Kitzhaber: Measure 50 is far from perfect, but I'm voting for it.
By John Kitzhaber of Portland, Oregon. Kitzhaber is the former Governor of Oregon and the leader of the Archimedes Movement.
Over the past few weeks I have been asked several times whether or not I am supporting Ballot Measure 50, which seeks to fund the Healthy Kids Plan. While each Archimedes Movement member in Oregon will need to decide how to vote on this issue, I am writing to clarify my own personal position.
I intend to vote for Measure 50 for one simple reason - we have Oregon children who desperately need better financial access to health services now and they cannot wait. This is one way to address a very real problem in the short term.
At the same time, I agree with many of you who argue that the financing mechanism in Measure 50 is far from perfect on a number of counts. First, I do not believe that the Oregon constitution is the appropriate place to put a tobacco tax increase. This should have been a statutory measure. Second, I believe that financing health care for children is the responsibility of our entire society, not just those who smoke. The general fund would have been a more appropriate and a fairer financing mechanism. However, it is also not fair that so many of Oregon children lack timely access to needed medical care. We should not penalize them because this was the best the legislature could come up with.
So I intend to vote for Measure 50 and will urge others to do so as well. But we must also recognize that this is not a solution to the larger challenges facing our health care system. It is a bandaid - albeit an important one - but it does not take on the underlying structural problems which are driving up costs in our health care system.
If we do not deal honestly and effectively with these issues - which is one of the central objectives of the Archimedes Movement - the promise of access we are making to our children in the Healthy Kids Plan will be a hollow one and, in a few years, we will be dropping kids from coverage once more. We can do better.
So, even as we commit ourselves through Ballot Measure 50 to dealing with the immediate crisis in access faced by thousands of Oregon's children, we must also recommit ourselves to the larger challenge of serious system wide reform.
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September 26, 2007 |
guest column | Comments (78 so far)
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Comments
Posted by: East Bank Thom | Sep 26, 2007 10:37:17 AM
The good Doctor sums up best my reason for endorsing Measure 50. It won't fix "the problem" but it will bring some children some care for some while.
[Disclaimer: My other reason to vote for the measure is out of sheer spite. I despise how Big Tobacco is already trying to buy this elect.]
Posted by: leinad | Sep 26, 2007 10:40:19 AM
The legislature had a chance to resolve this without sending it to the voters, but at the last minute Republicans with private tobacco interests balked. I am all for health care for children, I just feel that this "stop gap" solution will fester and nothing will be done to fix the larger problem. At this point I am inclined to vote no on this measure. If someone can show me that relevant work is being done to find a better solution, something that can be worked out in the special February session or in 2009, then and only then will I consider voting yes on 50.
Posted by: andy | Sep 26, 2007 10:46:10 AM
Sorry John, I won't vote for it because it is bad public policy. Targeting one small minority of the population just because they are vulnerable is not good public policy. You know better than that but you still endorse M50. If kids really need access to health care (not sure that underlying need has ever been proven) then get the general public to add another tax to their pocketbooks. If the general public isn't willing to fork over the money for the poor kids then I guess that tells you something. Targeting smokers just becuase you think you can overwhelm them by numbers is very bad policy. Who are you going to pick on next? Fat people?
Posted by: Anon Squared | Sep 26, 2007 10:53:34 AM
So I got the schwag lit that the opposition sent out to everyone and their mother this past weekend. What really got my attention wasn't that but rather the pro-BM50 lit piece. I noticed a lot of names were not on there? Big names too? What's up with that? Why are some of the other big names like AARP distancing themselves? Shouldn't they be helping?
Posted by: Eric J. | Sep 26, 2007 11:20:06 AM
Sorry. No go here.
John is correct when he says this should be a statutory measure, but I will not gut the Oregon Constitution on purpose with garbage to circumvent rule of law or to make a point, even if it is for the short term. The constitution is a document to help interperate the law - not be the law in and of itself. I guess no one learned a lesson with the US constitution's 18th amendment that was later repealed.
I will not weaken Oregon's constitution any further with such ubiquitous drivel and degrade it into an eventual glorified paragraph of the ORS.
We can not sacrafice our constitution like this.
