Oregon Better Health Act: An Update.

By Governor John Kitzhaber. (Editor's note: The following was sent by the former governor to supporters of his Archimedes Movement - and is republished here with permission.)

KitzwecandobetterI want to give you an update on SB 27 - the Oregon Better Health Act. As you may recall, at our rally in Salem on March 14, it was announced that an attempt would be made to merge the concepts of SB 27 with those in SB 329 - the legislative proposal which emerged from the Interim Senate Commission on Health Care Access and Affordability.

Although this was a sincere effort, undertaken in good faith, the resulting amendments to SB 329 - which were introduced Monday evening, April 9th, at the Senate Special Committee on Health Care Reform - do not reflect the work which was done by you through the Archimedes Movement. Although the amendments to SB 329 incorporate much of the preamble and principles developed by the Archimedes Movement, the body fails to reflect them.

For example, the preamble in SB 329 now states that:

"...we cannot control cost unless we reevaluate the structure of our 50 year old federal and financing and eligibility system in light of the realities and circumstances of the 21st century and of what we want the system to achieve from the standpoint of the health of our population."

Yet SB 329 itself has deleted all references to the Medicare program - leaving a process that excludes from consideration the very program on which an ever-increasing number of Americans depend, even as it leads our system toward fiscal collapse.

The preamble in SB 329 also states that:

"Oregon must take immediate action to develop, for consideration by the United States Congress, a proposed alternative to the way public dollars are currently being spent on health care in order to create a sustainable system that will optimize the health of Oregonians."

Yet in the body of the revised SB 329 the only interface with the federal government is to request waivers to "maximize federal matching funds" under the existing Medicaid and State Children's Health Insurance Programs.

This is not meant to be a criticism of SB 329. It is simply to point out that SB 329 and SB 27 have fundamentally different policy objectives. While on the surface there are some structural similarities between the two bills - both propose to establish a board, to create a fund in which to pool resources and to use the Oregon Health Services Commission to help develop a benefit - they seek to do different things.

SB 27 - The Oregon Better Health Act - seeks to establish a process through which Oregonians themselves can create a shared vision for a new health care system and to use that vision to both initiate an honest reevaluation of the underlying structure of the current system and to offer an alternative with which to replace it.

By contrast, SB 329 seeks to create a permanent board with sweeping administrative and regulatory authority over health policy in Oregon - including functions within the Oregon Health Policy Commission, the Health Services Commission, the Department of Human Resources, the Public Employees Benefit Board and the SAIF Corporation, to mention but a few. It also seeks to build on the current system to implement a "Heath Care Trust Fund Program" which would pool health care "contributions" - from private sector employers; from both private and public sector employees; and from individual health care premiums - to finance a package of essential health care services for all Oregonians under the age of 65 - leaving many segments of our current fractured financing and delivery system unexamined.

It is important to note that during the two public hearings on SB 27 - on March 12 and March 14 - nobody testified in opposition to SB 27. All the testimony was in support of the legislation with the exception of AARP, which stated its position as "neutral," and a disabilities advocate who asked for clarification about SB 27 and its impact on Oregon's community-based and long term care programs. Since then, however, AARP has raised some legitimate issues concerning how SB 27 was initially drafted - in particular, their argument that the bill seeks to take over the Medicare program at the state level.

Unfortunately, since the work on merging the two bills has not taken place openly before the committee, AARP raised their objections to SB 27 with individual legislators, with no open public forum in which they could be addressed. As a result, many senators expressed concerns about including anything dealing with Medicare in the merged bill. I was informed of this last Friday by Senators Westlund and Bates.

It is not surprising therefore, that the proposed amendments to SB 329 fail to reflect either the process or the objectives of SB 27. For that reason we have asked the committee to delete all references to the "Oregon Better Heath Act" in the merged bill.

We have always recognized that we cannot solve the growing crisis in our health care system at the state level - that there are issues involving portability and interstate commerce, issues involving people moving in and out of Oregon and companies operating in Oregon but headquartered elsewhere, to mention but a few. We do need a federal solution.

But to get that solution we must create a safe forum in which a thoughtful and rational discussion can take place in order to build consensus around a shared vision for a more equitable and sustainable health care system. This, in turn, can provide the basis for federal legislation and/or for state pilot programs to test various elements of the vision on the ground.

I have seen nothing to date to suggest that such a process can succeed in Washington, D.C. - at least in advance of the 2008 presidential election. The fact is that there is currently no federal legislation which seeks to address the long term financial stability of the Medicare program or to directly challenge the glaring problems with our delivery system. And that is precisely why we need the Oregon Better Health Act.

The kind of thoughtful process of engagement that we so desperately need can take place in Oregon where we still have the capacity to join as a community to discuss important questions which affect us all, even if they do not have clear-cut, easy answers. And indeed, that is the basic premise of the Oregon Better Health Act and of the Archimedes Movement itself.

Our intent has never been to reform Medicare at the state level; nor has it been to provide an Oregon-specific solution to either Medicare or to our crumbling system of employer-sponsored coverage. Nonetheless, as the AARP has fairly pointed out, one could draw that conclusion from the initial drafting of SB 27. As you know, the Archimedes Movement has always been willing to modify its legislative concept to address a variety of legitimate concerns raised by the wide range of people who have participated in the process.

We are willing to do so again to address those stated concerns of AARP which we feel have merit. We began meeting with a group of Medicare consumers in the middle of last year - a group which included representatives from Oregon's AARP - and we incorporated all of their recommendations into the first draft of SB 27. After hearing about the pressure being placed on legislators we pulled that group together again last week. We feel the set of amendments we are proposing for SB 27 reflect the concerns expressed to us last week by AARP Oregon's director, Jerry Cohen. We have drafted a set of amendments to SB 27 which leaves the bill that you helped to draft intact but clarifies that our intent is to offer a blueprint for national health care reform -- to initiate a design process, not an implementation process. You can download the amended version of SB 27 (PDF).

