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Great post! I think what bothered me about the AZ decision was not that it was particularly insensible -- a OLT is a huge commitment of resources, etc., that could perhaps be deployed more widely elsewhere. What bothered me most is exactly what you have identified: lack of transparency in reasoning, further advancement of disparities in access, and a rabid concern for the budget, possibly at the expense of the public's health. For this reason the isolated decision seemed irrational and even worse potentially hypocritical, since the Governor of the state is on record with her anti-government interference views. A rational and transparent process is what is desperately needed.

As part of the state of Wisconsin's Medicaid Rate Reform 2 efforts, CHSRA at UW-Madison simulated the effect on WI Medicaid expenditures if the Oregon system as operating in 2009 was directly applied to the actual WI 2009 medical expenditures. The result was a projected annual savings to the state of approximately $55M. To date apparently the anticipated negative legislative response to the Oregon process has dampened any further action related to this obvious cost-saving but likely controversial approach.

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