Leading the Way on Health Care with SB 27

By Chris Greiveldinger of Portland, Oregon. Chris is a software engineer and member of the Beaverton chapter of the Archimedes Movement.

Health care reform efforts are percolating around the nation this year, and Oregon is home to one of the most innovative proposals, the Oregon Better Health Act (SB 27) from the Archimedes Movement. A rally in support of SB 27 was held at the State Capitol yesterday, once again demonstrating the support that Oregonians are willing to give to bold policy measures. Before discussing the Oregon Better Health Act, it's important to acknowledge two other notable state-level health reform proposals in Oregon.

There has already been discussion at BlueOregon about Governor Kulongoski's Oregon Healthy Kids Plan (HB 2201). The Healthy Kids Plan has the admirable goal of bringing health coverage to more children, but there is resistance to using an increase in the tobacco tax to fund the plan. The bigger problem is that the expansion in coverage is only incremental, and adults are entirely omitted.

Senator Alan Bates and Senator Ben Westlund have proposed Senate Bill 329, which requires health insurance for all individuals. The state will cover those earning less than 250% of the poverty level, and others will have to pay a premium. SB 329 will get insurance coverage to everyone, but it will get there by utilizing the current health care system, notably relying on private health insurance plans and Medicare.

The first two proposals basically answer the question, “How can we use our current system to provide better health coverage for Oregonians?” Under the leadership of Governor John Kitzhaber, the Archimedes Movement asks the more radical question, “How can we use our current public health care funds to build a new system to provide better health coverage for Oregonians?” The Oregon Better Health Act is the answer to that question.

SB 27 seeks waivers to get health care funds from Medicaid, Medicare, and the value of tax incentives supporting employer-sponsored coverage. As Governor Kitzhaber recently wrote in the Oregonian, involving Medicare in the plan is essential, because as the baby boom generation ages Medicare comes under great strain.

In addition to seeking waivers, SB 27 proposes several principles to be considered when defining the core health benefit that will be provided by the plan. Notice that the legislation does not propose what that core benefit should be, nor does it prevent individuals from purchasing additional coverage from private insurers if they desire. The core benefit will be defined through a public process after the legislation is enacted, thus giving Oregon the flexibility to restructure the health care system. SB 27 lays the foundation for implementing a better health care system.

Finally, I should mention this intriguing quote from Senator Bates in the OPB article about the rally.

“We sat down with the Governor and others and worked out a plan that we're going to amalgamate these two bills and get the best out of the both of them.”

I'm optimistic that with this willingness to work together Oregon will lead the way for the nation on true health care reform.

Comments

  • Walpurgis (unverified)
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    Umm... when you say:

    "SB 329 will ... get there by utilizing the current health care system, notably relying on private health insurance plans."

    You know that SB 27 does the exact same thing, right? It's not a single-payer system.

  • More Than a Band-Aid (unverified)
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    Chris said: I'm optimistic that with this willingness to work together Oregon will lead the way for the nation on true health care reform.

    I was at the rally yesterday on the capitol steps and this was the feeling felt by all.

    Governor Kitzhaber's plan is a bold one and a necessary one. The 2007 Oregon State Legislature has the opportunity to place Oregon at the head of the pack towards health care reform in this country.

    As the next Presidential election comes closer - there is no doubt that health care reform will be a top issue and there is also no doubt that there will be nothing done at the Federal level about it. After that our next chance is 2012. But what happens in 2011? The first wave of baby-boomers will be Medicare eligible and if there is no plan in place or states are not prepared with their own plans on how to deal with this - we won't have time.

    In SB27, our legislative leaders have the opportunity to place Oregon in the national spotlight again as being a leader state. Our system is broken. This isn't a shock. What's shocking is the lack of initiative we're seeing in so many places around this Country.

    I take my hat off to Governor Kitzhaber and applaud all those co-sponsors who were next to him yesterday at the capitol.

  • More Than a Band-Aid (unverified)
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    Why do we want a single payer system??

    Taken from: www.wecandobetter.org

    Is this the same thing as "single payer" or "socialized medicine"?

    Answer

    The term "single payer" simply refers to where the money to finance health care comes from. When people refer to a single payer system they often think of the Canadian system as an example, implying that it is the only example of a single payer system. It's not. In the U.S. Medicare is an example of a "single payer" in that most of the financing come from the public (the government). Yet the care is delivered through the private sector with insurers playing a significant role. "Socialized medicine" is a model where the providers work for the government. This is not what the Archimedes Movement is proposing,

    The health care system we create for the future will be uniquely American, reflecting our values, our culture and our preferences. The Archimedes Movement is simply committed to changing the way we use the public dollars we are already spending on health care to create a fair and sustainable system that includes all of us and optimizes the health of Oregonians.

