Oregon Healthcare Lottery

Postby Relee » Tue Mar 04, 2008 1:47 pm

Meagerbucks: the cruel odds of a health care lottery
More than 83,000 adults have entered a desperate drawing
Tuesday, March 04, 2008

B eginning this week, a computer in Salem will start randomly drawing names in a unique state lottery that literally could mean the difference between life and death for some Oregonians.

Shirley Krueger is one of them. She'll be holding her breath this month in hopes of winning the lottery's precious jackpot, which is health insurance.

The 61-year-old Salem woman's hometown newspaper, the Statesman Journal, told her story recently, and it's chilling. She says it's been six months since she has regularly taken her medication for high blood pressure or insulin for her diabetes. This puts her at extremely high risk for stroke, heart disease, kidney failure, blindness and a host of other medical calamities.

Should any of them occur, the health care costs will be far greater than if we'd simply provided her basic treatment.

The reason Krueger hasn't been taking her medications is that she can't afford them. Her meager income is just high enough that she doesn't qualify for Medicaid, but after she pays her $500 rent and other bills, there's nothing left for health insurance or basic health care.

The Oregon Health Plan has a program designed to help people like Krueger, the working poor. In the mid-1990s, this godsend of a program covered more than 130,000 Oregonians, paying for their most basic medical services, prescription drugs and limited dental, vision and hospital care with monthly premiums ranging from zero to $20.

But then recession struck. By 2004, the program was closed to newcomers and began finding ways of disqualifying Oregonians already registered. Today, it covers fewer than 18,000 while the ranks of uninsured Oregonians have ballooned to nearly 600,000 -- including more than 100,000 children.

Credit Oregon's Department of Human Services for identifying a creative -- though heart-wrenching -- way of reducing the number of uninsured even though no general fund money is available for the program. By leveraging medical provider taxes with federal matching funds, the agency figures it can extend state coverage to a few thousand more Oregonians.

But who should get it? The sickest? The youngest or oldest?

Federal law bars the agency from discriminating. Thus the one-of-a-kind state lottery.

It's fair, but inescapably pitiless. In the lottery's one-month entry window that closed last Friday, more than 83,000 Oregonians put their names on the reservation list for the health program's first 3,000 slots, to be filled this month.

That means Shirley Krueger has about a one-in-27 chance of receiving a state postcard in the mail, notifying her that her name has been drawn and she can apply for the insurance plan. Those odds are much friendlier than Oregon's Megabucks lottery but still awfully steep.

The cold truth is that Krueger isn't likely to receive a prize-winner postcard in March. Nor will about 80,000 other uninsured Oregonians who entered this desperate drawing.

While insuring a relative few, it also will serve the greater good as a jarring reminder of just how broken the U.S. health care system really is.
- From the OregonLive.com website

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Re: Oregon Healthcare Lottery

Postby RaharuAharu » Tue Mar 04, 2008 2:31 pm

Yet another step closer to the Idiocracy.

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Re: Oregon Healthcare Lottery

Postby Relee » Tue Mar 04, 2008 2:48 pm

What do you know? The person who linked it to me said "It's just like idiocracy, except nobody watched that movie."
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Re: Oregon Healthcare Lottery

Postby RaharuAharu » Tue Mar 04, 2008 2:56 pm

Relee wrote:What do you know? The person who linked it to me said "It's just like idiocracy, except nobody watched that movie."


I have seen it several times.

Humans are not to far from it now... tone down "Ow my balls" by say 60% and you have most of network Television today.
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Re: Oregon Healthcare Lottery

Postby draque » Tue Mar 04, 2008 3:35 pm

Relee wrote:Spin, spin, spin to win! Which serfs will live and which serfs will teeter on the edge of death? No wage-slave can resist the chance of a lifetime... the chance to not die!


It's very easy to criticize, but suggesting solutions is harder. With limited resources (which when spread equally would do no good at all), how is this such a terrible decision? Certainly it would be best if there were more money available to the providers to dole out... but in a situation where there isn't (and out of the control of the people deciding how to dole), what else are they supposed to do?
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Re: Oregon Healthcare Lottery

Postby RaharuAharu » Tue Mar 04, 2008 3:43 pm

draque wrote:
Relee wrote:Spin, spin, spin to win! Which serfs will live and which serfs will teeter on the edge of death? No wage-slave can resist the chance of a lifetime... the chance to not die!


