practical significance In addition, they found that patients were often able to receive supposedly excluded services when physicians, for example, treated an uncovered illness in conjunction with a covered one During the period of the study, the number of people covered by the plan expanded substantially and yet rationing of services essentially did not occur How they explain this seeming contradiction? Quite simply: state government increased revenues from various sources to support the plan Indeed, they argue that, because treatments that might not be included were explicitly stated, political pressure made excluding them even more difficult and may have inadvertently increased the cost of the program In the early 2000s, Oregon, like many other states, confronted severe budgetary pressures To limit spending, it chose the perhaps less visible strategy of reducing the number of people covered through the plan Once serving more than 100,000 people, budget cuts reduced the number served to about 17,000 Whereas in 1996, 11% of Oregonians lacked health insurance, in 2008 16% did Trailblazing again, in 2008 Oregon realized that its budget allowed room for coverage for a few thousand additional people But how to choose among the 130,000 eligibles? The solution: to hold a lottery More than 90,000 people queued up, hoping to be lucky winners Sources: Jonathan Oberlander, Theodore Marmor, and Lawrence Jacobs, “Rationing Medical Care: Rhetoric and Reality in the Oregon Health Plan,” Canadian Medical Association Journal164: 11 (May 29, 2001): 1583– 1587; William Yardley, “Drawing Lots for Health Care,” The New York Times, March 13, 2008: p A12 Attributed to Libby Rittenberg and Timothy Tregarthen Saylor URL: http://www.saylor.org/books/ Saylor.org 222