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?

Continue reading Health care reform could start with one significant change


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.

Continue reading Profile of Health Policy Commission Straw Plan: Massachusetts Moving West?


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


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?


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.

Continue reading Oregon’s Mental Health System Transformation


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.

Continue reading Most Americans believe health care system needs fundamental change


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.

Continue reading Health Reform: Could this work?


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.

Continue reading Values-driven health care: has the time come?


Guest column
Joel Ario, administrator of the state’s Insurance Division
Cory Streisinger, director of the Oregon Department of Consumer & Business Services

The authors have submitted this Op-Ed (a version of which originally appeared in the
for discussion on this blog.

You're about to have a baby and since your employer switched to a high-deductible health plan, you care about price a lot more than you used to. You're a savvy shopper, adept at using the Web to find the best deal. So you quickly discover, an Oregon hospital association Web site that tells you the statewide median charge for an "uncomplicated vaginal delivery" is $5,024. More clicking and you learn hospital charges are about 10 percent higher in the Portland area and vary by as much as 40 percent among local hospitals. You're disappointed the site doesn't rate the quality of services. You figure delivering a baby isn't all that complicated, so you're willing to decide based on price. Then things get really frustrating. You learn that the $5,024 is figured on so-called "billed charges" that nobody really pays, just like nobody pays a new car's sticker price, and that this amount might not include other charges, like the anesthesiologist's bill. Your insurer has negotiated a discounted rate, but it only applies to one local hospital. Even worse, the amount is a closely guarded secret - your hospital and insurer won't tell you what it is.

Welcome to the world of so-called "consumer-driven health care" where the rosy rhetoric is well ahead of the reality. You can't find out how much your hospital stay will cost you, but you know it will be expensive. You start to wonder just who can control costs like the multi-million-dollar hospital expansion projects busting out all over the Portland area.

Continue reading Cost Transparency and Affordable Health Care


As a proportion of total U.S. health care expenditures, emergency department (ED) costs are small: 1.9% of all expenditures of which 88% are covered by insurance.[1]  If ED costs are so small, relative to the whole pie, what can trends in ED use tell us about the broader health care system?

I believe trends in ED use – patient type, insurance status, etc – are like the canary in the coal mine. They can tell us when there are serious systemic access problems in the health care system.

Across the nation, 62% of EDs are now overcrowded.[2]  As an emergency physician, I have noticed a specific category of patient that gives insight into the problems with our medical care system. Two anecdotes illustrate what I think is currently happening.

Continue reading The canary in our coal mine



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