The amendments create an Oregon Better Health Design Board that will oversee the process of developing a plan to ensure that all Oregonians have access to treatment for a defined set of essential health conditions. The members of the board will serve concurrent terms which will expire on July 1, 2009, at which point the board itself will sunset as well.

The Oregon Better Health Design Board will develop a plan to implement the provisions of the Oregon Better Health Act for consideration by the United States Congress as the basis for national health care reform and submit it to the Governor for approval. The plan must include recommendations for the appointment of a permanent Oregon Better Health Board.

The Governor is required to present the plan as a legislative proposal to the Oregon Legislative Assembly and the legislative proposal must:

  1. Request that the Oregon Congressional delegation submit federal legislation which reflects the plan;
  2. Request federal authority to implement portions of the plan as pilot projects.

Today, SB 27 - the Oregon Better Health Act - is still sitting in the Senate Special Committee on Health Care Reform, where it was referred over a month ago. In light of the decision not to incorporate the central elements of this bill into SB 329, I have made a request to Senator Bates, Senator Westlund, and to Senate President Courtney for a work session on SB 27 for the purpose of adopting the amendments (download them here), conducting additional hearings and then moving the bill to the Ways and Means Committee.

We acknowledge the important work that has been led by Senators Bates, Westlund, and the Senate Special Committee on Health Care Reform. We appreciate their commitment to the health of all Oregonians. At the same time, we will continue to pursue the objectives and process embodied in SB 27, the Oregon Better Health Act - the only legislative proposal that will create an explicit link between our work here in Oregon and the pressing need for national health care reform.

During the public hearing on SB 27 held on March 14th Senator Frank Morse asked whether the Archimedes Movement was sustainable - saying how important the movement was to the success of the next phase of civic engagement - designing a new system. We told him that not only is it sustainable but membership continues to grow and that Archimedes members will be there giving input all along the way.

In this state we have a long tradition of leading the way; a tradition of going up any hill - no matter how steep, no matter how difficult the politics, if it is for the right cause. Surely the health of our people, the fiscal stability of our nation, and the future of our children is the right cause.

Thank you for your ongoing commitment.

John

P.S. You can download the proposed amendments to SB 27 here and download the proposed amendments to SB 329 here.

Comments

  • Marvin McConoughey (unverified)
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    SB 27 wishes to finance "a commitment to ensure all citizens have timely access to the effective treatment of essential health conditions..." How? Why, by tapping into the general fund, if and when money runs short. Dr. Kitzhaber's group has labored diligently to produce an elegantly worded script. I disbelieve its ultimate success. A basic problem is that humans desire more health care than they can afford, will resist attempts to impose rationing, as implied in the bill, and will quite possibly starve other essential social services as the elderly become an increasingly high percentage of the population and vote in great numbers. An added problem is that medical science is adept at creating ever more effective and costly medical interventions whose cost potential grows faster than do state and federal economies.

    I also do not agree that the solution to our health care challenges can be found at the federal government level. Having recently lost a Canadian friend who died after an extended wait for treatment despite living in a country whose medical system is much praised, I am skeptical that any government has a solution.

  • ellie (unverified)
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    Someone please help me with this.

    After reading all of that, here's what I get:

    1. The Feds have to approve Kitzhaber's plan (no, wait... "the work which was done by you through the Archimedes Movement"... "the bill that you helped to draft"... because it's all about public ownership, folks -- not ego /sarcasm) for it to go forward.

    2. At this point, the Feds will not be approving Kitzhaber's plan anytime soon.

    3. So we should just wait until they do. Forget about trying any local solutions...

    Can someone please draft Kitzhaber for Senate? Clearly, that's where his interests are. In the meantime, why don't we try addressing this in the best way we can? SB 329 seems like a reasonable attempt to do what we can with what we have.

  • Terry (unverified)
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    Senators Bates and Westlund have spun the progress of universal healthcare with, in part, this Happy Talk element of today's Email offering: "We have been working diligently to merge concepts from all of the health care reform proposals and have introduced the new improved version of Senate Bill 329, soon to be re-named the Healthy Oregon Act."

    Hillary Clinton did some merging of concepts in 1993. Concept-merging in healthcare invariably leads to ensuring enrichment for some and the status quo for others. Failure struck fear in the fibers of politicians ever since. Today, the politicians and bureaucrats subscribe to the marker set forth a hundred years ago by Upton Sinclair: "It is difficult to get a man to understand something when his salary (or political war chest) depends upon his not understanding it."

    Changing the paradigm may evolve only through the public funding of electoral political campaigns. Government need not own the brick and mortar of a healthcare system. The funding and rigorous oversight of it would be quite sufficient.

    Now we are left with: "... too many times, after the election is over, and the confetti is swept away, all those promises fade from memory, and the lobbyists and the special interests move in, and people turn away, disappointed as before, left to struggle on their own." --- Senator Barack Obama, 2/10/07

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    Dr. Kitzhaber's posting was originally a message e-mailed to participants in the Archimedes movement -- I got one. As such it presupposes some knowledge of that movement, its goals and self-imposed limits, knowledge evidently not held by commenters so far.

    Despite Ellie's apparent cycnicism, the grassroots of the movement, which exist both on the net and in face-to-face chapters in all geographic regions of Oregon, have had a substantial role in shaping what has become SB 27. That input had two phases. First there was debate, comment and criticism on an initial "legislative concept" and set of related principles drafted by Dr. Kitzhaber & other initiators of the movement. That process changed some of the initially proposed principles (e.g. adding a "personal responsibility" principle which I personally opposed, as did many in my Portland chapter, but was important to some others there and evidently to many others in other places) and led to efforts to address other concerns raised. Then there has been further discussion of drafts of what eventually became the bill, with further changes to it. Also, as Dr. Kitzhaber indicates with respect to the Medicare recipient constituency, the organization solicited comments, criticisms and suggestions in a more targetted way from various constituencies. Clearly that process of openness to change is continuing.