It's very easy to criticize, but suggesting solutions is harder. With limited resources (which when spread equally would do no good at all), how is this such a terrible decision? Certainly it would be best if there were more money available to the providers to dole out... but in a situation where there isn't (and out of the control of the people deciding how to dole), what else are they supposed to do?


http://www.truemajorityaction.org/oreos/
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Re: Oregon Healthcare Lottery

Postby SilverFeathers » Tue Mar 04, 2008 5:25 pm

As someone who works in the public health care insurance system, I'm reluctant to get into this as the sheer level of snarling and snarking would probably start an impressive flame war, which I choose to not do.

All I will say is that while no system is perfect, the idea of an insurance lottery is so far out there that my brain hurts. Lots.
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Re: Oregon Healthcare Lottery

Postby Anna » Wed Mar 05, 2008 1:31 am

I'm eager to see if and when this system comes to Germany.
(Every nonsense they import here in a couple of years)
Then it is time to start a revolution.
That's not what I've elected the politicians for!

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Re: Oregon Healthcare Lottery

Postby Relee » Wed Mar 05, 2008 7:44 am

draque wrote:
Relee wrote:Spin, spin, spin to win! Which serfs will live and which serfs will teeter on the edge of death? No wage-slave can resist the chance of a lifetime... the chance to not die!


It's very easy to criticize, but suggesting solutions is harder. With limited resources (which when spread equally would do no good at all), how is this such a terrible decision? Certainly it would be best if there were more money available to the providers to dole out... but in a situation where there isn't (and out of the control of the people deciding how to dole), what else are they supposed to do?


I can think of plenty of ideas, and they've got plenty already. The thing is they're just not willing to do them.

And I'm not just talking about the health officials who decided to dole out their limited services like this. I'm talking about the system that isn't giving them enough fundage.


I don't know what makes people think privateized healthcare is a good idea. It changes the focus of medical institutions from healing the sick and preserving lives to making money and satisfying the investors. The whole point of a government is to organize people, establish a system of justice, protect fair commerce, and aid the less fortunate.

*sigh* Anyways I don't appreciate you suggesting that I'm making fun of someone in an inescapable situation. I'm upset that they're shaming themselves by failing to care for the serfs and wage-slaves. The whole damned U.S. government.

You guys know things are getting bad there, but do you know what it really means? You used to be the shining beacon of civilization, the great hope of the world! In America, dreams came true! You're killing the hope of the world, and as a foriegner all I can do is watch and pity the poor people crushed; and try to keep my own homeland from falling like that. :/

It's not right that I should feel the same sorrow looking at poor Americans that I do looking at the third world or the oppressive regimes of eastern asia.

Oh but I digress. I'm just upset 'cause of what draque said.
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Re: Oregon Healthcare Lottery

Postby draque » Wed Mar 05, 2008 8:37 am

Relee wrote:*sigh* Anyways I don't appreciate you suggesting that I'm making fun of someone in an inescapable situation. I'm upset that they're shaming themselves by failing to care for the serfs and wage-slaves. The whole damned U.S. government.

You guys know things are getting bad there, but do you know what it really means? You used to be the shining beacon of civilization, the great hope of the world! In America, dreams came true! You're killing the hope of the world, and as a foriegner all I can do is watch and pity the poor people crushed; and try to keep my own homeland from falling like that. :/

It's not right that I should feel the same sorrow looking at poor Americans that I do looking at the third world or the oppressive regimes of eastern asia.

Oh but I digress. I'm just upset 'cause of what draque said.


I appologize if I offended Relee, but there wasn't any implication that you were making fun of people... I just quoted the only part of the post that had your words. Anyhow, I think that we agree on more than you're seeing. The system isn't being given enough funding. All I was saying was that given the limited funding that the Oregon healthcare system was given that they were honestly trying to make the best of what they had. I can't see any angle from which they would be able to profit from that illegitimately.

SilverFeathers wrote:All I will say is that while no system is perfect, the idea of an insurance lottery is so far out there that my brain hurts. Lots.


You obviously are going to have a better perspective on a lot of this than most of us here. I don't understand why the lottery system is a bad response to severely limited funding. Given a situation in which only a limited number of people can receive care and where splitting care 50/50 between two people does not result in each of them getting half the benefit... is something like a lottery entirely unfair?
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Re: Oregon Healthcare Lottery

Postby SilverFeathers » Wed Mar 05, 2008 1:13 pm

draque wrote: SilverFeathers wrote:All I will say is that while no system is perfect, the idea of an insurance lottery is so far out there that my brain hurts. Lots.

