News report

“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

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.

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."

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.

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?

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.