    I'm not entirely easy with some aspects of Archimedes/We Can Do Better -- the internal structure is potentially undemocratic and weighted toward business, insurance and medical industry interests, due to who is co-opted into an unelected Council. But the practice so far has in fact involved a great deal of participatory direct democracy, and I believed served one of the movements key goals, which is to bring together a wide range of people interested and concerned about health reform, engage them in a process of self-education and deliberation, and widen attention and discussion of the issue among the people.

    Dr. Kitzhaber has used credibility he has from his history as a state senator & developer of the Oregon Health Plan, as a former governor, and as a doctor to exercise leadership, and bring people together at the table. Leadership always involves an element of ego, but Dr. K's has been well under control and certainly is no greater than Senator Westlund's or Senator Wyden's in their respective efforts. Dr. Kitzhaber has been open to modifying his initial ideas and has acted in a collaborative manner and engaged substantially with a wide variety of people.

    As for the general fund, in fact SB 329 is more likely to need to turn to it than SB 27 would be. That is because the two bills take fundamentally different approaches and to a certain extent have different aims.

    What the commenters so far apparently do not understand is that the aim of SB 27 is take all current public resources spent healthcare provision and recombine them in an entirely different way to provide a floor of basic services to everyone based on a number of core principles including first of all effectiveness, and also efficiency (in both cost and health-outcomes), personal responsibility, and orientation to prevention, earlier intervention, and health promotion and maintenance, i.e. public health principles and not just coverage for treatment. Also this floor of services would be provided on a basis analogous to public schools, in the sense of not being insuranced purchased by individuals. Within its self-defined limits of reorganizing current public spending, in fact SB 27 aims to be revenue neutral, just to use extant public spending better. I.e. not to go to the general fund.

    In order to combine these public resources (defined as Medicaid, Medicare and the tax subsidies to employer-based systems) a federal waiver of rules would be needed. There is nothing particularly unusual about that -- the Oregon Health Plan required such a waiver, and got it under the first Bush administration I believe, I am reasonably sure that the (odious) Massachusetts forced lemon insurance plan of Mitt Romney required one, many of the experiments with "welfare reform" in various states required such waivers.

    I have not looked into the matter, but I would not be surprised to learn that HB 329 also would require federal waivers, and actually would be a little surprised if it didn't. To the extent that it doesn't, most additional coverage it provides/mandates will have to be paid for with new revenues, since it wouldn't be changing much.

    Quite clearly it is a rationing system. It does not propose to cover everything, nor does it propose itself as the answer to deeper crises of the health system. It merely proposes that if we are going to spend public money on healtcare, we should do so in a more rational and equitable way than at present to provide certain central basics to all. The current system is also a rationing, which inequitably and inefficiently rations by price, in an unfree and distorted market that uses the market system of rationing -- excluding persons from the market. That market will become even less free under SB 329 or any other coerced insurance model.

    One can argue about SB 27's approach -- I am not sure about the prospects of tapping the tax subsidies either from a procedural or political point of view, and as has been anticipated from the beginning & Dr. Kitzhaber's message shows, Medicare would have to be handled carefully and poses special challenges to make sure elders are protected. Yet a further aspect of SB 27 is that the ultimate shape of a program emerging from it is not actually defined -- a key element is providing for a body to implement the principles and analyze what can be provided and what priorities should be under the principles in using public healthcare and health promotion and maintenance monies.

    So Ellie's observation that SB 27 is not going to produce anything immediately is quite right. It's not intended to. Which is exactly what Dr. Kitzhaber wrote and also why he writes that keeping SB 27 separate does not mean opposing SB 329 (or any other more immediate approach based on patching the current system). The two are not in principle alternatives. They could be related to one another as phases -- SB 329 or something like it to try to meet current unmet needs and solve certain problems emerging for businesses quickly, SB 27 or something like it to look at longer term revisions of public spending to get more effective healthcare and promotion out of public monies.

    My understanding of Dr. Kitzhaber's expression of disappointment is exactly that the "merger" did not build the longer term substance of the intent of SB 27 into the "merged" bill. Apparently it only incorporated some of the good sounding boilerplate about goals that emerged from the Archimedes process, without the approach to implementing them.

    As for SB 329, I haven't yet had a chance to look at it closely. But my understanding is that it is close in concept to the draft recommendations to the governor recently produced by the Health Policy Commission, which at its heart relies on coerced insurance purchase. The insurance supposedly is going to be affordable, either by having high enough income or by having low and moderate income subsidies. In Massachusetts already it is clear that "affordability" means lemon policies with enormous deductibles relative to low or moderate incomes, and many exclusions. If Oregon mandates different minimum standards for policies, the premiums will go up, as will the subsidies paid by the state. The latter money will either come from new payroll taxes or from the general fund. Other costs are unlikely to change much, as SB 329 doesn't change many elements or sources of inefficiency in the current system.

    A final word on a universal national government funded system, which is what I favor as soon as possible. Waiting periods depend in part on levels of funding. They don't exist in the same way in France or Germany as in the U.K. for instance. In Canada my understanding is that they vary with procedures, again tied to funding and spending choices.

    While I am genuinely sorry to learn of Marvin M.'s friend's death, it does not in itself constitute a good argument against a Canadian-style system (or French or other variant). Our system is also characterized by long waiting periods. It has much longer waiting periods for many individuals -- they wait and wait and can't see doctors even to learn that they might need a procedure, because they aren't insured. Others wait or never get procedures because of exclusions in policies even though they are nominally "covered."

    (Evidently the U.S. system also failed Marvin's friend, since he or she apparently didn't have the money to come here and pay for what was needed, and didn't have insurance that would pay, making the friend a great deal like many Americans. Perhaps if Canada had a U.S. style system, the friend would have had private insurance, and perhaps the procedure whould have been covered -- but there's no guarantee of either. Which is the point, isn't it. Marvin, I apologize for making a debating point out of this death, but its power when you so used it requires a response.)

    The next point doesn't help with individual cases where the Canadian system fails someone. But in terms of premature, preventable deaths due to failures of the system to provide needed care in a timely fashion, I am sure the prevalence of such deaths in the U.S. is much higher in the U.S. than in Canada.

