“Our current system is based on structures and assumptions that are now 40 to 50 years old and
reflect the realities of the last century, not the realities of today,” said Kitzhaber, who practiced
emergency medicine for almost 20 years before becoming governor. “Without finding the
courage to rethink these assumptions in light of today’s realities, we will be unable to meet the
health-care challenges facing our state and the nation.”

Download the full news release as a PDF.

Read what the Oregonian had to say:
The ex-governor wants to use Medicaid and Medicare cash to heal the staggering system ::  By Bill Graves :: The Oregonian, Thursday, January 18, 2007

What went wrong with the Oregon Health Plan, and what does it say about the prospects for coverage expansion initiatives in other states? Those are the questions addressed by Jonathan Oberlander in a Health Affairs Web Exclusive published today.

When it was first enacted in 1989, and approved by the federal government as a Section 1115 Medicaid demonstration project in 1993, OHP represented a leading state policy innovation that sparked a national debate on rationing health care. OHP was "intended to expand Medicaid to more people by covering fewer services," says author Jonathan Oberlander. But now the plan is "covering both fewer services and fewer people, and the elimination of entire benefit categories and rollback in enrolled beneficiaries looks more like the arbitrary cuts common in other states than the rational and equitable model of prioritization to which Oregon aspired."

You can read the article at: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.1.w96

According to a recent article by Bill Graves in the Oregonian, the proposal would give every Oregonian access to a card that could buy complete health care coverage at a lower cost.

On the surface, it seems a terrific idea. As explained by Graves, the Senate commission's plan would require all employers and individuals to contribute money to a common pool called the Oregon Health Care Trust Fund, but people with low earnings relative to the federal poverty level would not have to pay (thereby "solving" the problems facing 600,000 uninsured Oregonians). The fund also would include public employee and federal Medicaid contributions.

But the devil, as they say, is in the details....and working out the details will not be easy but it is at least something, right? Still, questions fly: Is it workable? Is it affordable? Have we been down this (dead-end?) road before? How will it fit in with national proposals? Will it drive physicians out of state?...and so on.

There is an old folk tale about the peasant wife and how she solved a problem. Every night, she and her husband found that their feet were cold while they slept, because their blanket was not long enough to tuck in.

To solve the problem, she cut off a wide strip from the top of the blanket and sewed it on the bottom. That way, she reasoned, there should be enough blanket at the bottom to tuck it in at night.

This kind of thinking seems to be what is going on in "health care reform."

Solving the whole health-care conundrum all at once would be too much to ask, but what about starting with one significant change?

A new national survey finds widespread support across the political spectrum for a number of health initiatives likely to be taken up by the new Congress, as well as a widely-held view that government should do more to address the high cost of health care. At the same time, the war in Iraq continues to play a dominant role among the public’s priorities, with economic and health concerns following distantly.

The poll, conducted November 9-19 by the Kaiser Family Foundation and the Harvard School of Public Health, included a nationally representative sample of 1,867 adults. The survey looks at the public’s priorities and views on health issues as a new Democratic majority takes the leadership of Congress and as the 2008 presidential campaign begins to take shape. It focuses, in particular, on differences and similarities among Democrats, Republicans, and those who identify themselves as Independents or something else.

When asked to pick their top health care priority, most people point either to expanding coverage for the uninsured (35%) or reducing health care costs (30%). Fewer (18%) choose improving the Medicare drug benefit. And, while policymakers struggle with the budget deficit, few people (6%) rank reducing spending on government health programs as their top priority. But partisan differences emerge on priorities, with Democrats placing a much higher priority on expanding coverage, Republicans emphasizing reducing costs, and Independents split.

Although the budget announced this week by the Governor is by no means the final product, the Governor's budget sets the tone for the legislative session. The proposed new $700 million will be used to provide health insurance coverage to 117,000 uninsured children, expand Oregon Health Plan/Medicaid to up to an additional 65,000 Oregonians, improved mental health services, train more health care providers, lower prescription costs and more. Unquestionably, these are welcome proposals, but is more needed to address the health care access crisis in Oregon?

Read more on the budget in the Oregonian article or read the governor's budget summary.

Researchers Use Income Of Three Times Poverty Level As Affordability Threshold; Alternative Measures Show Coverage Out Of Reach For Even More Uninsured People

Bethesda, MD -- More than half of the nation's uninsured residents are ineligible for public programs such as Medicaid but do not have enough resources to purchase coverage themselves, researchers from the Urban Institute report in a Health Affairs Web Exclusive published today. The report was funded by the Robert Wood Johnson Foundation.

Of the 44.6 million uninsured Americans, 56 percent are ineligible for public programs and have insufficient incomes to afford coverage on their own, the researchers report. Another 25 percent of the uninsured are eligible for public programs, and the remaining 20 percent have incomes high enough to afford coverage.

"Sometimes you hear arguments that all but a small minority of the uninsured could either purchase coverage or are already eligible for assistance," said lead author Lisa Dubay, now a research scientist at the Johns Hopkins Bloomberg School of Public Health. "But our study shows that the affordability problem is far more serious than that."

The New York Times is reporting that the health insurance industry is proposing an expansion of Medicaid and new tax breaks to expand coverage to virtually everyone within 10 years.

