By Rajesh Mirchandani

BBC News, Oregon

A US state is running a lottery in which the prize is health insurance. Louanne Moldovan finds the arrangement 'repugnant' With some 45 million Americans uninsured, how to pay for medical treatment is a big issue in this year's presidential election. Now officials in Oregon say they have come up with a fair way of providing coverage for some of those who cannot afford it. In her comfortable home in Portland, Oregon, Louanne Moldovan sifts through a pile of papers. They are unpaid medical bills, stretching back a year, arising from treatment for Crohn's Disease, the chronic intestinal condition she suffers from. She thinks she owes nearly $15,000 (£7,500) in all. Louanne says she is looking for full-time employment but, she adds, her earnings through freelance work will not buy enough health insurance for the treatment she needs. For her the state healthcare lottery offers an uneasy solution. "It's a symbol of how degraded our system is in this country that we are resorting to a lottery," she tells me. "It's pathetic and repugnant at the same time... [but it's] a necessity because I don't earn thousands each month." 'Sad reflection' Many do not share her feelings, but Louanne is not alone in trying her luck. More than 90,000 in Oregon are vying for a maximum of 10,000 places in the state's healthcare plan. I think the system is falling apart and it needs some radical deep change

John Duke

Director of Outside In clinic, Portland Yet it is a drop in the ocean. There are some 600,000 uninsured in Oregon. At the Outside In community clinic in downtown Portland, doctors see 7,000 different patients a year, 90% of whom have no health insurance. The clinic's director, John Duke, says the lottery provides hope for the few who are picked but is indicative of a wider problem. "I think it says it's a pretty sad state of the health care system in Oregon and in the nation as a whole," he says. "I think the system is falling apart and it needs some radical deep change. "This is a small Band-Aid. I think the best it can do is draw attention to the problem and maybe bring change in that way." Drawing attention The question of how to pay for medical treatment is increasingly a function of the country's wider economic worries and is an important campaign issue for presidential hopefuls. Yet Oregon's Director of Human Services, Dr Bruce Goldberg, hopes national leaders will take note of his state's efforts but not copy them. "I hope what they're working for is not a national lottery..." he says. "I think it's an issue about how to use this as an example of what the problem is. "I mean this is about real people and real people's lives." And lotteries can change peoples' lives. Twice a week on TV, as millions watch, numbered balls are drawn from a rotating drum, and someone somewhere wins millions of dollars. Oregon's healthcare lottery could be equally life-changing but is much less glamorous. Insurance 'winners' Among a sea of identical office cubicles in the state capital Salem, two women sort, staple and stamp their way through a large pile of application forms. Louanne Moldovan has a bathroom cabinet full of medicines These are the first 3,000 names randomly selected by computer. They could be the lucky ones but first their eligibility must be verified with bureaucratic precision. It can take up to 30 days before these people know if they are "winners" of health insurance. Some of the 3,000 will turn out to be ineligible for a variety of reasons. But the lottery will continue drawing out names until the 10,000 places are all filled up. Louanne Moldovan's name was not in that first batch. Back in her suburban Portland home, she shows me the bathroom cabinet full of the medicines she has taken over the years. Some treatments went unfinished as her diagnosis was refined. Still, everything needs to be paid for. For now, the pills and the bills continue to pile up but there is always next month's lottery draw.



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