    To point out that the Canadian system isn't perfect is a red herring -- perfection isn't the proper standard of comparison. The U.S. system isn't perfect either. The questions are, which is more imperfect, and how do the systems compare to each other in what they provide and don't.

    From a population health perspective in health outcomes, Canada's system is clearly superior. A similar U.S. system would be even better if we devoted the same larger proportion of GDP to it than we pay for our grossly imperfect system, or even if we lowered to overall spending by half the difference between their %GDP spent on health and ours.

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    When I wrote "quite clearly it is a rationing system" I meant SB 27. CL

  • Chris Greiveldinger (unverified)
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    I agree with much of what Chris Lowe wrote. The Oregon Better Health Act, as written by the Archimedes Movement, is geared at reforming the system and encouraging that reform to get pushed up to the national level. SB 329 does not seem to have that objective, which is why I'm more enthusiastic about SB 27.

    I have to admit that I'm torn. When it was announced that the bills would be merged I thought that was a great sign, but the result of the merger didn't meet my expectations. And now we are left with two separate bills that are similar enough to cause some confusion, and possibly resistance to pursuing both of them.

    On one hand there's the legislation that I'd really like to see passed (SB 27) and on the other there's the legislation that's pretty good and (at this time) seems to have a better chance of getting passed (SB 329). Governor Kitzhaber has demonstrated a willingness to modify SB 27 during the drafting of the legislation and with the newly proposed amendments, and I'm sure that this flexibility will only help its chances of getting passed. I hope that both bills will make it through committee so that a larger conversation can be had.

  • Terry (unverified)
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    Chris, please give yourself a break: You reflect," ...and I believed served one of the movements key goals, which is to bring together a wide range of people interested and concerned about health reform, engage them in a process of self-education and deliberation, and widen attention and discussion of the issue among the people."

    This is one of the movement's key goals ... to bring together those whose wealth and power are contingent upon co-opting healthcare reform of a substantive nature? Those folks don't need self-education, deliberation and discussion forums. They have all of the cameraderie, contact networks, lobbying hired guns, 'consumer-driven' healthcare 3-ring circuses, and other instruments for manipulating public opinion they can buy and then some.

    We don't include Al-Qaeda in discussions on national security and terrorism. To my knowledge, the Portland Police Bureau doesn't have on-going dialogue with the prison population to discuss crime-fighting techniques. Most people don't include realtors in family decisions about which home to buy. The sales manager of most auto dealerships isn't a decision-maker for enlightened and informed customers. Unfortunately, Congress has been known to allow special interests to write and dilute the legislation intended to regulate them.

    The Titanic was designed and constructed by professionals. Democracy requires that amateurs selectively utilize professionals, learn from them, benefit from them, and that the latter invariably work for them in the public interest. It is not rocket science to detect the difference between behavior consistent with the public interest and greed.

  • Tia (unverified)
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    The elegence of the original SB 27 (and its new amendments) is that it puts Oregonians in power of their own health care, as well as directly questioning the rest of the nation abou theirs.

    It is simple and straightforward - even though, after its passage, the questions to be addressed about "how" will require many minds and innovative solutions. The current federal system, including the priviledged place of businesses in medicine (whose only incentive is profit, regardless of any purported "we care about you" labels), is not interested in providing care to the vast majority of citizens. This is unarguable.

    Perhaps the true argument here returns us to state's rights. Does the Oregon government have the ability and confidence to request that it distribute funds to its citizens, pulling us out of the failing federal health care funding loop? It sounds risky; as though the individuals who currently receive benefits may lose them. But fear will not get us closer to caring for our loved ones. The money will still be in our hands - and will still go to those who need it. I am disappointed the AARP did not directly bring up their concerns earlier.

    Our representative federal government continues to act outside of the wishes of its citizenry. We are about to hit crises mode where Medicare funds, especially under the current structured federal distribution system, will be inadequate to serve the aging.

    The merged new bill is inadequate and yet another method of working with the failing pre-existing system.

  • Miles (unverified)
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    Wow, Chris, over 1,700 words, with hardly a typo. If anyone gets down this far, here are my thoughts about Archimedes and health care reform in Oregon and nationally:

    • There is a difference between what we should do, academically, and what we can do, politically.
    • Archimedes strives for what we should do. That's useful, but probably not achievable.
    • Bates and Westlund and the Oregon Health Policy Commission are pushing for what we can do. Their reform plans may be achievable (still a heavy lift), but won't solve every problem.
    • The question we have to answer is whether it's better to spend time and resources on an unachievable ideal, or an achievable compromise. They aren't mutually exclusive, but people only have limited time and resources.

    Politically, here's the problem with Kitzhaber's approach. Although he often mentions the 16% of Oregonians who lack health insurance, he does not talk about the 84% who have it. That includes everyone over 65 who has Medicare. Any effort to reform the health care system that takes away from the 84% is bound to fail. Any reform that keeps those benefits in place is going to require additional taxes to cover the remaining 16%. Any plan that "redistributes" public resources (and private resources through the tax code) will take away from a large portion of that 84%. Unless they see the benefit, it's DOA.

    In order to combine these public resources (defined as Medicaid, Medicare and the tax subsidies to employer-based systems) a federal waiver of rules would be needed.

    It's more than just a federal waiver of rules. Kitzhaber knows that, but he glosses over it. His plan requires an act of Congress -- a new law amending the Social Security Act to divert Medicare payments to the State of Oregon -- signed by the President. It probably also requires an amendment exempting Oregon from ERISA. Not only will this be opposed by most Republicans as a big government solution, but it will be opposed by most Democrats who have spent their careers protecting Medicare from being dismantled. The Oregon Health Plan required a waiver of Medicaid rules -- authority that was already in the Medicaid statute and had already been used by other states. Politically, this is a much different ballgame.