  • Michael Wilson (unverified)
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    So how will this improve the quality and keep costs in check?

    Just for the record I recently exchanged emails with a group of people regarding the cost of a PET scan. In one state the costs ran more $4000 while in another it was less than a $1000.

    One idea that might help is for information regarding costs of medical services be available to the public.

    Why is medicine different? And who mandates that doctors don't post their prices?

    MHW

  • Garlynn (unverified)
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    As I understand it, SB 27 simply lays the groundwork legally for the Archimedes Movement to begin working. It sets up a conflict between Oregon and the Federal Government, which our congressional delegation can then use to change federal law to grant a waiver allowing Oregon to use Medicaid/Medicare & tax benefit funds to construct a different health care system within the state.

    After that, it's up to the Archimedes Movement (that is, interested citizens of the State of Oregon) to craft the shape of the new system, and design it in such a way that all Oregonians are covered for basic health care. Will "basic" include dental and vision? That's up to the implementation committee.

    So, learn more about the We Can Do Better/Archimedes movement, get involved, and help to shape the system that you would like to see.

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    Michael:

    There is a house bill in the OR legislature that would do just what you're asking for: transparency. It's HB 2213, and it's been passed out of the House Health Care Committee headed to the House Floor.

  • SinglePayerSupporter (unverified)
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    As I understand it also, Garylnn describes SB 27 properly.

    Bates and Westlund, and their supporters, seem to be out there spreading misinformation about the level and tenor of their discussion with SB 27 supporters in what really seems to be a dishonest attempt to win support for their plan. Bates and Westlund specifically desire to protect the business interests of insurance companies, SB 27 would only do that if the people of Oregon decide we want to do that after being provided with all the facts and asked for our opinion.

    Walpurgis appears to either not understand, or perhaps be one of the misinformation spreaders: The comment "they do the exact same thing" is so vague - what is the "thing" - that it appears to be an attempt to mislead people into believing these plans are similar. Or worse, to deceive people into believing the Archmides Movement people have signed on to the Westlund plan.

  • Chris Greiveldinger (unverified)
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    Walpurgis wrote:

    "You know that SB 27 does the exact same thing, right? It's not a single-payer system."

    The summary page of the Oregon Better Health Act states that the act "Finances the 'core benefit' from a pool of public funds to which all Oregonians will equitably contribute."

    The brief description of SB 329 states that Oregonians will "choose an authorized insurance provider."

    These don't strike me as "the exact same thing."

    With that said, SB 27 does have provisions that allow for the involvement of private insurers, and the fact that it provides the framework for making changes means the exact implementation is still undefined. It is possible that enacting SB 27 could ultimately lead to a plan very close to what SB 329 is advocating. A major difference between the plans, though, is the inclusion of Medicare in SB 27.

  • Christine Newkirk (unverified)
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    "I'm optimistic that with this willingness to work together Oregon will lead the way for the nation on true health care reform."

    I hope so. Having spent the past couple of weeks traveling about the state, doing needs assessments among our farm worker population, I feel a bit more sick to my stomach about the state of health care in the US than usual, which is saying a lot. I've heard people talk angrily about racism and discrimination, but I've seen them cry about watching their children suffer, waiting for essential medical care until they have enough money to pay for the services up front. I've heard them talk about work injuries and facing the impossible decision of notifying their at-will employers and being fired or of spending money they do not have on medical care, missing work, and endangering their housing. It's visceral and ugly, looking at the human costs of a broken (or non-existent) health care system.

    Those are the things I think about when people mention health care reform. And I genuinely hope that it is on the way.

  • Walpurgis (unverified)
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    Chris -- I think we're both basically on the same page. Section 10 in SB 27 does allow for private insurers (as you've pointed out), but I don't see any indication that a resulting plan would eventually be very different than SB 329.

    And single payer guy, I just reads me the bills and then I calls 'em like I sees 'em. Sorry, no conspiracy theory here.

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    Question: What's more important - goring the insurance industry, or ensuring universal health care? Are we more concerned about hewing religiously to one particular financing model (single payer) or ensuring that everyone has affordable, portable, high-quality, health care?

    Yes, I know that there are those that believe you can't go universal without going single-payer, but let's give others the benefit of the doubt. But if it is possible, don't we owe it to ourselves to examine those possibilities?

    I got problems with the insurance industry as much as the next progressive, but I'm not willing to demand that we hold up universal health care just so we can take the opportunity to whack the insurance industry.

  • Isaac Holeman (unverified)
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    In comparisons of SB 27 and SB 329, it is very easy to jump to words like "single payer" and "private industry," but I would like to call attention to the issue of public dialogue in the reform process. The Oregon Better Health Act is a process more than amalgam of rules and implementation plans; this is what sets the Oregon Better Health Act apart from SB 329 and every other piece of legislation out there. SB 27 is specifically designed to facilitate a continued dialogue between the people of Oregon and the policy makers who will form the implementation plan. This allows us to be participators in our government - it is only way that we will be able to realize that precise, quirky, very Oregonian way of doing things.

