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Guest column
Sara R. Collins, senior program officer, The Commonwealth Fund

Dr. Collins and colleagues issued a report this week: "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help.” She has contributed an excerpt here for discussion.

Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the population without health insurance in the United States. Often dropped from their parents’ policies or public insurance programs at age 19 or on graduation day, they are left to find insurance on their own as they make the transition from high school to work or college.

Yet, jobs available to young adults are usually low wage or temporary - the type that generally do not come with health benefits. Young adults who are able to go to college full-time may have some protection through their parents’ policies, but upon graduation usually lose access to family coverage.

The number of uninsured young adults ages 19 to 29 climbed to 13.7 million in 2004, an increase of 2.5 million since 2000. Young adults were the fastest-growing age group among the uninsured over this period, accounting for 40 percent of the increase in the uninsured under age 65. Even though they  comprise just 17 percent of the under-65 population, young adults account for 30 percent of the non-elderly uninsured.

Continue reading Rite of Passage?


Awhile back, the consensus was that America was facing a surplus of health care providers. A popular refrain then was that new nursing grads would be “driving taxis” for a living.

Turns out, the rhetoric worked and too few people entered the health care field. Now, just as the baby-boomers reach the age when they need health care more than ever and as the health care system is besieged with other cost and access challenges, we also now face a serious shortage of both nurses and physicians, said OHSU President Peter Kohler during his remarks at a recent Oregon Health Forum meeting in Portland. Nurses will definitely not be driving taxis in the future.

Kohler agreed with Kitzhaber’s premise that fundamental change to the health care finance system is needed (see Part 1: “What’s Wrong With That Fish?”). Kohler then talked about delivery models, which both speakers also said need to evolve to meet current and future needs.

Continue reading Why nurses won’t be driving taxis… (part 2 of 2)


At a (very) early breakfast put on today by the Oregon Health Forum, former Governor John Kitzhaber and OHSU President Peter Kohler talked about their visions of health and health care in the future. General agreement: the system must be fixed.

Both men spoke eloquently; there were many memorable lines and anecdotes but two in particular seem to encapsulate their respective thinking: “What is wrong with that fish?” (John Kitzhaber) and “Nurses will not be driving taxis.” (Peter Kohler).

First, we unravel the fish anecdote (what follows is a brief summary of Kitzhaber’s presentation. Check out www.archimedesmovement.org for more information).

Kitzhaber described a boat trip down the Rogue River with a friend from New York. A large salmon floated by, lethargic, scales falling off, a shadow of its former glory. The friend asked:” My gosh, what is wrong with that fish?” and Kitzhaber responded: “Nothing. It is just dying.” Having spawned, it was at the end of its natural life-cycle.

Kitzhaber used this anecdote to shine a light on the ineffective allocation of health care funds in the current system. “We think death is optional,” he said. And we use a huge amount of public money to prove it.

Continue reading What is wrong with that fish? (part 1 of 2)


On April 12, Massachusetts Governor Romney signed into law a plan to extend health insurance coverage to the state's nearly 500,000 uninsured people. How? The law makes health insurance compulsory, like auto insurance. Every "body" is required to have it. The law also requires the state government to figure out ways to make sure insurance is available and theoretically affordable to employers and individuals. 

At first, the new law resulted in tons of favorable media coverage and general jubilation. Since then, on closer scrutiny, Massachusetts’s law has sparked debate, and not all of it is complimentary. Why?

Continue reading You have a body, so insure it!



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