    I applaud Kitzhaber's push for the ideal. The danger, however, is that we spend 5-10 years and millions of people hours striving for it, only to find ourselves back where we started. Bate and Westlund and the OHPC have good ideas that will help mitigate Oregon's uninsured. Don't let the perfect be the enemy of the good.

  • James (unverified)
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    So, we who have decent healthcare are forced risk what we have sacrficed and worked hard for in order for Kitzhaber to run his experiment. Oregon is not an island and we need national healthcare to make any plan work, until then don't put my benefit at risk with SB329 or SB27! I beleive I speak for many workers in Oregon who have sacrificed to get decent healthcare as part of our benefits at our jobs.

  • Rick Ray (unverified)
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    To support measure 27, please ask your Oregon state senator to support a hearing and work session on SB 27 (The Oregon Better Health Act), so that amendments can be moved and the bill can be sent on to Ways and Means. Visit our web page where you can quickly send a message to your senator using our web form. » Take Action Now

    For bonus points you can call your senator, too.

  • Ginny (unverified)
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    James, You may be one of the lucky people who gets healthcare through your job. As a self-employed person, I have to attempt to cover my own health care with insurance. Not only is it frighteningly difficult to get health coverage for a family of three (god-forbid that someone has asthma or ADD in your family), but it's fairly expensive. I hope for your sake that:

    1. Your employee-sponsored coverage does not erode or get canceled completely, and
    2. That you don't get laid off or lose your benefits because you lose your job for some other reason beyond your control.

    It's a much more severe problem than people realize. Once you don't have employee-sponsored coverage, it can be a bit frightening. To accomplish what Kitzhaber is trying to accomplish is a long and arduous undertaking. That said, he does have a plan, and through hard work, it's possible to see the health reform this country so desperately needs. I'd rather be doing something that appears to be headed in the right direction than wait and cross my fingers at the expense of my young child's future.

  • Ginny (unverified)
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    BTW, hope my post didn't come off as too confrontational. I have just experienced such frustrations with our current healthcare system, that I sometimes get a bit preachy :-) I'm sure we all want the same thing... to be secure in the knowledge that if we get sick, or someone in our family gets sick, we can access the healthcare we/they need.

  • Alison Bahr MD (unverified)
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    I wish to thank CL for his very thorough and articulate review of the intent of the Archimedes Movement and SB27. We appreciate that SB27 would require an act of Congress to be implemented and are aware of the barrier this represents. But to require Congress to examine the principles of the bill already would be an enormous achievement that is central to the goals of the Archimedes Movement, and it also would be an enormous demonstration of power of grassroots work.

    It is also true that equity in healthcare will require fundamental change in Americans' deep-held expectations of medicine as well as intellecutal honesty about the two-tiered system we already support and personal responsibility for their own health. These are changes long overdue. Is this possible? Today I was putting my time at the gym--one of the ways of being personally responsible-- and I had the opportunity to observe a blind woman with her guide dog exercising. It was so inspiring, and, I thought, one of those great moments of our culture that honors self-determination. As a culture, we have tremendous energy and creativity, and where we have supported a common goal, such as a basic level of education for everyone, we have done very well. How hard can it be to develop such a goal in healthcare? SB27 is about process a much as it is about ends. The Archimedes Movement is sustainable, and equity in healthcare is attainable. We may need to compromise some of the end goals, but requiring a hearing and work session on SB27 without question is a way of NOT compromising the discussion.

    As for those who have sacrificed for benefits as part of their job . . . I see many patients every day who do not have insurance, and they fully employed, but do not have employers willing to provide insurance. It is not that these people don't sacrifice, they simply don't have options available to them at the jobs they do have. The two-tiered is already firmly in place. We just don't like to talk about it.

  • Nancy MacDonald (unverified)
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    As someone who is self-employed and a lifelong Democrat I applaud the Archimedes Movement but partly because I've had the chance to listen to Governor Kitzhaber speak about his objectives in person and in detail. This is not an idea that can be captured in a sound bite but the hardest issues aren't prone to quick quips.

    I was frustrated after elections in November 2004, and encouraged in November 2006. We have an eloquent, intelligent former governor and physician who doesn't want to pretend that he has an answer that will work for seniors, people with disabilities, employers, employees who have good coverage, employees who have mediocre coverage, and people like me who pay for insurance out of my own pocket. He's proposing that we all get a say in what the future looks like. Shouldn't that be something we applaud instead of criticize. He's saying that decisions about what is on or off the table should be debated in public. (Doesn't Oregon still have an open meetings law on the books?)

    Archimedes gives us a chance to play a role in determining our own fate - when's the last time we got to do that?

  • BlueNote (unverified)
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    Does SB27 propose to take money (and therefore coverage) from existing Medicare programs and reallocate that money (coverage) to those who are not eligible for Medicare?

    That is a terrible idea and an idea that AARP will smash like a bug on a Freightliner windshield. A lot of progressives fought for 30+ years to obtain government paid medical coverage for seniors. The current health care disaster should not be addressed by taking away from a very successful program. If anything, more people should be added to the existing Medicare program, using it as a framework for an eventual single-payer system.

  • William Ware (unverified)
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    As an ardent supporter of Single Payer national health care and an ally of the Archimedes movement, I found Gov/Dod's statement a bit disapoointing. I give him that he is dealing with "political realities"- to wit, the cigarette and insurance lobby's have now gotten their noses so far under the tent they are threatening to knock it over entirely. But this may well be the fault of not being straight forward and enlisting Oregonian's pride, imagination and common sense in the inevitable struggle of single payer health care whicle we can still be the nation's cutting edge.

    The following quote from above troubles me the most:

    "Our intent has never been to reform Medicare at the state level; nor has it been to provide an Oregon-specific solution to either Medicare or to our crumbling system of employer-sponsored coverage. Nonetheless, as the AARP has fairly pointed out, one could draw that conclusion from the initial drafting of SB 27. As you know, the Archimedes Movement has always been willing to modify its legislative concept to address a variety of legitimate concerns raised by the wide range of people who have participated in the process."