    SB 27 is not JUST a new (and better) set of rules, it is an invitation to have a voice in health reform, a chance to give our state legislators some leeway from the fed to work with, and a mandate to do that work with all of us.

    I think the Oregon Better Health Act stands alone. However, we shouldn't underestimate the value of expiditing the process by merging SB 27 and SB 329. If this does happen, it is imperative that we maintain aspects of the Oregon Better Health Act that facilitate dialogue.

    cheers -Isaac Lewis & Clark College

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    Kari,

    How about we give a unified government funded national system the benefit of the doubt for once? I prefer this description because it is clearer than the "single payer" jargon and because I think supporters have to get over being scared to use the "g" word. As the brokenness of the current system shows, in fact government is more efficient than the private sector at providing effective health care on a universal basis.

    In case you haven't noticed, this eminently practical, as in actively practiced to good effect already in many places and even sections of our own system, and sensible type of system is not allowed into serious public debate over health system reform in the U.S. This appears to be the result of a self-fulfilling and circular argument that it is "not realistic" or "not politically realistic." But if people aren't permitted to learn more about it, we are not having a full and intellectually honest debate. National government funding should be included as a full element of the debate, not as a faintly stinky last resort.

    A government funded system is not a panacea nor without problems, but it has many advantages over the current system, which has massive problems. If it is legitimate to consider continuing dysfunctional features of the current system, it should be legitimate to consider national government funding. The standard should be comparative advantages and problems, rather than worst (& often exaggerated) aspects of government funded systems vs. against abstract idealized claims for market efficiency that clearly are false in our failing health sector.

    The Westlund-Bates bill sounds as if it is very much in line with the draft report of the Oregon Health Policy Commission set up by Gov. Kulongoski a while ago, and now several days into a ridiculously short (originally 18, now down to 14 day public comment period). The index to the draft report can be found at a state website here and a pdf of the whole 60-plus page report here. Comments can be made here.

    What both have in common is apparently aiming to follow the coercive Massachusetts model for achieving spurious universality, as Gov. Schwarznegger apparently wants to do in California as well.

    As I wrote in a letter to the OHPC director, Gretchen Morely, requesting an extension of the public comment period:

    "Some ... proposals make me very uneasy, in particular the mandate to purchase insurance. This appears possibly to be in the coercive Massachusetts mold, which has proven to be a major boondoggle that secures additional insurance company profits either at the expense of persons who can ill afford the costs, or at the expense of public subsidies, or both, while delivering poor quality insurance with huge deductibles (relative to low incomes) and wide exclusions. This combination seems unlikely actually to reduce reliance on emergency rooms for first-line care-seeking cited so heavily in the report. ...

    [The report may not provide enough information to evaluate proposals.] To take just one example, the report ... relies upon model budgets from the Economic Policy Institute [suggesting] that 15% of household income is a reasonable cost for individuals and families at 300% or more of federal poverty level to expect to pay. Footnotes tell us that 300% of FPL for an individual is $29,000 and for a family of three is $42,000 this year. What the footnotes do not tell us is whether those are gross income figures or after-tax figures, while the report does not tell us whether the 15% figure is 15% of gross income or 15% of after-tax income.

    Also these figures appear to involve only insurance premiums, whereas actual health-care costs to care-seekers also include deductibles and co-pays, which in most "affordable" policies are set very high. Likewise private low-cost policies generally have many exclusions. [The OHPC report seemingly also] envisions many such exclusions.

    In fact it seems highly likely that many Oregonians in better-paying jobs will also have superior employer provided coverage, with respect to employee contribution costs, smaller deductibles and fewer exclusions, despite greater ability to pay.

    So on the face of it, the mandate on low and lower middle income individuals to secure proportionally high-cost and probably lower benefit insurance, despite lesser ability to pay, and even with contemplated subsidies, looks to me like a regressive tax. This tax is to be farmed out to private contractors (insurance companies) to collect, collectors with inherent conflicts of interest with both forced-holders of policies, and with the interests of the state in effective, efficient health-care delivery."

    What the Massachusetts and I think the Westlund-Bates/OHPC approach do is provide an illusion of universality. At this point the lack of coverage problem includes inadequate coverage for the nominally insured. Employer-based health plans are increasingly being hollowed out in terms deductibles and exclusions, even as premiums rise several times faster than other inflation. Giving more people bad insurance and saying they're "covered" is neither cost- nor health-efficient.

