Oregon Takes a Lead on Health Care

While California gets most of the press for Health Care reform, Oregon seems to be moving forward with plans to dramatically restructure the State's health care system. And unlike in California it has a chance of passing in Oregon (California has some screwed up laws on budgetary matters allowing a minority to easily block the legislation). The debate is beginning in Oregon, and not just on the topic of whether universal health care is the best policy (it is), but rather about exactly what plan is best to do that, good serious proposals are being made and sent into committee in the Oregon Legislature, there seems to be a growing consensus that something needs to be done and that the health care system as it is today is unsustainable. Former Governor John Kitzhaber is leading this charge with the Archimedes movement.

Former Gov. John Kitzhaber rolled out a bold legislative plan for overhauling Oregon's health care system Wednesday, hoping to leverage a national debate on health care reform that will spread to the 2008 presidential race.

"The health care system today is unsustainable," he said. "It is remarkable we are utterly unable to change our direction."

The plan would pool roughly $7 billion from employer tax deductions for health care and from state and federal tax money spent on Medicare and Medicaid in Oregon. The pool then would be spent in a more efficient and rational system that would provide a "core benefit" of essential health services to every Oregonian, including the 609,000 who now have no health insurance, said Kitzhaber, a former emergency-room doctor, during a news conference in downtown Portland.
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Kitzhaber's bill will go to the Senate Special Committee on Health Reform, said the Democratic co-chairs, Sen. Alan Bates of Ashland, and Sen. Ben Westlund of Bend. The committee will consider Kitzhaber's plan along with at least three other health reform plans: one developed by a Senate commission led by Bates and Westlund and others from the Oregon Business Council and the Oregon Health Policy Commission.

"What is most significant and shows the true depth of this (health care) crisis is the number of groups that have come together to propose solutions," Westlund said.
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No plan will work if it does not contain costs, Kitzhaber said.

Like other plans before the Legislature, his would seek administrative efficiencies, include incentives to keep costs low and the quality of service high, and would guarantee Oregonians health care no matter where they work.

Its a shame Kitzhaber appears to have no plans to challenge Gordon Smith for the Senate seat in 2 years, but it does little good to dwell on that. What Kitzhaber recognizes that Ron Wyden doesnt is the section I put in bold from the Oregonian article. Wyden seems to think that we cant effectively control the costs but we can ensure access to health care for all. This concedes ground in the debate that doesnt need to be conceded, one of the most compelling reasons for health care reform is the runaway cost of care in the current system. Massachussetts, Vermont, and Hawaii have all drastically reformed their health care systems, if California and Oregon do it too then perhaps the US Congress will begin to really take this issue seriously and do something about a broken system. The Oregonian piece also mentioned that Kulongoski is backing a bill to guarantee coverage for all children, and if we're going to take baby steps toward this thing that's certainly admirable, but it fails to deal with the larger health care crisis in the State and the country choosing instead of focus on select social groups while ignoring the larger problems. If a universal plan cannot get through the legislature than Kulongoski's plan to cover all children would be nice, but if we can make health care in this State more efficient and change its fundamental structure we should.

Patience My Friends

The health care debate seems to have picked up steam since Ron Wyden introduced a plan for universal health care a few weeks ago. Today, Paul Krugman wayed in on what needs to be done in the short term.

Universal health care, much as we need it, won't happen until there's a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.
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What should Congress do? The new Democratic majority is poised to reduce drug prices by allowing -- and, probably, requiring -- Medicare to negotiate prices on behalf of the private drug plans. But it should go further, and force Medicare to offer direct drug coverage that competes on a financially fair basis with the private plans. And it should end the subsidy to Medicare Advantage, forcing H.M.O.'s to engage in fair competition with traditional Medicare.

Conservatives will fight fiercely against these moves. They say they believe in competition -- but they're against competition that might show the public sector doing a better job than the private sector. Progressives should support these moves for the same reason. Ending the subsidies to middlemen, in addition to saving a lot of money, would point the way to broader health care reform.

It seems to me that the calls for a national single payer health care program have been getting much louder the last few weeks, which is good. I agree with Krugman however, and have articulated this before (though perhaps not on this blog). In terms of necessity the time for this is absolutely now, today in a perfect world we should institute national health insurance. However, the institutional standing of our country at this moment does not lend itself to this possibility. Before we can institute such a program, Democrats absolutely have to control the executive branch. If we push too hard, too fast for national health insurance without controlling the executive branch we risk losing the argument at a time when there was never any possibility of passage. Bush cannot hold the veto pen when we pass such a program. That's why I believe Krugman is correct here, ultimately we need national health insurance, but in the meantime we cannot possibly get it signed into law today, so we should chip arround the edges of American health care to make some good positive changes for people that we can get passed into law.