Posted by: chris | Sep 26, 2007 11:23:52 AM
Nice to see someone who is in favor of this measure, but also owning up to it's short-comings. I've gone back and forth on the issue. I think gaining access to healthcare for kids should be a #1 priority. But I also feel that this responsibility should be shared among oregonians, not just put on the shoulders of tobacco users.
Thank you, Mr. Kitzhaber, for not resorting to the typical common response to this concern that goes something like "smokers should pay because they cost the system more...".
That line just isn't sitting right with a lot of folks.
Thank you also for working on a more substantial, long term solution. I will likely join you in voting "yes", so that the children don't have to wait for the better solution that I'm sure is coming.
Posted by: JHL | Sep 26, 2007 11:30:13 AM
Leinad, at the beginning of October, the Oregon Health Fund Board, created by the 2007 legislature (SB 329) starts meeting. Their mission is to do just what you've asked: design an overhaul to the health care system so as to lower costs and expand access to everyone and issue final recommendations to the 2009 legislature (and updates to the 2008 legislature). Timeline for the Health Fund Board (PDF)
More info at www.HopeForAHealthyOregon.com.
Targeting smokers just becuase you think you can overwhelm them by numbers is very bad policy. Who are you going to pick on next?
Every time a smoker buys a pack of cigarettes in Oregon, it costs the taxpayers $3.45 (According to the CDC) in increased health care costs. So apparently, Andy feels that smokers deserve huge subsidies to support the heath costs associated with that habit? We'd have enough money in the public health system right now to get health care to kids if it weren't for the increased costs due to smoking.
Kitzhaber is right on!
Posted by: Rural Uninsured Kids | Sep 26, 2007 11:45:37 AM
Tell me again how this ballot measure is going to help all those uninsured children in rural parts of Oregon (ie. most of the state)? We have access issues not coverage issues?
From what I understand, we will have to apply for grants to help expand current programs? Gee, I feel better already.
Posted by: Portland Dem | Sep 26, 2007 11:52:14 AM
Again, I 100% agree with Kitzhaber and so I'll whine about this for another couple of weeks but I will also vote YES on it at the end of the day.
Posted by: chris | Sep 26, 2007 11:59:21 AM
If it's true that tobacco use is so costly to the general public, then perhaps we should ban it, not profit from it as a community. It just doesn't make sense to allow something like this. I think that the argument that 'if not for smokers, we would have plenty of money for healthcare for all' is a bit bogus. Tobacco use may be a factor in healthcare costs- not may be, but is- but it is just one of a number of factors. Not the least of which is the corrupt insurance companies and big pharma. Not to mention other health and lifestyle related issues such as obesity, air pollution, water pollution, etc.
Should we allow manufacturing companies to dump whatever the heck they want to in our rivers and drinking waters just as long as they pay a big tax to cover the healthcare costs of those downstream? And maybe throw in the burial costs too, that makes sense...
Posted by: JHL | Sep 26, 2007 12:10:20 PM
Chris:
Yes, there are a number of factors contributing to rising healt hcare costs, and many of those are being addressed as well. That's why we voted last election to expand the prescription drug pool. That's why the legislature is working towards gettin junk food out of schools. That's why toxic mixing zones in our rivers has been a huge issue. (Though, to my knowledge, the state doesn't pick up the tab for burial costs to the degree that it pays for health insurance).
All of these factors are being addressed, some faster and more strongly than others. We're making progress on this larger issue, and Measure 50 is another huge step forward... though it's not an end-all.
Posted by: chris | Sep 26, 2007 12:26:41 PM
JHL-
All very good points and I agree. I think what is not sitting well is the direct correlation between taxing this product, and funding children's healthcare.
A high tax on tobacco, preferable one that is NOT written into the constitution, sounds like a good idea. But it would make much more sense, and have a more progressive and just ring to it, if the revenue would go to the general fund, and the voters or legislature would then decide to make kids healthcare a priority.
What inspired me to comment here was Kithaber being upfront about the faults of the measure. I don't think this one is ever going to sit right with me, and many others. But I am very likely to vote in favor of it.
Posted by: Kevin | Sep 26, 2007 12:35:38 PM
I'm going to echo Chris and thank Kitzhaber for such an atypically even-handed and honest statement by an M50 supporter while declining to agree with the good Governor's rationale... even though I am very sympathetic to his reasoning.
