Oregon's Ballot Measure 39 Insurance would be required to cover alternative health care

By Bryce Buchanan

How tobacco companies may amend the Oregon Constitution, and how it may affect your health care choices and your wallet.

"Divide and conquer" is an old, effective battle strategy. Just such a strategy is being used by the tobacco industry to fight the health care industry in Oregon. It began when the Oregon hospital industry placed Measure 44 on the ballot. Measure 44 would raise state cigarette taxes by $0.30 per pack. The tobacco industry was expected to spend millions to defeat this measure. Tobacco, however, adopted the "divide and conquer" strategy: They financed another ballot measure; one which would force most health care "soldiers" onto another battlefield and diminish their strength on the cigarette-tax battle front.

     Tobacco interests spent $750,000 buying signatures to place Measure 39 on the ballot. Measure 39 is a vaguely worded, constitutional amendment which would force all health care plans in Oregon, both government and private insurers, to pay for "alternative" health care services. The measure would add a new section to the Oregon Constitution which states, "No agency of the state or any private entity subject to the laws of this state shall discriminate among categories of health care providers."

     Currently, health care policies can offer coverage for any alternative therapies the market demands. If people are willing to pay for plans that include acupuncturists, naturopaths, chiropractors, marriage counselors, sports therapists, dietitians, or massage therapists, the market can provide them. Measure 39 says that every policy must provide payment for these services.

     There are approximately 27 licensed categories of state health care providers which would be covered by this amendment. The alternative therapists who have not won acceptance into free-market insurance plans are understandably enthusiastic about a law that would force all health insurers to pay for their services. And as a constitutional amendment the measure would not be easy to reverse. The governor and the legislature could not amend it. Any changes to the law would require a vote of the people.

     Measure 39 is called the Health Care Freedom Initiative. One could argue, however, that a plan which forces every insurance plan to carry the same coverage and which outlaws options for those who desire them, might more honestly be called the Health Care Coercion Initiative.

     The financial impacts of Measure 39 are difficult to calculate; however, it is likely to change the way health care is rationed. The Oregon Health Plan currently rations care by rating the relative importance of medical procedures. Services at the top of the list get paid for, services at the bottom don't. Private medical plans increasingly use a "gatekeeper" to ration care. The "gatekeeper," usually a primary practice physician, limits access to specialists. To visualize how Measure 39 will force changes in these rationing systems, picture a large container into which you pour health care money. Imagine there are six holes in the bottom through which money flows out. Measure 39 drills many more holes in the bottom of the container. Now more money must be poured into the container to keep it from running dry. There are limits to how much more can be poured in, and since Measure 39 requires all the holes to remain open, the size of the holes must be restricted to limit the flow. Endless political battles will revolve around how much each hole should be restricted.

     If Measure 39 passes, the Oregon Health Plan may not be allowed to "discriminate" against cost-ineffective treatments. Under some interpretations of the law, constraining health care costs with a gatekeeper may no longer be legal because all patients will have direct access to any category of care they choose.

     Oregon's State Accident Insurance Fund (SAIF) instituted reforms six years ago to stop runaway cost increases. Among other things, restrictions were made on the ability of chiropractors to manage extended cases. The reforms were successful and Workman's Compensation costs have decreased by $80 million. According to an Oregon Legislative and Policy Research Office publication, Measure 39 is expected to undo these reforms. The National Council on Compensation Insurance, the nation's largest worker's compensation statistical and data gathering organization, estimates Measure 39 will increase in worker's compensation costs by 11%, adding about $66 million per year in costs to business. And they add, "the ultimate cost of the change could be much higher."

     Proponents of Measure 39 argue that costs will not go up, and may decrease, because alternative care costs less than traditional Western medicine. In The Business Journal (May 3, 1996), one proponent, State Representative Sharon Wylie, a Gresham Democrat, used children's ear infections to illustrate this claim. She said M.D.s treat ear infections with antibiotics and, possibly, tube implant surgery; naturopaths would use allergy tests and dietary remedies. The less expensive naturopath would be better, she argues.

     This is a good argument to analyze. It contains an egalitarian premise which is common among proponents of alternative health care. It assumes that all ways to treat diseases are equally valid, and further implies that the arrogant practitioners of scientific medicine have no justification for their belief that scientifically proven treatments are superior. Scientifically trained physicians may treat a bacterial infection with an antibiotic known to kill the pathogen. Some alternative practitioners may treat the infection with an allergy test and food. Some may stick needles in the patient to redirect the patient's Chi energy flow; others may attempt to balance the patients Yin and Yang. Since all treatment are equally valid, the state should force all insurance companies to pay for the less expensive treatments. In Wylie's example, that would be allergy tests and diet to treat an ear infection.

     I see three problems with this argument. First, it is absurd to think that all treatments are equally effective. The purpose of centuries of painstaking medical research has been to separate what works from what doesn't. Testing is done so we can "discriminate" among treatments - and select those which have been proven to work. It is precisely this "discrimination" in favor of scientific medical treatment that will become illegal for insurance providers and unavailable to insurance buyers if Measure 39 passes. Why would we want to amend the constitution to require payment for treatments before they have been tested and proven worthwhile? Alternative practitioners are free to submit their treatment theories to double-blind, scientific tests. Allergy and special foods as an ear infection treatment is a testable theory. Testing the effects of Yin and Yang or Chi manipulation requires a demonstration showing that they even exist.

     Second, the least expensive treatment method does not necessarily assure the least expensive cure. It would be less expensive to put homeopathic gasoline (1 part gasoline per trillion parts water) in your gas tank than to use traditional gasoline, but it wouldn't really get you anywhere. You won't get where you're going until you buy what works. Meanwhile, you've wasted your time and money on the "alternative."

     Third, is there a legitimate justification for the government to force every citizen to have the same health coverage? When private citizens make contracts with private businesses for many different types of health care policies, should the state invalidate these contracts and dictate new terms?

     Most of the concern expressed here has been about the elevation of non-scientific treatments to a stature they have not earned. But many of the licensed practitioners who stand to benefit from Measure 39 provide undeniably useful services, e.g. dietitians, marriage counselors, and massage therapists. In the interest of saving money, most people do not choose to have these services covered by their health plan. They should remain free to make that choice.

     UPDATE: Oregon's Ballot Measure 39 was rejected by voters.