    While I understand where Walpurgis is coming from in the sense that the Archimedes/We Can Do Better approach is not a fully developed national government funded system, it really is not the same as the coerced insurance model. Rather it aims to unify and rationalize spending of current public resources to provide core benefits for all, within a single-state context. In providing a "core benefit" for all, it would move away from the means-testing stigma that affects Medicaid and would also apply to subsidies for forced insurance.

    It also aims to create and provoke debate not only about cost-efficiency but effectiveness, what we might call health-efficiency, of health expenditures. In a full honest debate, we might decide that in some situations cost-efficiency is more important, in others that health-efficiency is.

    Walpurgis is right that the Archimedes approach does not fundamentally challenge the private insurance system, although in theory it would redirect government tax subsidies of that system into public spending. That would reduce incentives for employers to provide health benefits & it is not clear to me that a common pool restricted to current public resources would be able to make up the difference. I also am not really sure how that would even work in practice -- companies not allowed to take current deductions & the feds circulating money collected back to Oregon?

    This part of the proposal will doubtless raise issues about "business climate", competitiveness nationally, ability to attract desired employees etc. Yet if the core benefit is good enough it might allow small businesses to compete better & more people to risk entrepreneurship as contractors/freelancers, and might enable companies to pay less for "add-on" benefits beyond the core.

    I also believe that Archimedes/We Can Do Better will get a lot of pushback and probably not be able to overcome resistance to including Medicare in a unified public funds pool.

    But in a sense all that nuts and bolts stuff as to whether the envisioned system is workable is down the road. Ultimately the proposal's value may not be in getting implemented as currently envisioned so much as if it succeeds in cracking open the terms of debate about public funding.

    One thing that Walpurgis and people like me should keep in mind is that Canada did not arrive at its national system in one fell swoop. In fact it got there through evolutions in a number of provincial systems, some of which were initially half-measures. Of course they had fewer provinces, a stronger labor movement and a more social democratic political culture than the U.S.

    Still, at the end of the day, if we're going to talk about gradualist approaches, I would prefer that approach of national legislation proposed by John Conyers (H.R. 676) that would open Medicare to participation by anyone, i.e. not an age defined population, but not force anyone to join. I.e. let government insurance compete with the private sector. Of course there would be screams about unfair advantages, but that's just the point, isn't it. For what it's worth, Marcia Angell, for many years editor of the New England Journal of Medicine, recently endorsed the concept of Medicare for All.

    P.S. I'm a graduate student in public health at OHSU.

  • (Show?)

    P.S. I'm a graduate student in public health at OHSU.

    No kidding? That was a mouthful.

    I'm certainly not arguing that single-payer shouldn't be a full and complete partner in the argument.

    I frankly haven't been as close attention to the state proposals as the national ones, but here's what I know about the national level -- Single-Payer ain't happening.

    I suppose you could say that it's a "circular" argument, and we shouldn't shut down the debate, but there's not 30 votes for it in the US Senate, much less 60.

    As I said upthread, are we most concerned with financing schemes, or meeting the goal of universal, affordable, quality, portable, nondiscriminatory health care?

  • Walpurgis (unverified)
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    Hey, I love Archimedes. All I'm saying is that 329 is so similar that I'll be satisfied with either.

    It is not simply a Massachusetts-style mandate. Yes, some people would be covered through their employer, but that would only be acceptable if that plan met minimum coverage standards set by the same type of oversight board that SB 27 would also set up. As I understand it, both plans have this board set up to ensure that everyone gets covered up to a certain level.

    Yes, people with spare cash (including employers) can buy even better coverage outside of the system if they like. Is anyone atually against that?

  • Chris Greiveldinger (unverified)
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    As I said upthread, are we most concerned with financing schemes, or meeting the goal of universal, affordable, quality, portable, nondiscriminatory health care?

    I'd add "sustainable" to the list of adjectives. We need something in place that will provide quality health care for years to come. I have concerns that if we implement a plan that does not address Medicare, then once the baby boomers start qualifying for Medicare we'll need to come back and address the strains that will cause on the system. We should make sure that we get it right the first time.

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    "Sustainable" - agreed.

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    Yet another (and the most important) adjective:

    Achievable

    My wife has been working with Bates and Westlund for months on their health care bill in her capacity as chair of the Governor's Small Business Council. The council had Governor Kitzhaber come in and do his presentation at their meeting in Welches and this was followed up by Bates and Westlund interacting with the Council and the local Chamber folks to explain and market.

    The senators have been very hardheaded and true to the idea that whatever they produce has to be able to pass and hopefully to survive the inevitable backlash referral by petition.

    Universal care ain't worth a bucket of warm spit if it doesn't get implemented.