If M50 funds were targeted at alleviating the costs of smoking then I would buy the connection. It doesn't do that however. This reality is very revealing as to what many M50 supporters really care about. Hint: it ain't reducing smoking!
M50 backers like to cite CDC stats while glibly ignoring the fact that the CDC also pointedly advocates EDUCATION as the primary and most effective means of mitigating the costs of smoking.
Posted by: Phil Philiben | Sep 26, 2007 12:46:00 PM
The last few weeks Oregonians have been inundated with TV commercials and mailings from the Tobacco Industry opposing Measure 50 - the Healthy Kids Initiative. Most of this I would characterize as misinformation. Questions that need to be asked are as follows:
Parents if you send your child to school and they become ill because their classmate’s parents can’t afford Health Care coverage are you protecting your children? Is your family more secure? Are you willing to wait for a perfect law to protect your family?
Oregonians ask yourself – What’s more important protecting children or protecting the Tobacco industry? Studies have concluded that every 10 percent increase in the price of cigarettes will reduce youth smoking by seven percent and overall cigarette consumption by three to five percent. See The Campaign for Smoke Free Kids
Oregonians don’t allow perfect to be the enemy of good. Politics is the art of the possible.
Vote Yes on Measure 50.
Posted by: Bill Bodden | Sep 26, 2007 12:52:33 PM
Deciding how to vote on Measure 50 will be good practice for the general election for president in that people will have to choose the lesser of two evils.
I'm for the kids without insurance. People with justifiable concern about putting a tax in the Constitution can work later to take it out and get the program right.
Posted by: Eric J. | Sep 26, 2007 12:53:33 PM
I am not protecting the Tobacco industry - I am voting NO to protect our constitution from being gutted long term by a short term solution. I wont fall for the ubiquitous propaganda that Phil is spewing.
Posted by: Phil Philiben | Sep 26, 2007 1:10:53 PM
What's a matter Eric? Don't you believe in protecting children. And Yes you are Protecting the Tobacco Industry
"Studies have concluded that every 10 percent increase in the price of cigarettes will reduce youth smoking by seven percent and overall cigarette consumption by three to five percent"
What is it that you don't get about that FACT.
Posted by: Inthewoods | Sep 26, 2007 1:19:51 PM
I am a NO vote, The Gov does not need any more money, heck, he is giving 4 people $32,000.00 each on top of there $120,000.00 plus salaries. I hate cigs as much as the next guy; these taxes are for the Oregon out of control with money Governemnt, not the kids!!!
Posted by: Kevin | Sep 26, 2007 1:19:55 PM
Oregonians ask yourself – What’s more important protecting children or protecting the Tobacco industry?
Logical fallacy alert. Not only is it a false choice but it's a blatent strawman.
Studies have concluded that every 10 percent increase in the price of cigarettes will reduce youth smoking by seven percent and overall cigarette consumption by three to five percent.
Dig deeper into the relevant studies and you'll find that many teens merely put off starting up until they are older and more able to afford the higher prices... and that among the overall drop in consumption it is those who are both better educated and more affluent who represent an increasingly larger percentage of those quitting.
If you actually care about reducing smoking among the most vulnerable populations then you'd support what the CDC and virtually every other anti-smoking organization of any repute suggest - education!! That M50 does next to nothing to increase anti-tobacco education tells me what I need to know about it.
Posted by: Eric J. | Sep 26, 2007 1:23:20 PM
I believe that Phil has fallen for the Political Correctness bug with the phrase "protecting" children. How can we "protect" them long term if our constituion becomes weak and gutted by more and more of simular political manuevering (sp)by those who couldn't pass it in a more logical way? My concern is the health of our constitution and whether it will be there in the future for these healthy kids to enjoy.
Posted by: Phil Philiben | Sep 26, 2007 1:36:23 PM
Protect children by turning off the ubiquitous propaganda from the Tobacco Industry.
If the protecting children was the widespread meme we would have been able to pass the Healthy Kids Act in the legislature and wouldn't be having this discussion.
And Kevin if you look even farther into those studies the later you start smoking the easier it to quit the habit later on.
