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by Kathleen O'Connor, Founder and CEO CodeBlueNow!

The year is 1932, The Committee on the Cost of Medical Care said there were four reasons America¹s health care costs so much:

  1. There are too many medical specialists;
  2. There were too many infectious diseases;
  3. We have a disease based system of care not prevention; and
  4. Total lack of community-based health care delivery.

All this is pretty much still true, except for two things. Chronic diseases have replaced infectious diseases and Oregon is taking the lead in getting communities involved in health care. 19 of 36 counties in Oregon have taken matters in their own hands to address health care needs in their communities and over 10 other groups are working on system transformation.

CodeBlueNow! is working to find what Oregonians want in a health care system by using our new survey tool, an Opinionnaire®, which helps us find areas of common ground or disagreement.

Continue reading Let Your Voice Be Heard


Insurance preimiums grow faster than wages and inflation

That's not really news to anyone who is paying for health insurance. It confirms what everyone who works for a living already knows. The burning question is: Given how messed up the system is, and how upset people are about access and skyrocketing costs, where is the outcry from the masses? Why are people not insisting on legislative action? There must be a reason why a grassroots demand for change does not seem to exist. Care to speculate?

For fodder, check out a recent article in the Oregonian..."Politicians offer small repairs, not big reform for Oregon's ailing health care system."

And for more fodder, here is the report on rising health insurance premiums. The survey found that premiums have increased 87 percent over the past six years. Family health coverage now costs an average $11,480 annually, with workers paying an average of $2,973 toward those premiums, about $1,354 more than in 2000.

Continue reading They keep growing and growing


We want to bring you up to speed on the Archimedes Movement, provide you with some background information and outline what we’re trying to get done throughout the rest of September.

There are two documents that provide the basic background: the text from John Kitzhaber’s presentation On the Road to Revolution; and a second document called Moving from Principles to a DRAFT Legislative Concept: Next Steps. This second document describes the process we are setting up and the ground rules for participation – such as the willingness to engage as citizens rather than as stakeholders, and the ability to envision what a new system would look like “if anything were possible” (which, by the way, is harder than it sounds).

As you will see from this second document, Archimedes is engaging different groups in a discussion of how to move from a draft set of principles to an actual legislative concept that could be considered in next year’s Legislative Session. You may be participating in one of those groups already, in a chapter discussion or here – online at the OHSU blog or on the Archimedes website.

This is an issue that many people are concerned about; they know the current system is unsustainable; they want to change it – but they don't know how to make it happen or how to engage – they feel disempowered. The Archimedes Movement has tapped into this enthusiasm and this frustration and given them a sense of hope. People seem genuinely excited about having the opportunity to help shape the Vision for a new health care system and to spark the kind of serious national debate we so desperately need.

Continue reading Moving from Principles to a Draft Legislative Concept


Last October I lost my mother at the age of 88. Like most elderly people, both she and my father wanted to die at home - not in an acute care hospital bed. Indeed, throughout my political career senior advocates have supported legislation to create “durable powers of attorney” and “advance directives” for exactly this reason.

I remember a point in her gradual decline when we went to see her physician because she was having increased muscle pain. Lab work had been done to find the cause of this pain which was being treated with low dose steroids. One of the laboratory results that came back was a high erythrocyte sedimentation rate, a nonspecific indicator of inflammation. It was not just high, it was extremely high, and one of the possible reasons was an undetected cancer.

The workup to find out exactly what was going on would have been very invasive - including endoscopes, colonoscopies, and possibly a biopsy. My mother was not interested in any of these aggressive therapies because even if a tumor were discovered her question was “what were we going to do about it in a frail 88 year old woman?”

At this point my mother made a conscious distinction between “cure” and “care.” She was interested in being comfortable and enjoying whatever time she had left. She did not want to spend her remaining time in the hospital or recovering from various invasive diagnostic procedures.

