Among the results of last month’s elections, a little-noticed referendum in Oregon could have some of the biggest consequences. Measure 111 amends the state constitution to establish “the obligation of the state to ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right.” The ballot initiative may have results beyond the wildest hopes of Sen.
Bernie Sanders’s
socialist supporters.
Measure 111 goes beyond Mr. Sanders’s single-payer legislation in Congress, so-called Medicare for All. His bill, which asserts that healthcare is a human right, doesn’t guarantee a patient’s ability to receive care—only that the federal government will absorb the cost of that care, should a patient find a provider willing to treat him. By contrast, Measure 111 creates a legally enforceable right to care in Oregon that residents can, and likely will, seek to enforce in court. Its text mentions legal remedies “arising from an action against the state to enforce the provisions of” the measure.
Supporters of Measure 111 note that its language specifies that Oregon’s ability to provide healthcare “must be balanced against the public interest in funding public schools and other essential public services” and that lawsuits “must not interfere” with that balance. They also observe that the ballot measure doesn’t necessarily require Oregon to adopt a Sanders-style system of centrally controlled healthcare. Yet several factors suggest that Measure 111 represents another step down the road to socialism.
By creating a legal right to healthcare for “every resident of Oregon” regardless of citizenship status, Measure 111 would effectively encourage migration to the Beaver State. Nearly 30 years ago, First Lady
Hillary Clinton
testified before Congress against extending health benefits to “undocumented workers and illegal aliens” because “we do not want to do anything to encourage more illegal immigration into this country.” “We know now that too many people come in for medical care, as it is,” she added. By ignoring Mrs. Clinton’s advice, Measure 111’s backers will increase pressure on the state’s health system by mandating that uninsured patients receive care—whether legally present in the U.S. or not.
Given the amendment’s provision of a legal right to “cost-effective” care, one can easily see a scenario in which progressive judges effectively force the Legislature to create a single-payer health system à la Mr. Sanders’s. Implementing a system of universal coverage and standardized care, as Measure 111 requires, demands a far greater role for government. It could also cost Oregon $2.5 billion annually simply to enroll all uninsured residents in Medicaid, according to one analysis.
Universal care could come with another price. In 1989 the Oregon Legislature passed a bill endeavoring to extend healthcare to all residents under the poverty line. The bill created the Oregon Health Services Commission, which was tasked with crafting a proposal limiting Medicaid’s coverage to only cost-effective treatments. In 1992 federal officials rejected the first iteration of the state’s “rationing list” because its metrics presumed “that the value of the life of a person with disability is less than the value of the life of a person without a disability.” More recently, the state had to revise its crisis-care guidelines after numerous hospitals rationed treatment to Covid patients with disabilities during the early months of the pandemic.
Given this controversial history, and uncertainty surrounding Measure 111’s implications, the progressive Oregon electorate approved the measure by a narrow margin of fewer than 30,000 votes out of nearly 1.9 million cast. Oregonians now face the prospect of billions of dollars in additional government spending—coupled with higher taxes—and a legal system empowered to micromanage their healthcare. Measure 111’s supporters should have been more careful about what they wished for. They might get it.
Mr. Jacobs is founder and CEO of Juniper Research Group and author of “The Case Against Single Payer.”