Posted by: Eric J. | Sep 26, 2007 1:42:10 PM
I do not smoke. I hate tobacco companies as much as the next person. They are evil to say the least. But I feel the continuing existance of a strong and uncluttered constitution is more important and more valuble than any tax, study, or protection can ultimately provide.
Posted by: torridjoe | Sep 26, 2007 2:00:29 PM
"Thank you, Mr. Kitzhaber, for not resorting to the typical common response to this concern that goes something like "smokers should pay because they cost the system more...".
That line just isn't sitting right with a lot of folks. "
And why is that? Do we subject people without cars to the gas tax? (Well, if they have gas mowers and ATVs I suppose we do, but you see the point). Or let's put it another way--is it better for all Americans to pay into Superfund, or just companies who handle toxic waste, many of them responsible for the dumping that requires cleanup?
Posted by: Bert Lowry | Sep 26, 2007 2:02:18 PM
I also agree with Gov. Kitzhaber 100%. This is a flawed measure, but I will almost certainly vote for it. Why? Because I'd rather have health care access for 100,000 or so kids than a pristine state constitution. And, honestly, Oregon's constituion is already pretty full of junk.
I'm unwilling to let the perfect be the enemy of the good -- especially when the health and lives of so many children are at stake.
Posted by: Kevin | Sep 26, 2007 2:06:31 PM
Protect children by turning off the ubiquitous propaganda from the Tobacco Industry.
Be that as it may, I think that Eric's self-evident point is that the constitution isn't the place to do it at.
If the protecting children was the widespread meme we would have been able to pass the Healthy Kids Act in the legislature and wouldn't be having this discussion.
It would still be a patently regressive tax scheme and would still largely side-step the educational approach most favored by virtually every authority on the subject as the most effective means of reducing tobacco consumption among the educationally and economically disadvantaged.
Slice and dice it however you like and at the end of the day M50 is about a convenient funding source for health care which allows the huge majority to avoid having to do more than give lip service to funding any of it and which, as Kitzhaber rightly underscored, doesn't even begin to address root causes. At best... AT BEST, M50 is a bandaid over a wound that is guaranteed to keep getting larger until such time as we decide to actually treat the wound rather than covering it up.
Posted by: Eric J. | Sep 26, 2007 2:07:59 PM
And thats why a NO vote is needed - to quit putting that junk into the constitution that erodes it further.
Posted by: JHL | Sep 26, 2007 2:08:37 PM
FYI, the original Bill of Rights was placed into the Constitution rather than statute over the strong objections of Federalists who suggested that it would clutter up the document.
The "constitutional clutter" argument is one of the more ridiculous straw men ever constructed.
Posted by: Kevin | Sep 26, 2007 2:11:18 PM
Torrid,
What percentage of the actual doctors visits and hospital stays likely to be covered by M50 can be directly attributed to tobacco? Unless you can show me that it's even a simple majority then I submit that your oft-stated rationale is akin to a bait-and-switch.
Posted by: Phil Philiben | Sep 26, 2007 2:14:53 PM
I love it when you guys repeat my frame!
Except it makes me feel kinda icky inside, almost Republican.
Posted by: Portland Dem | Sep 26, 2007 2:18:55 PM
Again,
I agree with Kitzhaber 100%. He says what most of us are thinking on this one. And by most of us - I mean the general public.
Posted by: pdxatheist | Sep 26, 2007 2:52:44 PM
i hate doing it but there's no way in hell i'm voting to alter our constitution by putting a stupid cigarette tax in it. it is absolutely not the way to handle this; i would fully support a statutory measure, but screwing around with the constitution is not something to be taken lightly. i'll probably be accused of being a troll, but there it is. let's find a better way to go about this, rather than junk up our cluttered constitution any more.
Posted by: Glen HD28 | Sep 26, 2007 2:54:18 PM
And let's not forget to replace the State Legislators who vote against health care for kids, forcing us to blog about M50.
Posted by: Portland Dem | Sep 26, 2007 3:13:23 PM
Agreed. Leadership dropped the ball on this. I'm sure I'll get the usual response back from folks on this blog but leadership did drop the ball.