    I call upon Gov/Doc Kitzhaber to clarify his remarks to demonstrate that he is not actually selling out the main, brilliant thrust of his proposal, which is to pool all available healcare funds and begin to fashion a universal delivery system. Anything that does not specify this will appear to be selling out to the ususal suspects.

  • Miles (unverified)
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    Does SB27 propose to take money (and therefore coverage) from existing Medicare programs and reallocate that money (coverage) to those who are not eligible for Medicare?

    Bingo, as well as redistributing money from Medicaid and SCHIP and the tax system. Unlike BlueNote I don't think this is a terrible idea, but I do think it's politically impossible.

    We appreciate that SB27 would require an act of Congress to be implemented and are aware of the barrier this represents.

    With all due respect, I don't think you do appreciate the magnitude of this task. Exactly what constituency do you think is going to support the block-granting of Medicare and other federal health programs? Those who won't support it include Democrats, Republicans, the elderly, doctors, hospitals, and disability advocates.

    I usually argue for policy over politics, for substance over partisanship. But sometimes, you have to be honest about what you can achieve. My problem with Kitz and Archimedes is that he is promising more than he can deliver. In the meantime, he's going to suck up money and time from well-meaning people who could otherwise be helping to achieve the attainable. He currently has progressive groups all over the state spending time in meetings, talking abstractly about "health care reform" and hoping for the day when our dysfunctional system is overhauled. Meanwhile, incremental reforms like Healthy Kids are languishing in our legislature. More substantive reforms are even further away from reality.

    There are things Oregon can do, this session, to improve the lives of thousands of uninsured people and improve the state's health care system. These things do not require Congress renegotiating a 40-year old commitment to provide health care to the elderly. They simply require some grassroots lobbying to show your support.

  • BlueNote (unverified)
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    I am way too young for retirement, but anybody who proposes to diminish Medicare needs to consider the consequences on the elderly and on their children, grandchildren, etc. Medicare pays medical bills for my parents, inlaws, etc., so that they have coverage and so that I don't have to pay. Just like Social Security gives our elders money so that, in most cases, you and I don't have to mail them a check each month to buy groceries or pay the rent.

    I am sure there are a few folks out there who can't or won't support their parents or grandparents, but for the rest of us, Medicare and Social Security take a huge burden off of our shoulders. Would you want to explain to your mother that she can't have heart valve surgery because she can't afford it and you promised your spouse a vacation in Aruba? Do you want to explain to your son that his college money went to buy a new hip for Grandpa?

    Not me. Leave Medicare alone!

  • Kade (unverified)
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    BlueNote, the idea of Medicare is a great one. We definitely should be helping the elderly with their healthcare and providing both access and funding. The problem is that Medicare simply will not be able to cover the medical bills for the aging baby boom generation without imposing an incredible burden on everyone else. We need to act now to restructure our health care system and ensure coverage for everyone, seniors included. SB27 is the best movement toward this goal that I've ever seen.

  • Robert G. Gourley (unverified)
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    The Archimedes Movement has always meant a chance to take a fresh look at our health care system to design something better. For this to work, everything has to be on the table. Comments like, Unlike a socialized health care system, the legislation calls for “public and private health care partnerships that integrate public involvement and oversight, consumer choice and competition within the private market.” do not indicate a willingness to leave all on the table, plus may have been made by someone who has an Oregon drivers license - indicating no problem with using our socialized road system.

    So, if in the final analysis a hearing and work session on Senate Bill 27 is not granted, then the focus should be on including in the final bill only those elements based upon broad agreement. Positions like the one quoted above clearly do not qualify. Such might be in the health care system finally implemented - Medicare, for example, is a very important element to consider and is clearly "socialized" - so getting rid of Medicare should be carefully considered before doing. The AARP for example, is opposed to the dismantling of Medicare.

    Clearly we are at a stage in the process where confusion reigns. Oregon AFL-CIO President Tom Chamberlain states that SB 329 "puts all of the elements of our dysfunctional health care system on the table" on the same day that Senators Bates and Westlund announce "we chose to leave Medicare out of the bill" - illustrating the piecemeal approach to health care reform taken by Senate Bill 329.

    I do not believe we will get to a better health care system by taking a piecemeal approach - only a comprehensive approach will succeed. Lawmakers are already complaining about the time left to enact health care reform legislation. That's why the smartest thing to do is take a bare bones approach - enact only what's strongly agreed and necessary to carry on the design phase. That's a formula for success.

  • Bulah Jo McCallaster (unverified)
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    << * There is a difference between what we should do, academically, and what we can do, politically. Archimedes strives for what we should do. That's useful, but probably not achievable. Bates and Westlund and the Oregon Health Policy Commission are pushing for what we can do. Their reform plans may be achievable (still a heavy lift), but won't solve every problem. The question we have to answer is whether it's better to spend time and resources on an unachievable ideal, or an achievable compromise. They aren't mutually exclusive, but people only have limited time and resources>>

    To be clear with respect to Miles earlier quote, AARP made the frame/perception that SB 27 was not possible by lying in public that they were "neutral" on the bill while behind closed doors they made threats to our democratic senate leadership that anyone who voted for the Medicare waiver "risked losing their seat and that AARP was prepared to take out TV, dirct mail..." etc to derail the opportunity for Oregonians to have a discussion about what our health care system could look like.

    SB 27 was and still is possible, if it wasn't possible, then why would Bates & Westlund take advantage of the AM movement with the BOTH of them riding Kitzhaber's coat tails at the March 14th press conference saying they were going to merge the bills? Why would Bates & Westlund's staff make phone calls not only to AM members but to other groups and organizations that also supported SB27/The Medicare Wavier to do turnout for their "Road Tour?" Now, Bates & Westlund are saying they won't even give SB 27 a hearing and a work session? Looks like we know who rules the roost on health care this session, AARP.

    The ONLY player who opposes Oregonians from having a conversation about Medicare is AARP. Gee. Golly. Could it be that AARP is wrapping themselves in a message that they are a "voice for seniors" while in actually they are a "vendor for seniors?" Remember people, AARP sells a lot of insurance and should SB 27 be successful, they stand to lose a lot of business in the supplemental part of their little business.

