while curtailing payment for other types of service deemed less necessary or of benefit to only a few.

This type of arrangement has been denoted "rationing," and been piously denounced by policymakers who say, "Any legislation concerning who gets what service is a terrible idea. It means health care rationing will be aimed at poor people, and that's not fair."

But what really isn't fair, says