Posted by: Ed Bickford | Sep 26, 2007 3:34:50 PM
I am torn on whether to approve this measure because I know people that need these benefits, but what worries me is the adage "what survives a campaign is not the end sought but the means by which it is pursued." I fear that the worst long-term harm to the children of Oregon could come from approving this kind of bill.
I doubt that it would be easy to go back and fix the ungainly 'fix' later; the damage would already have been done in giving the 'green light' to muscling measures unable to gain a majority in the Legislature into the State Constitution despite their obvious weakness. The disregard for the Constitution demonstrated thereby is already on display when someone can just aver that it is aleady full of junk, so what? Our constitutions are the backbone of the rule of law in our country, and they are in desperate need of a building up of respect for them after the depredations of the recent Republican administrations.
I hate seeing the Democratic Party engaging in this kind of parliamentary maneuvering in which their opponents have engaged to mutual harm.
Posted by: Another Portland Dem | Sep 26, 2007 3:53:24 PM
I really think that it is pretty short sited to blame leadership when this is clearly a problem with our whole system of health care.
The legislature isn't even talking about how we waste money on the western medicine. There are sooo many more natural treatments to consider.
Tobbacco? Pharmeceuticals? It all just poisons what Mother Gaya has given us.
Posted by: alijane | Sep 26, 2007 3:59:21 PM
I am a no on 50. I simply cannot vote to hit my fellow citizen with this tax increase. Smoking is an addiction, if the money went to help people quit I could vote for it. They smoke, isn't that punishment enough?
We do nothing to big cigarette companies when we increase these taxes, if they don't sell them in Oregon, they will sell them in another state. They sell in overseas markets too. No tax will ever have a serious impact on these companies.
Why don't we place to excise on the service. A simple dollar spiff for each medical service would add millions each month to help cover the uninsured. Those of us with insurance should count our blessings and willingly give an extra buck when we visit the doctor or dentist. The service provider could remit the funds monthly or quarterly. Beer, wine and tobacco distributors remit their taxes on products, why not doctors on their services?
We need a steady source of funding, not a bandaid approach.
Posted by: David English | Sep 26, 2007 9:47:34 PM
I am sad to see some people make the same tired old arguements that if you vote NO, then you must be against provding kids health insurance and be a tobacco lobbyist.
I've have said that I was going to vote No on this measure and I have done that.
While I respect Governor Kitzhaber and applaud him for his work on healthcare (including admitting the bill has some flaws), I still can't agree to vote for it.
Phil and Ross can call me whatever they want, Kari can claim (as he did on my blog) that I owe it to come up with my own alternative. In the end, I don't agree with it. If any of the above want to lambast me for voting my own conscience, then it just goes to show how unprogressive Blue Oregon is.
Posted by: Bill Bodden | Sep 26, 2007 9:49:18 PM
We do nothing to big cigarette companies when we increase these taxes,...
Then why are the tobacco companies fighting Measure 50? I have a hunch some of the above bloggers opposing this measure are trolls from Big Tobacco.
Posted by: torridjoe | Sep 27, 2007 12:20:17 AM
"What percentage of the actual doctors visits and hospital stays likely to be covered by M50 can be directly attributed to tobacco? Unless you can show me that it's even a simple majority then I submit that your oft-stated rationale is akin to a bait-and-switch."
I'm not sure what your point is. What can be directly attributed to tobacco is $3 for every pack bought in this state. Those health care costs don't exist without smokers.
Also, please stop saying there's no education in Healthy Kids. There is cessation funding, and in any case the strongly evidenced expectation is for a price-based reduction in smoking, particularly among children.
As to leadership: if I recall correctly, there was a disagreement between the parliamentarian and the legislative counsel over whether M50 was in fact a revenue bill, per se. The parliamentarian argued that because it was a referendum that charged the VOTERS with creating a revenue bill (should they pass it), there was no need for 35 votes, and thus it could have been passed out statutorially. The LC argued differently. Speaker Merkley thus had the decision power as to whether it required 35 votes or not, as I understand it. He sided with the LC.
I don't know the reasons--perhaps the LC, being the legal representative, is a safer choice in such matters--but if M50 was a statutory referendum, there'd be no question it would pass. As a constitutional measure, I believe it will fail.
