NO MORE anguishing decision confronts any politician or judge or citizen than the allocation of public money for life-saving medical treatment. The Oregon legislature has now made the decision to focus its health money on prenatal care, rather than on transplant operations. As Michael Specter reported in this newspaper, the funds that could make 30 transplants possible will provide care for some 1,500 pregnant women.
The choice is particularly painful because the people who need transplants are individuals, with names, faces and their own stories of rising desperation. Preventive medicine is much less dramatic. Prenatal care benefits children who haven't yet been born. The infant mortality rate in Oregon, and throughout this country, is a good deal higher than it would be if all women had even the most routine prenatal attention. The numbers of lives saved, and the general contribution to the health and longevity of the population, will be greater when the money goes into the kind of preventive practice that the Oregon legislature has chosen to support. But the beneficiaries are lost in a statistical blur. They are the children to whom misfortunes did not happen. Their faces don't trouble the consciences of people who have to make the choices about public funds.
There are two things that you can't say about these choices. First, you can't say that they are new, a recent phenomenon produced by the high costs of modern medicine. Through most of history the world has rationed medical care by wealth and social standing. The poor were expected to die quietly. In this country it's only within the past generation that people have begun to think of even the most advanced medical remedies as the right of anyone who is sick, regardless of ability to pay. American society now affirms that principle for all but the most complex and difficult procedures. The transplant operations, and the enormous resources they demand, are an example of the exceptions that remain at the border line.
Nor can you say, as one of the Oregon legislators tried to say, that there's no need to choose -- that the state can provide all the care needed by everyone. The requirements are literally unlimited.
Other states will no doubt answer the same hard questions somewhat differently. But Oregon confronted this decision the right way. It didn't dodge or pretend that there was a simple way out. It recognized a political issue of the deepest sort and dealt with it rationally and carefully.