Continue reading Putting "Caring" Back into Health Care


Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families

By The Commonwealth Fund

"As health care costs continue to rise, there has been steady erosion in the proportion of workers covered under employer-based plans, as well as in the adequacy of such coverage. Workers forced to turn to the individual insurance market often find coverage unaffordable or unavailable, while families with employer coverage face ever-rising deductibles and other cost-sharing burdens. This study uses the Commonwealth Fund Biennial Health Insurance Survey, 2005, to examine the experience of adults ages 19 to 64 in the individual insurance market compared with adults with employer-based coverage. Compared with adults with employer coverage, adults with individual market insurance give their health plans lower ratings, pay more out-of pocket for premiums, face higher deductibles, and spend a greater percentage of income on premiums and health care expenses. The report also analyzes the implications of rising out-of-pocket spending among all privately insured Americans, particularly focusing on the effect of high deductibles." Read full report at The Commonwealth Fund site.

Even though employer-based plans can be great (if you have one), is this approach to insurance relevant anymore? Employer-based plans arose in the WWII era as a incentive to attract scarce workers. Does this still make sense for modern society employment trends? With the rise of small businesses, sole proprietorships and similar non-traditional approaches to work, should we stick with this approach?

Continue reading Are employer-based insurance plans relevant anymore?


A new study suggests that sudden cardiac arrest is linked to poverty. The study validates what many people had assumed. How are such findings to be incorporated into a more just approach to health care? What role does this type of information have in health care reform? In this context, it would have been interesting to know the percentage of these people who had health insurance or access to health care to see if that makes a difference, of course, but such information is not always readily available.

A team of Oregon Health & Science University researchers have found that the incidence of sudden cardiac arrest, one of the nation's most lethal public health problems, was 30 percent to 80 percent higher in the lowest socioeconomic-status neighborhoods in a large urban community than in the high-status areas in that community during the two-year period evaluated. The disparity was most acute for those younger than 65.

The findings were based on a study of 714 cases of sudden cardiac arrest (SCA) in Multnomah County, Ore., reported between February 2002 and January 2004 by the county emergency medical services system, the county medical examiner and 16 area hospitals. At the outset of the study the county had a population of more than 660,000 people.

Ninety-eight percent, or 697, of the SCA cases surveyed had residential addresses in one of the county's 170 census tracts. The tracts were divided into quartiles for each of four measures: median household income, percent of population below the federal poverty level, median home value and percent of population older than 25 with at least a bachelor's degree. For each of the four measures, SCA incidence rates were lowest in the highest socioeconomic status quartiles. Annual incidence of SCAs in census tracts in the lowest versus highest quartiles of median home value was 60.5 versus 35.1 per 100,000. The differential was much more exaggerated for the median home value measure in the younger than 65 population, where it was 34.5 versus 15.1 per 100,000.

Continue reading Sudden Cardiac Arrest Occurs at Higher Rates In Poorer Neighborhoods


by Dan Handel, M.D. and colleagues

An OHSU physician and reseracher, Dr. Handel has submitted an editorial from the Annals of Emergency Medicine for discussion.

It is the end of another busy afternoon in the emergency department (ED). As you finish up your dispositions, a 35-year-old patient with poorly controlled diabetes and hypertension comes in for a medication refill. Reviewing his medical records, you discover he presents often for medication refills. His demographics sheet is marked as “self-pay.”

“Sir, do you have a primary care physician?” you ask.

“No, I don’t have any insurance, and they all ask for the payment up front, which I can’t afford,” he replies.

You have heard this all before. You return to your desk to refill this patient’s prescriptions yet again, knowing that he will soon return to the ED when he runs out or, even worse, will present with an exacerbation of his medical conditions because of his inability to obtain medications.

Residency trains physicians to handle all medical emergencies that present to the ED’s door, but it does not necessarily train physicians to address the ED’s significant social issues. Physicians’ best acute clinical care may be undermined by the social factors that affect the way their patients receive follow-up care. Read the rest of the editorial (PDF).

Continue reading The challenge of patient follow-up in today's health care environment



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