Posted by: Chris Lowe | Sep 27, 2007 2:35:44 AM
It would be good to have a discussion about what progressives should do about Dr. Kitzhaber's last point, continuing to press for more comprehensive reform. How should we do that?
This is at least the fourth round of these arguments here and I don't think there are any new ones, except for the element of the ex-governor acknowledging that the issues raised by progressive opponents are real (note that he apparently doesn't regard them as the products of dishonest industry sock puppets).
If Measure 50 does pass, what should progressives do to fix it later? To promote wider health reform?
If it fails, what should we do to move as quickly as possible to another means to fund children's insurance and access -- the rural point is really important -- and to promote wider reform?
And on a slightly different note, what could be done to correct the anomaly that it is easier to amend the constitution than to pass a revenue statute? One thing I notice in the anti-M50 ads that started running in the last day or two is that one of them makes it sound like once it's in the constitution it will be extremely difficult to change, relying misleadingly on people's sense of the difficulty of amending the federal constitution I think.
Posted by: Eric J. | Sep 27, 2007 9:12:53 AM
Because, Chris, it is more difficult by design to overturn constitutional amendments than statutory items. Why do you think Sizemore puts in his ubiquitous garbage measures as constitutional amendments? Why do you think they put the double majority clause for shool referendums in as a consitutional amendment? If I remember correctly, this last session had a difficult time trying to overturn the double majority clauses becuase it is set in stone in the constitution and not a statutory item. Thats why I am voting NO - because after we use this band aid, we may have to bite the bullet and keep it longer than we really need it because we can't remove it properly as we would a statutory item. This is not what a constitution is geared to be used as.
Posted by: JTT | Sep 27, 2007 9:36:12 AM
Kevin- I think all of your other points have been rebuffed, but I wanted to correct your CDC education statements. CDC's peer-reviewed tobacco reduction best-practices call for a multifaceted anti-tobacco program; education is only one of the components of an effective tobacco prevention and reduction program. Nevertheless, as TJ points out, TPEP (Oregon's Tobacco Prevention and Education Program) is funded by M50.
Posted by: anonymous | Sep 27, 2007 10:20:49 AM
To the careful observer, Kitzhaber seems to have played questionable politics here in a way that many people may not fully understand.
First, if one looks at the AM website, the primary goal and values of AM are not first and foremost health care reform.
The Archimedes Movement is committed to creating opportunities for meaningful engagement. We firmly believe that we as a people can do better. We hope to recognize our common difficulties and promote the common good – to contribute to the things that make Oregon a great place to live, and solve the problems we all face
AM is much more like a nascent political party in which health care is just one party plank than a health care advocacy organization. Kitzhaber chose health care as a marquis issue that would attract people to AM, and indeed most of the grassroots has been attracted to AM in the mistaken belief that health care reform is the mission of AM because that is their primary goal in behalf of THEIR values. The point is that Kitzhaber is willing to compromise on some of the heatlh care reform principles he articulated to attract people to AM, and indeed he does right in this letter, if that expedient furthers the primary (political) goals of AM.
Second, this point is highlighted by the fact that any of us committed to health care reform who signed up for emails from AM got this letter from Kitzhaber. He used the (electronic) letterhead of AM to give the clear implicature to the us in the public that AM supports this, even though their website indicates that the AM membership has not met, discussed, or endorsed M50. This runs so contrary to the principles Kitzhaber had told health care reform advocates at public meetings they were endorsing if they joined AM it is not surprising the grassroots has not yet endorsed it. Despite his public claims he is trying to build a grassroots organization, he clearly now has stepped out before the Sept. 29 meeting announced on their website in an attempt to drive the debate.
Third, he did not publicly confront those who gave us this failed measure to get commitments what they were going to do to deal with the crisis if this measure failed, and he did not put the legislator on the spot publicly to commit to any action in the special session if it failed, thereby failing to establish the moral and political predicates for what amounts to nothing more than the rationalization "it's all we are going to get". (Note that if one reads the letter carefully, all of the substantive arguments he gives are reasons to vote AGAINST M50.) This is quite in keeping with the fact that health care is a fungible political issue for his larger vision of AM, rather than the primary goal and issue. He talks a lot about how bringing about health care refrom will depend on creating tension in the system by principled legislation. That has to start with the grassroots putting pressure on the state legislature, and from there the state legislature putting pressure on the federal legislature. By his approach, to the extent it proves decisive in the passage of M50, he has worked to break that chain of tension in the real world. As the next two points highlight, the legislature will move on in a very different direction that reduces tension up to the federal level.