  • gt (unverified)
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    I am interested to see how they implement this so called "Univeral Health Care" package. I wonder if it will be like their much bragged about "Universal Mental Health Parity" law that is anything BUT universal. Maybe to the benefit of the money grubbing government paper pushing trolls.

  • (Show?)

    Kari wrote:

    As I said upthread, are we most concerned with financing schemes, or meeting the goal of universal, affordable, quality, portable, nondiscriminatory health care?, others added sustainable.

    Mandated insurance systems are not going to provide quality or be non-discriminatory.

    Forced insurance may achieve nominal universality insofar as most have an insurance policy of some sort, though actually some will be uninsured plus financially penalized. But it will discriminate against the lower-middle classes and working poor. They will be forced to spend money on inferior insurance, or to pay extra taxes.

    For this extra expense, they'll have to pay most costs they'd have to pay anyway, or fall back on the emergency departments as they do anyway, due to high deductibles. There may be a partial exception for some kinds of catastrophic care, depending on what the exclusions are. This is lemon corporatism by government fiat.

    Pat, "achievability" isn't worth a bucket of spit if what is achieved is inferior, ineffective and discriminatory, and if it is likely to turn those forced to pay the regressive tax against the idea of universal coverage. In the latter sense I think it will politically unsustainable.

    Kari, I agree that universal national coverage isn't going to happen in this session of Congress, but since it is forseeable that the alternatives aren't going to work very well, it is important to treat the idea and get it treated in public debates as a legitimate option worthy of serious consideration, one that also provides standards and criteria against which to judge constrained market-based proposals -- for forced insurance is anything but a free market.

  • Read The Bills Please (unverified)
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    Chris -- I'm confused about what you wrote. Are you saying that either SB 329 or SB 27 contain some kind of Massachusetts-style mandate? Because, well, they don't.

  • gt (unverified)
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    I have some serious reservations about the incompetant government making health decisions for me. For one, what is going to happen to all the people working in private sector insurance after the state communizes health care? Two, is there any going back after people realize that the government will do as awful of a job running health care as they do, say, the transient systems, Amtrak, the mail, the education system, etc? Will we have the option to "opt out", and if we do, we should get a tax voucher for private care, right? Or will we be forced into the communist system against our will?

  • Read the Flippin' Bills Already! (unverified)
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    GT, I'll say it again:

    Read... the... Bills.

    I'm going to make it really easy for you. Click these links to download the text of the bills in PDF format. Then read them. Senate Bill 27 Senate Bill 329

    You're obviously just reacting to what you've imagined is in these plans... not what is actually in them.

    Neither of these plans has government "making health decisions" for you. They both very clearly utilize the existing private insurance system with existing dollars so that you can buy up if you so choose. And both plans allow private insurers to compete for your business!

    So someone's either giving you bad information, or you had a bad dream about these bills or something. Read them for yourself and make a decision based on tha facts.

  • You Read the Bills (unverified)
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    Apparently "Read the Bills Please" hasn't read the bills. From the initial Summary section of SB 327:

    Requires certain persons to participate in program. Requires uninsured individual with income greater than 250 percent of federal poverty guidelines to pay premium. Denies state income tax exemption credit for individual who fails to pay premium.

  • You Read the Bills (unverified)
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    Typo in the previous comment: The quote is from SB329, as it should be, and linked in the post before that, not "SB 327" as I erroneously typed.

  • gt (unverified)
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    Read the Flippin' Bills Already!, I read your stupid liberal bills. I even went to a seminar this afternoon on the proposed changes and I think it's an absolutely horiffic idea. They want to force everyone who makes above a certain income to pay into their insurance scam whether or not they actually use the state's forced insurance! If I want "the option" to go with a private insurer, I still can but the greedy state would still take my money for their poor people premium. Doesn't this idiotic despotic government already require enough of us? I am fed up. They aren't going to require anything from me at all. This is a free country.

  • Understand the Bills! (unverified)
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    GT, that's a completely different argument than what you first said! Yes, you have to pay for health care plans... you already put those same dollars into the system through Medicaid, Medicare, OHP, etc.

    You were railing against "government making health decisions for me" and "what is going to happen to all the people working in private sector insurance after the state communizes health care". Neither of these things are going to happen.

    Let me put it this way... Anyone participating in this plan will have get their health insurance through a private insurer. There will not be a government-run insurance company. That means, if you're already with Regence, you can stay with Regence. If you're already with Kaiser, you can stay with Kaiser. Etc.

    I guess what I should have said was to Read and understand the Bills.

