Many, including myself, have urged that the rationing criteria for healthcare decisions be made transparent and rational, with nationwide ranking of treatment priorities instead of obscuring it behind doctor discretions and little understood waiting list point allocations.

Sharon Crosbie chaired a committee that sat for 18 months (in the early 1990s) before giving up because comprehensive ranking was too hard for New Zealanders. The committee became the National Health Committee and its work did lead to booking systems for elective procedures and more evidence-based guidelines for funding services and decisions about resource allocation. That is not the same thing as transparent ranking for rationing.

The State of Oregon was one of the few states to achieve transparent rationing after years of being blocked at Federal level.

Apparently there was too much fear, from Presidential level down, of the poltical consequences of removing the doctor discretion mystery which gently shrouds the sharp edges of arguments about the comparative moral worth of differently ranked lives (not to mention contentious ‘treatments’ like abortion).

But Oregon persevered.

Now some research sugggests there was something in the opponents’ misgivings.

The explicit criteria have naturally become the target of lobbies. Political correctness is shifting priorities, to elevate treatment of favoured groups over rationing which most citizens might intuitively prefer.

For example:

"the rationing board thinks that stomach surgery to control obesity is more important than surgery to repair injured internal organs ( rank 88), a closed hip fracture ( rank 89), or a hernia showing symptoms of obstruction or strangulation ( rank 176).

Abortions rank 41st, indicating that the state considers using public money for abortions more important than treating an ectopic pregnancy (43), gonococcal infections and other sexually transmitted diseases (56), or an infection or hemorrhage resulting from a miscarriage (68). "

Conditions 5, 6, 7 and 8 in 2009  are respectively drug abuse treatment (in 2002 off the bottom of the list)  tobacco treatment (2002 – 186) contraception management and sterilization (2002 – 93 and 94), and intensive obesity counselling (previously not ranked).

In short it seems the self inflicted troubles now rank above the shafts of fate as most deserving of the worthy Oregonians’ collective help.

Perhaps it is less disturbing to leave it to the doctors and not to know their criteria.