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May 1, 1991

Is the Oregon Rationing Plan Fair?

Author Affiliations

From the Department of Philosophy, Tufts University, Medford, Mass.

From the Department of Philosophy, Tufts University, Medford, Mass.

JAMA. 1991;265(17):2232-2235. doi:10.1001/jama.1991.03460170086039

THE OREGON Basic Health Services Act mandates universal access to basic care, but includes rationing services to those individuals who are Medicaid recipients. If no new resources are added, the plan may make current Medicaid recipients worse off, but still reduce inequality between the poor and the rest of society. If resources are expanded and benefits given appropriate rankings, no one may be worse off; though inequality will be reduced, alternative reforms might reduce it even further. Whether the outcome seems fair then depends on how much priority to the well-being of the poor we believe justice requires; it also depends on political judgments about the feasibility of alternative strategies for achieving more egalitarian reforms. Oregon makes rationing public and explicit, as justice requires, but it is not clear how community values influence the ranking of services; ultimately, the rationing process is fair only if we may rely on the