Fourth, if one reads his argument carefully, he effectively, if not intentionally, fully endorses the principles of the Administration in the now infamous letter that SCHIP funds should only be used in ways that keep middle income families in the private insurance market. The Administration argues in that letter that SCHIP funds should not be used to further any plan which draws families making more than 250% of the Federal Poverty Level (FPL) out of private insurance. In fact, SB3 only devotes a small amount of revenues and matching funds to the current, now semi-public OHP for families making up to 200% of the FPL. The bulk of the revenues and matching funds are devoted not to any kind of public plan or system, but instead to the "Office of Private Health Partnerships" to subsidize insurance or HMO-style plans for families making 200% to 300% of the FPL. In all of his public material and with this action, Kitzhaber passively endorses the M50/SB3 plan, which gives the Administration even more than it demanded in that controversial letter. Again, these facts in evidence are supportive of the argument that health care reform is a fungible issue in service to Kitzhaber's/AM's goals and views, rather than as the sole or even primary goal that motivated many health care reform advocates to join AM.
Finally, (and this is a partial answer to Chris Lowe), the evidence is clear that there is zero chance the legislature will change the essential character of SB3 if this passes without a new level of difficult activism from health care advocates. Those would be the same advocates who Kitzhaber was attempting to motivate and has apparently now left in a lurch. The legislature no reason to act in the absence of that because no promises were extracted before the vote to do that. And it is perfectly in sync with the goals and principles of SB329, which the authors and supporters have said is based on the principle that universal insurance coverage is the goal, and (mistakenly) that somehow competition between anti-trust exempt insurance companies for business is going to control health care costs. There are plenty of health care economists who provide historical evidence this is not the case, particularly when people are compelled by law to buy from them as is the case with SB329.
In many ways, M50 is a very bad deal for the people that I believe Kitzhaber truly does want to help. If it passes, and to the extent his support contributes to that, the argument he makes contribute to making it a bad deal because it reduces the pressure to actually do better even in the short term (which is quite politically feasible), and the plans that would be put in place will offer poor benefits to people, and it will put programs in place that create real momentum in the wrong direction for the long term. Things will be even worse if the SCHIP authorization is vetoed and the House fails to override because there will be hardly any money to subsidize private insurance.
Posted by: Chris Lowe | Sep 27, 2007 10:35:54 AM
Eric, voters can amend Oregon's constitution by a simple majority. That is dramatically easier than amending the U.S. constitution and hardly constitutes being "written in stone" in my view.
My question wasn't about voting on the measure. It was about how we do fix the situation which creates the incentive to put revenue measures into the constitution?
Statutory revenue measures, like constitutional amendments, also all have to be referred to voters, but unlike amendments, require a super-majority.
There is something screwy if it's easier to amend the constitution than to pass a statutory tax, isn't there?
Is the answer to raise the bar on amending the constitution, lower it on tax laws, both, amend the constitution to exclude specific tax measures from it?
Posted by: Kevin | Sep 27, 2007 10:46:39 AM
JTT, read the editorial note at the bottom of this report, which a CDC officer participated in, and you won't find jacking up the prices listed as one of their 5 recommendations. In fact, 4 of the 5 listed recommendations hinge on education of one sort or another.
Of course those recommendations focus on how best to help persons of low socio-economic status. This I presume is largely because, as the earlier cited statistics show, the more affluent and better educated respond better to jacked up prices.
Interestingly enough, coping with lack of health insurance does get mentioned in the editorial notes of this report - albeit in terms of helping smokers themselves, whether those be teens or adults, in the lower socio-economic levels gain access to helplines (ie. education) and access to medical treatments. Nowhere is it even inferred that providing health care coverage for children is helpful in reducing smoking rates.
Posted by: Kevin | Sep 27, 2007 10:52:41 AM
I'm not sure what your point is.