  • gt (unverified)
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    "you already put those same dollars into the system "

    Yeah, I've already seen what good it does to put my money into your stupid system. I recently had to inquire about getting on the OHP because I've developed really bad light sensitivity in my eye. They said I wasn't really "needy" because I was above a certain income threshold for the last 4 quarters. Don't these simpletons realize that not ONLY "poor" people need help and sometimes "the rich" get destitute at times? Oh well my trip to the DHS found a bunch of paperpushers pandering to the criminal illegal Mexicans. They even had forms available in Spanish since the criminal illegal Mexicans are too lazy to even learn our language. How insulting! After 3 hours sitting in their office I got on a Tri-Met bus where I had to hear 3 young men (probably in their late teens) bragging about how they just got their Oregon Trail cards and were going to buy pot with them. So I guess the state views "the needy" as illegal criminals and people needing to buy drugs. If you're "too rich" you are just SOL if you are ever in need of help.

  • Understand the Bills? (unverified)
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    This is starting to get comical. One of the problems proponents of SB 329 have is that they don't appear to be straight shooters. I hope the SB 27 supporters are, and that the recognize that playing too much footsy with SB 329 supporters is going to start to raise questions.

    Understand the Bills!, and the public relations focus of SB 329, increasingly seems to be all about playing "hide the mandate", rather than stepping up and squarely focusing on the question of what should be the mandate when it comes to health care in a civilized society. Review the debate:

    1) Chris Lowe wrote the spot-on comment:

    Mandated insurance systems are not going to provide quality or be non-discriminatory.

    Forced insurance may achieve nominal universality insofar as most have an insurance policy of some sort, though actually some will be uninsured plus financially penalized. But it will discriminate against the lower-middle classes and working poor. They will be forced to spend money on inferior insurance, or to pay extra taxes.

    2) In response, "Read the (Flipping) Bills!/Understand the Bills!" wrote:

    Chris -- I'm confused about what you wrote. Are you saying that either SB 329 or SB 27 contain some kind of Massachusetts-style mandate? Because, well, they don't.

    3) In response to this, "You Read the Bills" quoted from the actual text of SB329 to highlight that SB329 is about mandating that everyone be insured (which is quite distinct from receiving health care) and those who aren't eligible for publicly underwritten insurance must buy it - whether it is they themselves or their employers - from private insurers:

    Requires certain persons to participate in program. Requires uninsured individual with income greater than 250 percent of federal poverty guidelines to pay premium. Denies state income tax exemption credit for individual who fails to pay premium.

    The result? RT(F)B!/UTB! then tries to spin off on a different argument by GT. As I read it, intentionally or not, GT is really expressing two connected, but distinct things. The first is the fears a lot of people have that any reform will be bungled and leave them worse off before. The second is one position in the legitimate debate we should be having, and that SB 329 supporters appear to be intentionally dodging, about what should be mandated in a civilized society.

    One does not have to agree with GT's position on the latter, to strongly agree that the fear about the former is quite legitimate and well-founded. The way in which the design and presentation of SB 329 really is about "hide the mandate", rather than stepping up to the honest debate of what should be the mandate, does raise significant concerns about their competence in many ways, and therefore the nature and performance of any plan they advocate.

    Even if the "hide the mandate" strategy of SB 329 is for arguably honorable goals of getting the uninsured insured, the strategy itself undermines the credibility of the supporters. In addition, the goals of SB 329 are only "arguably honorable" because, as Chris has quite competently pointed out, (forced) access to health care insurance is not at all the same as universal and equitable access to health care, so the motives for the former may not wholly and totally be the latter. SB 27 supporters would do well to consider that in forming any joint strategy, especially for purposes of political expediency, with SB 329 supporters.

    I have no desire right now to debate what should be mandated in a civilized society because I believe, in the end, most Oregonians and Americans will embrace the changes we need if they are competently developed, rather than having to be forced to do anything through mandates. I would offer two facts that opponents to health care reform should consider in framing their arguments about government, simply because they are facts: 1) Amtrack's Pacific coast runs and the DC-Boston runs are quite successful and popular, as measured by ridership and net value to the economy. 2) Medicare has been successful in providing health care for millions of Americans 65 and over who would only have emergency health care, at great cost to anyone who is privately insured, because they don't work (so they couldn't get it through their employer) and simply don't have the monthly income to purchase private insurance.

  • gt (unverified)
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    For the last 3 years I worked as an I.T. contractor. Sure I made close to $48 a year but I got VERY basic insurance that didn't cover most of my health issues. So I had to pay close to $2k out of pocket a month in health care. Sure, that's a lot of money but the liberals would deride me as "too rich" and therefore "greedy" as well. I live very modestly since I have had such outrageous health care costs over the years. I am insulted to no end that I had to pay in excess of $12k in income taxes for WHAT? So these so called "progressives" can live high off the hog with their six figure government incomes and lavish PERS benefits? Also so the illegal criminal Mexicans and drug dealers can benefit! I am irate at this situation. If the government hadn't stolen my money I wouldn't be in this situation right now. They are disingenuous liars to take everyone's money and force them to accept an inferior health system in return. In addition to the pathetic school system, transient system, sewer systems, the list goes on and on. The government is incompetant. Why should THEY be making decisions about people's health care and insurance options? They can't get ANYTHING right.