You obviously are going to have a better perspective on a lot of this than most of us here. I don't understand why the lottery system is a bad response to severely limited funding. Given a situation in which only a limited number of people can receive care and where splitting care 50/50 between two people does not result in each of them getting half the benefit... is something like a lottery entirely unfair?


No, it's more like putting a bandaid on a shark bite.

Part of the reason they have such limited funding is the lack of a state sales tax. Implementing that would help to fund state programs. It's not the only solution, but it's one that might help. Although Medicaid/Spend Down programs all over the country are having issues...

I've worked for CMS (Centers for Medicare and Medicaid Services) for a few years now. I could go for pages about the system, what's working, what isn't and why it's doing what it's doing, and what's coming, but there's a great deal of information I can't give out. I signed a confidentiality agreement. We'll leave it at that.
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Re: Oregon Healthcare Lottery

Postby draque » Wed Mar 05, 2008 1:59 pm

SilverFeathers wrote:I could go for pages about the system, what's working, what isn't and why it's doing what it's doing, and what's coming, but there's a great deal of information I can't give out. I signed a confidentiality agreement.


Now I'm super curious... telling me something is secret just makes me itch to know it, even if before you told me it was a secret I thought that it was boring. ^^()
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Re: Oregon Healthcare Lottery

Postby Relee » Thu Mar 06, 2008 5:55 am

draque wrote:I appologize if I offended Relee, but there wasn't any implication that you were making fun of people... I just quoted the only part of the post that had your words. Anyhow, I think that we agree on more than you're seeing. The system isn't being given enough funding. All I was saying was that given the limited funding that the Oregon healthcare system was given that they were honestly trying to make the best of what they had. I can't see any angle from which they would be able to profit from that illegitimately.


It's kind of a Canadian tradition to satirize any policy or system we don't like. We mostly treat it as comedy, but it's also serious in a way. You might have seen shows like Royal Canadian Air Farce or This Hour has 22 Minutes, those sorts of things are a Canadian tradition. Your own Colbert Report is the same sort of satire...


The profit commentary isn't really directly related to what we were talking about. I was feeling rather emotional and was voicing my concerns about all of the interlinking systems that make up American society.

One of the hardest things I've had to deal with in my adulthood is realizing that not only do people have different values between individuals, but my values are in the minority. To create my ideal society would be to create a non-ideal society for some other people. Because different people have different values, and because those values in many cases are opposite, it is also impossible to create an ideal society where everyones values are taken into account, without genociding those whose values are different.

Because my values preclude acts of genocide... Well I figure people like me are going to get 'evolved' out of existance. :/
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Re: Oregon Healthcare Lottery

Postby strange_person » Thu Mar 06, 2008 4:21 pm

SilverFeathers wrote:
draque wrote: SilverFeathers wrote:All I will say is that while no system is perfect, the idea of an insurance lottery is so far out there that my brain hurts. Lots.

You obviously are going to have a better perspective on a lot of this than most of us here. I don't understand why the lottery system is a bad response to severely limited funding. Given a situation in which only a limited number of people can receive care and where splitting care 50/50 between two people does not result in each of them getting half the benefit... is something like a lottery entirely unfair?


No, it's more like putting a bandaid on a shark bite.

Part of the reason they have such limited funding is the lack of a state sales tax. Implementing that would help to fund state programs. It's not the only solution, but it's one that might help. Although Medicaid/Spend Down programs all over the country are having issues...

I've worked for CMS (Centers for Medicare and Medicaid Services) for a few years now. I could go for pages about the system, what's working, what isn't and why it's doing what it's doing, and what's coming, but there's a great deal of information I can't give out. I signed a confidentiality agreement. We'll leave it at that.

Ah, but the problem is too many poor people and not enough money. A sales tax would mean more money, yes, but also more poor people, since they're the ones who spend most of their income on taxable sales.
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Re: TrueMajority -- NOT

Postby Monocheres » Mon Mar 10, 2008 9:40 pm

RaharuAharu wrote:http://www.truemajorityaction.org/oreos/


Interesting link. Vermont ice cream mogul Ben Cohen wants us to cut defense spending in order to fund his favorite Leftist causes and centralize power into an ever-expanding Federal bureaucracy, in usurpation of the prerogatives and responsibilities of the individual States. To that end, he likes to trot out a pie chart showing Federal spending, with the DoD appearing to be half the pie. But this is deliberately misleading. Oh, he's careful enough to identify the chart as Federal discretionary spending, but he breezes over that adjective as lightly as possible, and of course the fawning sycophantic lame-stream media stooges who interview him never press him for clarification.