Assuming M50 passes... what percentage of the actual covered doctor/hospital visits would be directly attributable to tobacco use? Or to put it another way, let's say that 10,000 kids covered by health care via M50 make 100,000 doctor/hospital visits which are covered by said M50-provided coverage.... What percentage of those 10,000 visits can be attributed to tobacco use? 5,000? 1,000? 50?
In order for your oft-cited rationale of the $3 per pack cost to be relevant to M50, the resulting coverage from a passed M50 would have to mitigate at least some of those costs. To what degree does your best judgement indicate it would do so?
Posted by: Eric J. | Sep 27, 2007 11:23:39 AM
I do not think we can fix the situation you pose, Chris. If we tried to fix it, even in a logical manner, someone (probably rich and well connected) with an axe to grind would oppose it on many constitutional grounds (read: ironic) and fight it until thier last dying breath. Add to that those legislators who are too lazy to think about it and you have what is normal now - no chance in heck to fix it.
Posted by: anonymous | Sep 27, 2007 11:30:51 AM
Chris - You ask good questions for which this forum probably is not the right place to get answers the questions deserve. I'll offer two brief comments to two general questions you ask based on arguments other close friends I respect have made to me in the last months that have convinced me to vote against M50:
The Oregon Constitution may be easier to amend than the U.S. Constitution, but that is no reason to amend it. Treating it like an alternative legislative forum undermines the power of the guiding principles it conveys. Particularly so to judges who are not supposed to be politicians or legislators, but rather interpretors of widely and closely held governing principles. If the people treat the constitution like a chalkboard for today's law fads and political expediencies, they do not demonstrate they have any closely held governing principles so judges are much freer to rule based on personal and political biases. That will really matter as hard decisions are about changing our health care system that are opposed by powerful entrenched interests and are challenged in the courts.
The answer to what we need to do was actually rejected by the governor and the Democratic majority this session because it did not fit into the political agenda for which I believe this strategy was seriously misjudged to be a winner. They should have referred Greenlick's constitutional amendment to the people which declared health care to be a right, and amended it to re-establish that simple majorities are sufficient to pass revenue raising measures that the proceeds of which are solely used to pay provider for services or to run the administration of the system rather than die in committee. It certainly didn't die for lack of committed health care advocates begging the Democrat leadership and the DPO to come out for this. That kind of calibrated, unifying approach has majority support, and it should have been as much of a slam dunk with Democrats in control of both the state house and the capital building to do that as it was to refer M50 if they hadn't had other political goals and allies they had to appease. Sadly, any calls to Greenlick's office will quickly show he has joined the pile-on of criticizing the very health care reform advocates who supported his constitutional amendment but who have problems with M50 as not being very smart or not really caring.
The problem with M50 is that much of the money goes to issues which are a distant second, and arguably counterproductive, to providing health care. Reducing tobacco use may be a good publicly policy that has actuarially linked contributions to the overall costs of health care, but it has nothing to do with providing health care. No serious health care economist cites tobacco use as the reason that U.S. health care costs are higher and increase at a greater rate than other industrialized countries. That is because it is an inherently controlled variable from an comparative actuarial standpoint. Many, many countries with more favorable health care costs have equal or higher rates of tobacco use, France being one notable example. Punitive taxes and advocacy are counterproductive to solving the crisis in providing health care, and so health care funding measures should at best devote limited funds to positive education measures and nothing to the anti-tobacco advocacy industry. Like a few percent at most. (Kevin has a lot to say and has offered a lot of solid, on-point, supporting evidence on this.)
Hopefully that will help you in seeking out informed people who can provide you the answers you deserve to the astute questions you ask. I want to also suggest the meme "not letting the perfect be the enemy of the good" is not accurate in this case. This is much more a case of "the bad crowding out the good, never mind the perfect".
Posted by: Robert G. Gourley | Sep 27, 2007 11:41:21 AM
If all who oppose Measure 50 here put in place a means to provide health care of these kids before the ballots go out, then we won't need to adopt Measure 50.
So let's see 'em get too it - my bet's on they're better at bellyaching than getting something useful like this done.
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Posted by: Portland Dem | Sep 26, 2007 10:34:18 AM
I 100% Agree!