    More problematic though, I find it interesting that while different groups and individuals were meeting for the last year and a half throughout the state, AARP was always at the table and NEVER once voiced a concern re: Medicare. When their concerns were finally able to make it to the top, every one of those concerns were addressed with different versions of the bill. First, they didn't want Medicare to be different from state to state, the way Medicaid currently is. Then they didn't want a state agency to be managing federal Medicare money. Then they didn't want this, then they didn't want that.

    Bottom line: AARP is a big lobby out of Washington, D.C. They didn't endorse democrats or help elect a pro-health care legislature. They didn't give money to pro-health care candidates, they didn't knock doors, they didn't phone bank. (Not that they could as they are a c-3 organization, well, supposedly a c-3 but with that kind of bulling, who cares.) Nor do they represent all Oregon seniors and people with disabilities. To "join" AARP, all you have to do is turn 50 and you get a card. Big deal.

    But that's okay. A top-down lobby group with no roots in Oregon, hey-AARP, they know what's best for us, right? No discussion for us on what our health system could look like because AARP "said so." Ya gotta love it.

  • Miles (unverified)
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    The ONLY player who opposes Oregonians from having a conversation about Medicare is AARP. Remember people, AARP sells a lot of insurance and should SB 27 be successful, they stand to lose a lot of business in the supplemental part of their little business.

    First, I don't think it's an effective strategy to impugn the motives of AARP. Yes, they sell Medigap insurance, but they are primarily a lobbying organization for the elderly. As such, it is their responsibility to protect Social Security and Medicare from attack -- either from the right (Bush's Soc. Security privatization scheme) and the left (Kitzhaber's redirection of Medicare dollars to the uninsured). That doesn't mean what AARP wants is what's best for society, but they fulfill a legitimate role protecting successful government programs.

    Second, you and other supporters of Archimedes keep using this euphemism of a "conversation" about our health care system. Let's cut the crap: What Kitzhaber is proposing is to pool all state, federal, and private health care resources and redistribute them more equitably. As I've said before, he's probably right, academically, but what that means is that those who have the resources now (the elderly who get Medicare, union members who bargain for good benefit packages, and anyone with a solid employer-sponsored health care benefit) will give some up in order to provide health care to the uninsured and underinsured. This is not about having a "conversation", it is about redistributing wealth. Like all good lefties, I support that idea in theory. But I'm also a pragmatist who doesn't want to waste time fighting a fight that cannot be won.

    The problem is that Medicare simply will not be able to cover the medical bills for the aging baby boom generation without imposing an incredible burden on everyone else. We need to act now to restructure our health care system and ensure coverage for everyone, seniors included. SB27 is the best movement toward this goal that I've ever seen.

    Beware those who advocate killing a successful program in order to save it. Republicans have been trying this tactic for years with Medicare and Social Security, and we have beaten them back every time. Now the left is doing the same thing? I agree that Medicare needs to be reformed, but what irritates me is the duplicity involved in the above statement. To make sure Medicare survives the baby boomers, we need to cut Medicare benefits. Or dramatically raise taxes. There are no other solutions, and to pretend otherwise is to mislead the public.

  • Lynn Porter (unverified)
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    To make sure Medicare survives the baby boomers, we need to cut Medicare benefits. Or dramatically raise taxes. There are no other solutions, and to pretend otherwise is to mislead the public.

    Actually there is another option: we could redistribute federal money away from the Iraq war, the so-called Defense dept. budget and tax cuts for the rich to Social Security and Medicare, until the Baby Boom has passed.

    When I was in college back in the 1960s I read that the Baby Boom would pass through society "like a pig through a python." All along the way the U.S. has had to redirect public resources, first into housing for all those young families, then to public education, then colleges, and now to Social Security and medical care. This too shall pass, but meanwhile we need to take care of people.

    I agree with AARP, of which I'm a member, that we shouldn't let the Oregon state legislature get their hands on Medicare funds. After all, over the last few years we watched them do their best to destroy the Oregon Health Plan (Medicaid).

    I do believe that SB 27 should get a committee hearing. It seems the Archimedes activists are due at least that.

    I also agree with a previous comment that Kitzhaber should put his healthcare reform energy into running for the Senate. He obviously wants to work on a national stage. Of course, as he once said about the Senate, it moves at glacial speed. Although with global warming....

  • Robert G. Gourley (unverified)
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    YEAH!!!

    http://wecandobetter.org/node/892

    Update on SB 27: work session scheduled for April 30th

    Thanks to the hard work of our supporters, The Senate Special Committee on Health Care Reform has scheduled a work session for our Oregon Better Health Act. It will be at 5 PM on April 30th. (See event details below).

    The goal of the work session is to adopt ammendments to SB 27 and move the bill to the Joint Ways & Means Committee for budget consideration.

    Nearly 300 Archimedes Movement members sent an email to their state senator using the web form on this site. Many other members called, sent letters, or sent emails on their own.

    We also got help from Onward Oregon. 740 of their members sent an email message.

    Below is a list of Oregon senators, followed by the number of emails sent to him or her. Senate leaders Kate Brown and Peter Courtney were copied on many of the emails, so their numbers are higher than just their in-district constituents. Gov. Kulongoski was also copied on many of the emails.

    Atkinson 28 Avakian 64 Bates 41 Beyer 20 Brown 900 Burdick 66 Carter 80 Courtney 811 Deckert 43 Devlin 63 Ferrioli 10 George, G 24 George, L 15 Gordly 71 Johnson 28 Kruse 10 Kulongoski 765 Metsger 32 Monnes Anderson 8 Monroe 12 Morrisette 44 Morse 58 Nelson 4 Prozanski 54 Schrader 23 Starr 18 Verger 34 Walker 35 Westlund 12 Whitsett 5 Winters 30

    Event Details:

    Date: April 30, 2007 Time: 5:00 P.M. Room: HR 50

    Work Session

    SB 27

    Creates Oregon Health Fund to pool state and federal expenditures for health care in Oregon and to finance treatment of defined set of essential health conditions for all Oregonians.