  • Understand the Bills? (unverified)
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    You don't have to answer GT (and reading another thread I understand that someone at BO has blocked posts from your primary IP address so it may not be convenient to answer), but I think you provide an important view of how some feel that those of us who support health care reform as essential to the surivival of our state and country need to think about, and think about hard. So here's my question:

    If someone:

    a) agrees with you that you are paying too much for what you get (I do agree),

    b) believes that you deserve more for less (I believe that), and

    c) they can make a case to you you are paying too much and not getting what you deserve because you are forced into the private market (I believe that case can be made on the facts),

    are you unwilling to enter into a discussion about how and what health care reforms would change that (I believe SB 27 supporters and others who genuinely care about that should be making that argument)?

    I agree that SB 329 does not take on the problem properly. I'm not sure yet SB 27 can deliver on it's main concept of bringing everyone who feels like you do into the debate. I am getting more concerned that the vague comments we are hearing about merging SB 329 and SB 27 are in fact selling out the core promise of SB 27.

    Are you listening SB 27 supporters? Except for the one cryptic comment with objectionable nativist overtones (which, by the way, I'm betting that a disturbing large number of "progressive" BO readers do NOT take exception to, and I also acknowledge is still important because it actually does bring to the surface one hidden feeling a lot of people have in the debate), GT is sending a very important and unambiguous message that you can get traction on if you are up to it. You are falling down on the PR job, and it is not legitimate to criticize someone for criticizing you for that: You can post right here to tell your story for 0$ and minimal time.

  • Understand the Bills? (unverified)
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    In the above: You are falling down on the PR job, and it is not legitimate to criticize someone for criticizing you for that: You can post right here to tell your story for 0$ and minimal time., I'm specifically talking about following up on the thread-starting post with more details and in-depth, timely, information about what is happening to merge SB 329 and SB 27. Apparently, this is based in part on ongoing feedback from the Bates and Westlund, SB 329 patent-medicine roadshow.

  • gt (unverified)
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    I have my ways - IP blocks won't do any harm to me. I just use the public system or my cell phone when I need to get around their stupid block.

    Anyway, to answer your question .... I am just disgruntled that our government has bragged so much about "the needy" or "the children" this and that and the other but when it comes down to it and someone who has paid A LOT into their system gets screwed. The stupid lady at DHS actually had the audacity to tell me "this isn't a bank account, you can't just withdraw what you've put in" and "here's a list of PRIVATE agencies that can help you out". What good is it for anyone to pay into something and then not get anything back except benefit the freeloaders and government paperpushers?

  • Understand the Bills? (unverified)
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    GT has made a very well-spoken point about a perception of not being treated equitably by government. Without knowing details, since that is irrelevant to the main point s/he has made about equity, it sure seems to me to be fair on it's face. And it is a viewpoint that in my estimation health care reformers would do VERY well to address. Most people really do have an innate sense of justice and fairness. Offending that is one sure route to having your ideas rejected.

    So now, I'm as interested as I suspect GT is in hearing responses from SB 329 and SB 27 supporters that speak honestly and respectfully to the main point about developing health care reforms that have the appearance and substance of equity.

    If this was a classroom assignment, it would go like this. In 500 words or less: Define equity, defend your concept and how your preferred solution provides equity, compare and contrast with other plans. The SB 27 supporters can refer to Section 3 of the bill, SO LONG AS, they can represent that this will be retained in whatever emerges as an SB 27/SB 329 marriage. Extra credit for discussing how we deal equitably with the huge health care crisis facing us with military people returning from battle. Chris Lowe already gets an "A" and doesn't need to take the test for his essay up thread. (Thanks Chris Greiveldinger for one of the best thread starting posts, ever, on Blue Oregon, and Chris Lowe for one the best comments, ever.)

    Pencils up, this is a timed test, begin.

  • GT (unverified)
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    Hi All,

    I actually met with someone in the Archimeds campaign this afternoon. She was very nice and thoughtful and was willing to put up with my ranting and raving. I explained my situation and concern about "the government" running the system. I considered everything the told me and was very open minded. It is a very important issue and I think we as Oregonians may have a unique opportunity to do something revolutionary! I have thought a lot about the issues and some of the points presented and I think I'm about to come to "the dark side" on this issue! :)

    Stay tuned!

    GT

  • Barney Gorter (unverified)
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    The fear about the government running a health-care program is spurious at best. The private sector has had the opportunity for well over 50 years and has done a miserable job of it. Medicare has the lowest administrative cost of any program designed for a group. The VA has a medical record-keeping system that is to be envied.

