Conference is warned health care rationing lies ahead


The United States will soon be forced to make brutal choices about rationing health care as the costs continue to outpace society's ability to pay for treatments, a Johns Hopkins anesthesiologist told a national conference yesterday.

While he did not offer a rationing plan of his own, Dr. Mark C. Rogers said intensive-care physicians may have to curtail "futile attempts at saving lives" and the use of experimental drugs, some of which cost $3,000 per dose, if there is little chance the drugs will work.

To deny that rationing is inevitable "is to stand here and say we don't want the weather to change, the wind to blow, that we don't want to grow old," Dr. Rogers, chairman of anesthesiology and critical care at Hopkins Hospital said during an address to the First World Congress of Pediatric Intensive Care.

The conference, held at the Marriott Inner Harbor Hotel, attracted 750 physicians, nurses and technicians from 27 countries.

Already, Dr. Rogers said, rationing exists in some covert forms:

The rich get better care than the poor because they can afford it; educated people who know how to "work the system" are more vTC likely to get the best doctors; children are sometimes turned away from intensive-care systems that are full.

"Once we recognize that, it becomes easier to contemplate the unthinkable: What are we going to do when this gets worse? And it's going to get worse. . . . It's never going to get better in our lifetimes."

This year, he noted, the United States is spending 12 percent of its gross national product on medical care. The figure is expected to rise to 16 percent by the year 2000.

"It goes up primarily because of critical care," he said, citing estimates that "40 to 50 percent of all health care expenditures occur in the last six months of life. To die in a civilized society is to spend money prolonging your life in an intensive-care unit.

"I'm going to die . . . attached to some massive machine at some enormous expense that someone else is going to pay for," Dr. Rogers said.

Oregon's plan to ration services to Medicaid patients may offer a snapshot of the future, he said.

So that it can afford preventive care, the state plans to deny payment for infertility treatments, stripping of varicose veins and intensive care for extremely small premature infants. On the other hand, it would cover prenatal care, treatable cancers, mammograms, appendectomies and treatment of burns and deep wounds.

Oregon's rationing plan cannot go into effect until it receives a waiver from the federal government.

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