Likewise, this cute little animation of him counting "oreo cookies", each representing 10 billion Federal dollars, gives the impression that most of the budget is for defense -- so why couldn't we just skim a few "cookies" off the top for the sake of motherhood and apple pie? But of course he deftly ignores the humungous amounts of mandatory spending the Federal government pours down the rat-hole of New Deal and Great Society entitlement programs.

I like this pie-chart a lot better:

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Yeah. However tall the pile of "cookies" we use for defense, a pile just as tall goes into Social Security alone (the greatest Ponzi scheme in history of mankind). Almost that much again goes into Medicare/Medicaid, and nearly half that again into other "safety-net" programs. So half the Federal budget is already devoted to Socialism. And each of those programs is continually and inexorably expanding.

If the United States is doomed to go broke and collapse as a superpower, it's not going to be because it chose to defend its way of life. It'll be because it chose to give the sheeple cradle-to-grave hand-outs in exchange for votes. And none of our cowardly elected officials have the intestinal fortitude to touch that third rail and do something about the impending disaster.
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Re: Oregon Healthcare Lottery

Postby draque » Tue Mar 11, 2008 7:40 am

Monocheres wrote:If the United States is doomed to go broke and collapse as a superpower, it's not going to be because it chose to defend its way of life. It'll be because it chose to give the sheeple cradle-to-grave hand-outs in exchange for votes. And none of our cowardly elected officials have the intestinal fortitude to touch that third rail and do something about the impending disaster.


I don't think that anyone here would argue against the idea that Social Security is anything but a disaster of epic proportions. It was a system designed to support relatively few aging folks who had been given a raw deal due to war the support of many young people. It was meant to be temporary, which meant it didn't have to be sustainable . The idea wasn't a new one, either. After the US Civil War, there were soldiers' pensions that were equivalent to Social Security. At some point however... there came to be the idea that if one lived long enough, there was an entitlement to government sanctioned support. Given that a) I'm saving up enough that I'll be able to support myself in my old age with foreign investments b) I'm never going to see a penny of the money siphoned into the black hole of SS and c) the age of retirement for my generation is likely to be... never, I get a little resentful of the whole operation. (for anyone interested here's a good read for the history of SS: http://www.ssa.gov/history/briefhistory3.html)

The question of course is how the problem can be solved. To simply remove the benefit would clearly be a disaster. It would result in the lives of innumerable people who had planned on SS existing being ruined and be nearly as unfair to those who were just before the age when they would be able to dip into the fund they had contributed to all their lives. It might be easiest to create the option to drop the program on a personal level. In the short term it would increase overall loss, as young people dropped out and older people stayed in, but as the population aged and died, the costs would drop to... well, nearly nothing, as I can't imagine many people would prefer putting their money into SS than an IRA or something.

Does the potential for people getting screwed without SS exist? Yeah, big time. It's a fallback that some people rely on. I'm willing to accept the responsibility of planning for my own future, though, and moreover... it can't continue to exist. It's unsustainable.

This isn't to say I'm defending the defense budget either. We're in the middle of the most expensive war that has ever been waged in the history of mankind. It was utterly unnecessary. If we actually use the defense budget for defending ourselves, as opposed to policing the rest of the world with offensive might, we would be able to trim that budget significantly.
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Re: Oregon Healthcare Lottery

Postby Monocheres » Tue Mar 11, 2008 8:51 am

draque wrote:This isn't to say I'm defending the defense budget either. We're in the middle of the most expensive war that has ever been waged in the history of mankind.


Draque, are you serious? In constant dollars? As a percentage of GDP? I'd like to see the numbers you base that conclusion on. Seems like WWII is still way up there. I mean, I don't see rationing going on. People aren't saving their used cooking oil for the War Effort and so forth...

draque wrote:It was utterly unnecessary. If we actually use the defense budget for defending ourselves, as opposed to policing the rest of the world with offensive might, we would be able to trim that budget significantly.


An argument could be made that:

defending ourselves == policing the rest of the world with offensive might

But suppose we did decide to stop doing the policing. Does anybody think that someone else won't step in to fill the vacuum? There are any number of eager candidates out there for top cop, most quite unsavory from our point of view. Would we really like the way the world would look if they were in charge?