    We do not have a health care system. We have sick care system. Our preventative health and treatment programs are abysmal. Our infant mortality rate is so low that we compare unfavorably to some third world countries. Yet, we have the highest cost per person in the world. If the private sector were able to do a better job, this would not be the case.

    We have a maldistribution of equipment and resources. In urban areas, we have more MRI machines that we possibly need; whereas, in rural areas, we have virtually none. Anywhere from 30 to 50% of our hospital beds are unoccupied.

    Medicare has approximately a 5% administrative cost; whereas, the private sector has somewhere between 15% and 18%. Do you believe the private sector will settle for a reduced administrative cost of 5%? Don't be silly. Those high salaries will become a thing of the past.

    All we need to do is take a look at Medicare part D. This boondoggle privatization of Medicare was foisted on us by the HMOs, pharmaceutical companies, private insurers, and the hospital industry in general. We taxpayers are looking at $1,000,000,000,000 to cover this cost over the next 10 years. Your government did not do this. Your profit over people, Republican Congress did this with the president's help.

    The vested interest is to hang on to this failed system because too many people are making money from it. I submit the true answer is in a government run, single-payer system. The people doing the work: doctors, nurses, technicians and all other support staff would be paid a living wage, while our costs both tax and private would decrease.

  • GT (unverified)
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    [Ranting deleted. -editor.]

  • gt (unverified)
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    [Ranting deleted. -editor.]

  • gt (unverified)
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    [Ranting deleted. -editor.]

  • Jim Klahr (unverified)
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    It is long over due that we have a decent health care policy
    in this country but I don't know if we can do it if the same elements insist on clinging on to the methods of determinations as to what is best for the patient. I have seen and heard the terms individual responsibility and evidence based, used frequently but rather than as terms of helpful actions for the ill they are veils used to hide the agendas of those who may not want to, due to costs, or their own personal opinions have them included.

    First personal responsibility has to reach not only to the patient to deal with their treatments in a way that positively reflects on their well being, it should also reflect on the individual agencies to not payout for personal interest reasons or lack of their own auditing processes outrageous prices for golden toilet seats.

    It should also be the personal responsibly for pharmaceutical companies to limit production of medicines to keep prices high.

    Evidence based, is also a poor gauge to use when it comes to a persons health and in particular well being, this should be given equal consideration when a patient and physician or alternative medical or medicine is being used.

    No AIDS patient or patient undergoing chemo needs a 15 year study to tell them that the non toxic herb cannabis increases their appetite or reduces nausia.

    If we want a new and better health care system in this state or country for that matter, it has to be based in the truth not money or politics. Intra grated and alternative medical and medicines need to stand side by side with the conventional as do the choices of the patients and practitioners.

    Jim Klahr - OGF Patients and Caregivers United

  • Larry (unverified)
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    I have enjoyed this constructive and informative debate. Health care reform is the most pressing economic issue for the competitiveness of our economy. Employer provided health care is slowly strangling our economy amd driving gt's job in IT onto broadband and overseas. Any discussion of health care reform must accept the fact that employer provided health care is going away or the job that provides it is.

    Any proposal for health care reform that doesn't address how we will pay for Medicare is just window dressing. That unfunded entitlement will eventually break our current system, the only question is when and how capable will our economy be in responding when it does.

    I believe SB 27 sets up the debate we need to have. SB 329 just postpones the real issues. SB 27 is horrible politics but it is about good governance. gt's rants about government keep us from having the discussions we need to have about what government should do and what it can do best.

    I confess to being one of those government bureaucrats that gt rants about. However, the lights are on and the Northwest survived ill-conceived reform in California's electricity market that assumed the private sector was best at everything. I would ask gt how much he thinks Portland would have had to pay in 1996 when the Willamette River reached the top of the floodwall if Enron had been running flood control on the Columbia River. The U.S. Corp of Engineers, the U.S Bureau of Reclamation, and the Bonneville Power Administration took six feet off that flood at a significant cost in lost power revenues. That was a governmental function that the private sector is ill-suited to provide.

    Defining the health care benefit that is socially insured by the largest insurance pool we have, government taxes, is the right governance question for health care. Our current government health care funding system is a patchwork system based on status and protected by powerful special interests. While this question would ideally be addressed at the federal level, should we sit and wring our hands in Oregon waitng for that to happen. How much will waiting cost us in lost jobs.

    SB 27 sets up a framework to describe a better governance system for health care. It holds out the promise of squeezing the costs of excess insurance overheads, malpractice costs, unnecessary emergency room costs, and the cost of operations in the last six months of life out of the social insurance pool funded by governement taxes. In place of those costs, we can provide a universal benefit for everyone that meets almost all their health care needs.

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