The Oregonian ICU: Multi-Tiered Monetarized Morality in Health Insurance Law

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See supra note 21 and accompanying text.

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The figures for mortality and time in this paragraph are fictitious. Specific quantification of the variables would be negotiated. Negotiations would permit buyers and sellers to meet in a morally contentful insurance market place.

See Morreim , supra note 15; and Morreim , supra note 39.

See Engelhardt Rie , supra note 40.

Some readers will be concerned about a hospital's ability to guarantee care to a patient in a basic tier entitlement status when that patient could be displaced by another who had previously purchased an enhanced benefit to marginally beneficial care. The Oregonian ICU applies to actuarially valid health systems with a minimum of 50,000 covered lives. In these systems, patients would be moved if necessary, and sufficient beds within the system will guarantee that the entitlement of the basic tier will not be violated by patients in a higher entitlement tier. Properly executed, mesoallocatory ICU health policy protects the least well off members of society by assuring quality delivery of the basic minimum benefits.

See Teres Lemeshow , supra note 41.

See Engelhardt Rie , supra note 40.

The SUPPORT project's definition of futility uses a mathematical definition of futility at the 1 percent survival rate. But such analysis itself is another articulation of the national health care ideology. Futility is a subjective value where consumers, providers, and the courts already disagree. The relevant question addressed by the Oregonian ICU is: What goals are worth pursuing with our collective health insurance funds, given the finite resources of the group and the infinite demand from the financially sheltered patient and the death-denying health professionals? See Teno J.M. , “Prognosis Based Futility Guidelines: Does Anyone Win?,” Journal of the American Geriatric Society, 42 (1994): 1202–07; and Lynn J. Knaus W.A. , “Background for SUPPORT,” Journal of Clinical Epidemiology, 43, Supp. (1990): 1S–4S.

See supra note 50.

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See supra note 21 and accompanying text.

See Society of Critical Care Medicine, supra note 4.

See supra note 9 and accompanying text.

See Morreim , supra note 15; and Morreim , supra note 39.

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See Teres Lemeshow , supra note 41.

See Levinsky , supra note 37.