Subject: (Editorial): Washington Prevails 
Date: Published: 8/5/92 (71 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    REVIEW & OUTLOOK (Editorial):
    Washington Prevails

    In the editorial above, we relate the extraordinary story of the
 French health bureaucracy's apparent decision to allow hemophiliacs
 there to receive blood that hadn't been tested for the HIV virus
 {see related editorial:  "REVIEW & OUTLOOK (Editorial):  Murder by
 Bureaucracy" -- WSJ Aug. 5, 1992}.  On Monday, the U. S. Department of
 Health and Human Services ruled that Oregon's rationed health-care
 system couldn't go forward because it violates the Americans With
 Disabilities Act.
    Within these two stories we have two faces of the modern state
 bureaucracy -- one brutal, the other benevolent.  In both cases, the
 government appears incapable of performing well.  The inadequacies of
 modern state bureaucracies seem to have become a pervasive problem.
    Our own sense is that national governments, or at least the kind
 of people who seem to be drawn toward them, seem to have been
 overwhelmed by public hubris.  They think there is nothing that the
 exercise of their great power cannot achieve.  So now we have the
 architects of the Americans With Disabilities Act deciding that
 Oregon's plan, the product of an arduous political consensus within
 that state, simply doesn't fit the grand design of their legislated
 benevolence.  The Americans With Disabilities Act is beginning to
 have the look of Big Brother.  The Oregon system exists because that
 state, like most states, can't afford to pay for the degree of
 Medicaid coverage Washington has mandated.  To extend coverage to the
 poorest, it decided to subject 709 medical treatments and conditions
 to a cost-benefit analysis.  On Monday the Bush administration said
 the plan is "tainted by discrimination" against the disabled.  An
 example?  The Oregon plan doesn't cover liver transplants for
 alcoholics who've destroyed their livers, and alcoholics are now a
 protected class under the Americans With Disabilities Act.
 Similarly, Oregon wouldn't provide coverage for terminally ill AIDS
 patients in the last six months of life.  The disabilities act covers
 AIDS.  
    The men and women of Washington, playing at benevolence, have
 broken free of everyday reality.  The same day the Bush
 administration ruled, the National Governors' Association issued a
 statement that Medicaid has become "so complex that it is
 incomprehensible to recipients and providers and unmanageable for
 governors."
    But the Remocrats and Depublicans plow mindlessly forward,
 pursuing some theoretically perfect fairness.  They have sent the
 American health care system reeling toward absurdity.  No nation, not
 even the U. S., has the wealth to provide all with equal degrees of
 state-of-the-art medical treatment.  But the disabilities act now
 apparently requires that.  And we don't doubt that a Clinton-Gore
 administration would attempt to add more.  Because no reform in
 health delivery services can meet this unattainable standard,
 efforts at reform will slow or stop.  Medical innovation is initially
 expensive, so the incentive to pursue such innovations weakens.
    We don't know that Oregon's rationing system is the full answer
 to the health-cost problem.  But this experiment and alternatives in
 other states won't get the chance to prove themselves.  Washington
 has arrogated this matter to itself; any political consensus
 achieved by people in a state can be waved away.  Again, the men and
 women of official Washington are convinced that they are merely
 doing great and needed good.  All that is needed to achieve the good
 is for the American people to conform.  The anger and frustration
 evident among the electorate suggests to us that U. S. voters would
 like to have a heart-to-heart talk with their leadership about this
 and many of the other conformities that Washington has imposed upon
 them.  The absurdities, and their costs, have become too much.

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