  • tj (unverified)
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    ..

    Archimedes advocates and Kitzhaber don’t understand Oregonians only pay 1% of the administrative burden (money flow, benefits, compliance, conflicts, litigation, etc.) to support federal Medicare. Were Oregon to displace federal administration, an immediate reduction in benefits would ripen in the need to duplicate in whole, what Oregon now is obliged to support, only in part.

    Changing Medicare also changes tax issues that Oregon agencies presently do not have to deal with, but that employers all over the world have to deal with.

    Changing Medicare also changes millions of insurance contracts.

    Reform exists in the infinite (permutations and combinations) possibilities of starting from scratch, or in the good sense of engaging and correcting a finite number of past OHP bungles. It is wildly dangerous to dive into policy and operations changes that can and have produced morbidity due to mismanagement, with no professional or competent plan or assurance that no harm will emerge. What John Kitzhaber seeks in a political crap shoot with real people’s lives absent economic good sense.

    OHP operatives and their interest groups are fractured and dissociated. There is no system and no track record that offers public assurance. Reform should be demonstrated in one Oregon county under guidance of a skilled manager with program policy and distribution experience in Oregon. It’s less risky and therefore less costly.

    The Oregon Health Plan is an on-again-off-again management failure. It needs to be dissolved, including poorly organized vendor and self serving interests that mismanaged it. The most outspoken supporters have no evident economic or management credentials and none appear to have experience distributing and administering statewide programs in Oregon. Wild and totally unsupported criticism of federal policies by folks with no management training or understanding of program distribution is a thinly veiled attempt to raid the “Medicare cookie jar”. Medicare did not create the economic problems with health care and Medicare resources are not the proper source of funds to craft a recovery. The Kitzhaber plan hopes to dissolve Medicare (SB 27 Section 2 (5) a) and morbidly burden the most active political base in Oregon.

    To be sure, uninsured and some illegal claimants burden American health care. It is partly a federal problem. Though Oregon could disparage illegal labor in moments, if it should be politically expedient and the Governor should regard the health security of Oregonians with seriousness. One solution is to bill the country of origin for the cost of health care on behalf of illegal travelers, or the last American employer of record, if any. Federal immigration policy might be suspended until amounts owed are paid.

    Massachusetts found that 20% of uninsured claimants could not be included in their attempt at a universal health plan. Advocates of SB 27 condition success on 100% participation that will never happen.

    Unfortunately Massachusetts recently adopted a large policy board, burdened with conflicts of interest (as had been the history in Oregon). It fired contributors, because they would not support commercial distribution of commercial products by vendors. The Board will almost certainly fail. Oregon will have the same problem with too large a board and too much political and self serving interest. Oregon’s Board should be three well administratively qualified persons with no conflict of interest.

    The Kitzhaber plan is a sickness system, that engages illness at the most expensive and least hopeful opportunity and hopes to disengage employers, who have a bottom line, pecuniary interest in the wellness of employes. Work sites, agencies and schools offer the best opportunity to deploy wellness services. The Kitzhaber plan will continue and engage more private disinvestment in health care, with is the dumbest accomplishment of OHP.

    The Kitzhaber plan makes individual claimants more vulnerable to arbitrary actions of large insurance companies, whereas group organized insurance plans empower individuals with valid disputes.

    The Kitzhaber plan seeks political guidance by vendors and professionals with a clear conflict of interest and attempts to play allocation (deprivation) games based on the politics of age. Recent referendum history with M 35, resistance to disclose and prevent clinical accidents, obscene (non medical) spending by clinics, hospitals and institutions clearly show conflict of interest. These are the same people from whom Kitzhaber would seek policy guidance while continuing to ignore exploitation of public money.

    The Kitzhaber plan promotes a (constitutionally) arbitrary rationing (deprivation) plan that does not reflect demonstrable public priority, as would not be the case in a public risk prioritized plan. The public have constitutional interest in risk and not in “overall benefit”, which is constitutionally vague (read Springfield v Board of Education).

    The history of the OHP Kitzhaber plan includes arbitrary curtailment of treatment after initiation of remediation, contrary to assurances to the federal government (a fraud).

    The Kitzhaber plan uses economic tools to annoy and misdirect clinicians. Clinicians are not economists or bookkeepers. Clinicians know how to work with risk.

    The Kitzhaber plan does not acknowledge that cost restraint can only be achieved by gaining remission of risk. The most direct remission of risk produces the least cost.

    ..

  • Robert G. Gourley (unverified)
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    For some reason whenever I try to post my last response, which includes links to several interesting things about AAPR, I get this error.

  • Robert G. Gourley (unverified)
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    Concerns raised by AARP are really a misunderstanding of the process proposed by Senate Bill 27. Recently offered amendments to SB 27 may help ease this misunderstanding. AARP's recently announced business plans may also have something to do with this. Paul Krugman wrote of the plot against Medicare: the stealth privatization embedded in the Medicare Modernization Act in an editorial available only to TimesSelect subscribers. This cannot help but increase fears about threats to Medicare's future.

  • Robert G. Gourley (unverified)
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    Finally we have a work session for Senate Bill 27 - Monday, April 30th, 5pm, meeting room HR 50 at the Capitol. We seem to have solid agreement on the existence of three parts of a new health care system. A list of covered essential health conditions, or "core benefits", for which we've already a start on at the Oregon Health Services Commission site. We have an Oregon Health Fund into which public and private monies will be put to pay for these core benefits. And finally we have a board, which might have two natures. One would be during the design phase where board membership would be different than in the final stage, the administration phase.

  • Robert G. Gourley (unverified)
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    So let's move on to Health Care Action day at the Capitol on April 26th, where folks will do what counts in a democracy - show up and express their concerns!

    (By dividing my previous post into three parts I was able to post)

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