More than few people would argue that Medicaid is barely functional now. Witness that many physicians and hospitals refuse to take these patients because the government does not reimburse enough to even cover the cost of health care. So, without new funding mechanisms, isn't this proposal simply a way to quietly shift the cost to providers who in turn will pass it on to private insurers who in turn, will pass it to, yep, the employees paying for health insurance. What will happen then? Higher co-pays, higher deductibles, more $$ paid by working individuals. In name, we will achieve universal coverage, but will it help the U.S. achieve what should be the real goal? Universal HEALTH?

By Curious George

I’m new to this field as a professional working in health care. Up ‘till now, I’ve only been its victim of its explosive costs; albeit one who has been brilliantly cured, helped and mended many times.

Before daring to make any suggestion about reform, however, I’d love to hear from others to see if I understand the problem. I’m a little confused. Do I have the following view of the situation right?

The United States is the last industrial nation that can’t seem to take care of the health needs of about a quarter of its population without squawking and sacrifice.

Despite this, we have a de facto health education system that ensures a constant undersupply of trained professionals in such a way as to guarantee constant demand and a large reading audience for such waiting-room pillars of culture like People and Us magazines.

Despite this undersupply, we’ve constructed a health care education system that guarantees the vast majority of graduates are so far in debt that their only choice is to become workaholic slaves to health care plantations. Of course, with steady work and a diligent effort they can clear themselves of this debt in time to realize that their only remaining choice is to stay in the system, make more money, and pledge that no one rocks the boat.

And setting the national health agenda, we have two giant industries whose only concern is our well-being: insurance and drugs. With record-breaking profits from an otherwise dysfunctional system, these two industries spread their wealth with obscene management salaries and much-needed gifts, contributions, golf and travel for our poor, over-worked elected leaders.

So, perhaps you can understand why I’m confused. Where’s the problem?

By Mónica Arce

I have found it very interesting that there is a lot of talk about reducing costs, and that our health care system's survival depends on it.  I would like to know what percentage of the expenses of the Oregon Health Plan and federal health programs pay for maternity care, including prenatal care, labor and delivery and postpartum.  The use of nurse-midwives has been shown in several studies to reduce the amount of interventions during labor and delivery.  Midwives have outcomes that are the same or better than Ob/Gyn doctors.  I would like to see more talk about the money-saving advantages of hiring and using more midwives in our hospitals and community health care centers.

Homebirths have also been shown to be as safe as hospital birth and use less interventions in birth, keeping costs down.  Several countries around the world with better mortality/morbidity rates than the United States use midwives as their primary care providers for pregnant women, and only have Ob/Gyn doctors when a pregnancy becomes complicated or high risk.  I would like to see more conversation around this issue.

With the mid-term elections almost upon us, and campaigning for 2008 soon to begin, Kaiser President Drew Altman and Harvard professor Robert Blendon called on political leaders to speak out on the need for health care reform:

"What health needs most to rise up in American politics is for national political candidates, whether from the political left, right, or center, to begin talking about the issue again as they did in the early nineties. Most important of all are the presidential candidates, who receive so much national media attention. If even one major candidate begins to seriously address health reform, the others will be forced to follow suit. ... If [candidates] do play a leadership role on health, the media will follow, and the agenda-setting power of a debate driven from the top will meet the public's concerns rising up from the bottom like two weather fronts colliding." 

For many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies, reports the New York Times. Would such a coordinated approach work in Oregon? Is it possible to care for the 600,000 uninsured Oregonians in this way without bankrupting hospitals and providers? Read the full article.

A new survey by the Employee Benefit Research Institute and its partners finds that the public’s increasing dissatisfaction with the American health care system appears to be focused primarily on the rising cost of care. Many Americans report that rising costs have hurt their financial well-being and feel that steps should be taken to slow these increases. The survey also shows a sharp growth in poor ratings of the health system: six in 10 Americans rate the health care system as fair (28 percent) or poor (31 percent). The percentage of individuals rating the system as poor has doubled since 1998 (15 percent). But Americans still seem satisfied with the quality of health care they receive, and quality is the primary metric they use when deciding where to go for their health care needs. Read the full results at: www.ebri.org.

by Maribeth Healy, Oregonians for Health Security

Earlier this year, Governor Kulongoski directed the Oregon Health Policy Commission to develop a plan to achieve universal health coverage within five years. For discussion purposes, they have spent the last few months developing a straw plan to arrive at universal insurance coverage.

The Commission has developed a straw plan that incorporates many of the reforms recently enacted in Massachusetts. With funding from a grant provided by the Northwest Health Foundation, the Commission is in the process of determining the costs for enacting such a plan.

From time to time, we will bring your attention to resources and books about health care reform. Our inaugural entry is a new book: Redefining Health Care: Creating Value-Based Competition on Results by Michael E. Porter and Elizabeth Olmsted Teisberg, published by the Harvard Business School Press (2006).

Here is the description of the book:

The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums--not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael E. Porter and innovation expert Elizabeth Olmsted Teisberg reveal the underlying--and largely overlooked--causes of the problem and provide a powerful prescription for change.

Check out the lively debate sparked by the book on the blog of Health Affairs.

"In their recently published manifesto, Redefining Health Care (2006), Michael E. Porter and Elizabeth Olmsted Teisberg — hereafter simply PT — offer a utopian vision of a health system that might occur to anyone possessed of a modicum of common sense but not too familiar with the real world of health care," according to a post by Uwe Reinhardt.

Or this one from James Robinson: "Redefining Health Care is a tour de force, a magisterial analysis, and a long-overdue application to the health sector of core principles of business strategy. It’s also a bit of 'Goldilocks and the Three Bears.'"