August 2006

The Oregonian newspaper reports that the census data shows that the number of Oregonians living without health insurance leveled off last year after a five-year rise.

But nationwide a record 46.6 million Americans lacked health insurance in 2005 and fewer received coverage through employers.

The number of U.S. residents without health insurance increased by 1.3 million in 2005 to a record 46.6 million individuals, or 15.9% of the U.S. population, compared with 45.3 million individuals, or 15.6% of the population, in 2004, according to figures from the U.S. Census Current Population Survey released on Tuesday, the San Francisco Chronicle reports. The data show that almost one in six U.S. residents was uninsured in 2005 (Colliver, San Francisco Chronicle, 8/30). The number of U.S. residents with health insurance increased by 1.4 million to 247.3 million in 2005, according to the report (Benjamin/Young, Bloomberg/Philadelphia Inquirer, 8/30). In addition, the report finds that the percentage of U.S. residents with employer-sponsored health coverage decreased from 59.8% in 2004 to 59.5% in 2005, the lowest percentage since 1993 (Appleby, USA Today, 8/30). By comparison, in 2001, 14.6% of U.S. residents were uninsured, and 62.6% had employer-sponsored coverage (San Francisco Chronicle, 8/30). Read the full report.

Guest column
David A. Pollack, M.D.

Oregon has a long tradition of progressive social and health policy, including its approaches to mental health and addiction services. However, in recent years, economic and other factors have combined to impede or even reverse some of the progress that had been achieved in prior decades. Oregon’s mental health policy leaders believe that increased public attention, an improving economy, and appropriate political support can lead to a turnaround: a transformation of our system into one that is more effective, efficient, safe, and responsive to the needs of the persons we serve.

Most of the publicly funded services for persons with mental health and substance use disorders are managed by the State Department of Human Services and its Office of Mental Health and Addiction Services (OMHAS). OMHAS has embarked on a number of initiatives, which, taken as a whole, constitute the key elements of this system transformation. The main aspects of that transformation are reflected in the visionary description of what we want our service system to be: Recovery-Oriented, Evidence-Based, and Culturally Competent.

By The Commonwealtlh Fund

Most Americans see the need for fundamental changes in the nation's health care system, according to new survey findings released today by The Commonwealth Fund Commission on a High Performance Health System.

The results, reported in Public Views on Shaping the Future of the U.S. Health Care System, by Fund staff Cathy Schoen, Sabrina How, and colleagues, indicate that change is desired in nearly every aspect of health care. Forty-two percent of respondents said they had recently received poorly coordinated, inefficient, or unsafe care. The survey also reveals strong public support for efforts to improve care coordination, as well as a shared belief that expanded use of information technology could improve care.

Additionally, paying for care is a major concern: about half of adults in middle- and low-income families reported they have experienced serious problems paying for health care and health insurance. Not surprisingly, expanding affordable coverage and controlling costs, they said, should be top priorities for federal action.

By Peter Kohler, MD, OHSU president emeritus

When the Institute of Medicine released the now landmark reports on the state of health care in the nation in 2000 and 2001, a key finding was that patients and their families do not have the information they need to be full participants in their health care. Even physicians may only have a partial view of the performance of any individual hospital.

The authors basically saw a system that was not living up to its potential in terms of health care excellence. In response, some institutions have begun to take steps to create a more patient-centered model of health care. First among these is the effort to become more transparent.

A transparent health care system is usually defined as one in which patients, their families and health care providers have access to information that supports the full range of their health care decision making. Such information includes outcomes and performance measures, patient satisfaction data and charges.

Guest column
Jim Holman

Jim Holman lives in Gresham, worked as an analyst for OHSU for many years, and now works in the field of veterinary medicine.

Changing jobs or employment status often means having to change health insurance, which often means receiving care from a new primary physician.  If you're self-employed you might not be able to purchase health insurance because it's too expensive. If you work for a company that doesn't offer a health benefit then you're out of luck. Many people with existing health problems can't purchase private health insurance even if they can afford it.

Specific health insurance reform is difficult even to discuss. Many proposals for health insurance reform are met with a charge of "socialized medicine," an accusation that can be fatal to the proposal.

But "private" approaches to health insurance reform are often little more than new ways to distribute the current unfairness. The system I propose contains both socialized and private elements. It socializes the opportunity for health insurance while retaining private funding and private choice. It retains the link between employment and heath insurance even as it widens the opportunity for health insurance to those whose employment status does not now afford them the opportunity for health insurance.

Guest column
Andrew Gioia

Andrew Gioia is currently a senior at Cornell University majoring in government and political science.

Though there’s been great debate lately over various issues in health care, few have spoken at any length on a moral or ethical basis for reform. Health care decisions are inherently personal, yet within the current health care system individuals and families have little genuine choice when it comes to the terms and benefits of their health plan.

Furthermore, advances in biomedical research promise great improvements in care, yet at the same time many Americans would likely object to funding procedures or treatments through their health insurance premiums that they find morally offensive. Such decisions, however, are almost always made by employers, insurance executives, or government officials, leaving no room for Americans to control their own health care dollars and participate in plans that respect their values.

Recently, the Heritage Foundation published a paper outlining the merits of what they call a values-driven health plan. In it, the authors answer a number of important questions and call attention to several freedoms current health plans prohibit, all of which respect individual moral beliefs and give greater control over personal health plans. The paper identifies the legislative and policy changes that would be necessary for consumer- and values-driven health plans to exist and flourish.

Peter Kohler recently chatted with reporter Kayley Mendenhall about this blog for an article in The Bulletin. He commented that, unlike most blogs, we all seem a bit formal. What do you think is the best way to encourage participation? How can we make this blog more welcoming for you to post your ideas for change in the healthcare system?

Nicole
Blog technical adviser