Ben Cohen tries to make the case that we don't face any credible threats because none of the potential adversaries are spending as much as we do on defense. But could it possibly be that those adversaries are deterred from spending more because they just can't match our overwhelming spending level? That's what did in the Soviet Union, after all. If we cut the DoD tenfold or a hundredfold, wouldn't that just give China or Russia or Iran or, heck, Venezuela an opportunity to compete for world domination?

And if we decimated the DoD, does anybody think that the proceeds would not get poured down a rathole anyway? But maybe that's the answer: Let's spend everything on Social Security and Medicare, by all means. Then, when the mullahs come in and establish shariya law, they'll solve all our budget problems by taking an axe to them. Literally.
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Re: Oregon Healthcare Lottery

Postby Tychomonger » Tue Mar 11, 2008 9:57 am

Monocheres wrote:But suppose we did decide to stop doing the policing. Does anybody think that someone else won't step in to fill the vacuum? There are any number of eager candidates out there for top cop, most quite unsavory from our point of view. Would we really like the way the world would look if they were in charge?

I would. I do not want the US to be top dog unless it also has the moral high ground. In my opinion, we have fallen far from that. Perhaps some other nation will do a better job than us.
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Re: Oregon Healthcare Lottery

Postby draque » Tue Mar 11, 2008 10:24 am

Monocheres wrote:Draque, are you serious? In constant dollars? As a percentage of GDP? I'd like to see the numbers you base that conclusion on. Seems like WWII is still way up there. I mean, I don't see rationing going on. People aren't saving their used cooking oil for the War Effort and so forth...


You're right about WWII, which cost something in the realm of $3 trillion (adjusted), but the projected costs of the war on terror is disturbingly close. Here's an article regarding it: http://money.cnn.com/2007/10/24/news/economy/cbo_testimony/index.htm

But suppose we did decide to stop doing the policing. Does anybody think that someone else won't step in to fill the vacuum? There are any number of eager candidates out there for top cop, most quite unsavory from our point of view. Would we really like the way the world would look if they were in charge?


That's assuming it's a vacuum that can successfully be filled. I believe that it's only through unsustainable funding that we are able to hold the power to police that we do now. We're able to keep this up for the moment... but I don't believe that it's something that can be supported (in terms of ability to act, as opposed to ethics) for any extended period of time. If we were to back down from the position, I do not think any other country would have the power to claim it.

If we cut the DoD tenfold or a hundredfold...


If we dropped max jail sentences for all crimes to 1 year, we would have problems with criminals, but that doesn't stop me from thinking the justice system needs reform. In the same way, while I don't advocating striking the standing army, I do advocate a rethinking of our mass military spending. The current war in Iraq isn't something we can simply pull out of, but we can modify our policies to avoid such needless expenses in the future. A stance on defense spending doesn't have to be black or white, all or nothing.


And if we decimated the DoD, does anybody think that the proceeds would not get poured down a rathole anyway? But maybe that's the answer: Let's spend everything on Social Security and Medicare, by all means. Then, when the mullahs come in and establish shariya law, they'll solve all our budget problems by taking an axe to them. Literally.


Are you arguing that we shouldn't try to change things because they would inevitably be just as bad as they are now? You chided me for poorly thought hyperbole earlier and now I'm doing the same for the alarmist tone you're using there. The idea that the war in Iraq is defending us against some sort of imminent Muslim regime takeover is patently absurd. It seems as though the implication that it's just around the corner if war support dwindles has been around since 9/11. If nothing else, I don't really think you can really accuse me of over-supporting SS.
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Re: Oregon Healthcare Lottery

Postby Monocheres » Tue Mar 11, 2008 11:26 am

Tychomonger wrote:
Monocheres wrote:But suppose we did decide to stop doing the policing. Does anybody think that someone else won't step in to fill the vacuum? There are any number of eager candidates out there for top cop, most quite unsavory from our point of view. Would we really like the way the world would look if they were in charge?

I would. I do not want the US to be top dog unless it also has the moral high ground. In my opinion, we have fallen far from that. Perhaps some other nation will do a better job than us.


I seriously doubt that. The reason I want the US to be top dog is precisely because in contains people like you, expressing sentiments such as the one you've just voiced. There is very little evidence that other nations would bother to seek the moral high ground if given the chance at superpower status. At least, they way we would define morality.
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