Kitzhaber: Public option won't matter if we're buying the same product

Charlie Burr

From the Daily Astorian:

"If you listen to the health care debate, it's not really been a debate about how to create a system that talks about how to improve the health of Americans, it's been a debate about how to pay for a system that we already have," Kitzhaber said. "I think that's a fundamental misdiagnosis of the problem."

The purpose of the health care system is to produce healthy people, not just to finance the medical community, he added. "There's a big difference between medical care and health. Health care is a means to an end, it's not an end unto itself."

To make the transition from health care to a healthy nation will mean huge challenges, he added. It will mean removing the barriers created by stakeholders who worry about how health care reform will impact them in the short term. "We need to change the question from how individual stakeholders are going to be disadvantaged in the transition to how we mitigate the economic impact on everybody as we move from the current system to the new one," Kitzhaber said.A former emergency room doctor and creator of the Oregon Health Plan, Kitzhaber said the country needs a shared vision about what a health system should accomplish, an "accurate diagnosis" of the underlying problem and a clear description of the system that meets these objectives.

The inefficiency and poor performance of the U.S. health care system is built into the system, he added, and "that won't change just by changing how we pay for it."

"That's why the debate over the public option, which I personally support, is a sideshow. It doesn't matter if we have a public option if what we're buying is the same product," Kitzhaber said.

Read the rest here.

Discuss.

Comments

  • (Show?)

    Dewd is smart; 'nuff said.

  • (Show?)

    The United States has spent the last 60 years wrestling with how to provide universal access to health insurance. Meranwhile, every other major industrial nation has somehow managed to accomplish this (as have most minor ones). To the best of my knowledge, not one of them did it the way Kitzhaber suggestss, i.e., totally revolutionizing the way health care is defined and delivered.

    I think some of the global issues Kitzhaber mentions are significant and deserve broad debate and discussion. But are we really supposed to put the current debate on how to extend health care coverage to everyone on hold while we first restructure the entire health care system?

    I think we are seeing a good example of why Obama never seriously considered Kitzhaber for Secretary of HHS.

  • Robert Harris (unverified)
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    Jack: Do almost all other developed countries provide access to universal health insurance or do they provide universal health care?

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    Kitzhaber is, of course, right that just changing the payment system is not enough. But most of bills under consideration do have provisions that seek to shift the US health care system in the direct he (and I) want. I would not want to hold getting coverage to more people hostage to the ultimate philosophical approach to health.

  • (Show?)

    Mr. Roberts,

    I realize Dr. Kitzhaber is in an election and thank you for avoiding personal attacks and sticking to the issues, but I disagree that we should follow the examples of other countries just because. We should learn from their mistakes and make something better even if it is a “revolution.” If at the very least, we can start talking about it and that’s all I have seen so for on this issue – a lot of talk. That’s neither bad nor good and no one likes to watch how sausages are made but why limit the debate? Can't we do two things at once?

  • LT (unverified)
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    "But are we really supposed to put the current debate on how to extend health care coverage to everyone on hold while we first restructure the entire health care system?"

    No, Jack, but have you checked the dates on when the various proposals will go into effect? Majority Whip Cong. Clyburn is worried (as are others) that the dates on some/most of the bills being debated are 2013, 2 election cycles down the road. Should that be a point of debate, or just how to pay for health care as if nothing else matters? The current system works well if only everyone had health insurance? Or maybe we should be looking at the Mayo Clinic model, the Cleveland Clinic model, etc. of better ways to do health care?

    That's why I'm never been a big fan of the WE MUST HAVE A PUBLIC OPTION crowd. Even if there were votes where all Democrats in the House and Senate voted for a public option (and congressional votes are rarely that simple) on a bill which doesn't go into effect until 2 election cycles down the road, how does that help people? People who just got dumped from their insurance because some company found they had acne in high school and that rates as a "pre-existing condition" or they were in the hospital and reached their "lifetime limit for coverage"? Or lost a job and couldn't afford COBRA? Or work part time and can't afford health insurance?

    I have talked to Sen. Atkinson's office multiple times abuot the need to broaden the health care debate.

    "If Sen. Atkinson could use his experience to talk about his vision of whether a low wage worker who has a freak accident on their way home from the fast food place or the retail store where they work would have access to the same level of care Sen. Atkinson had without going into debt or medical bankruptcy, then that would be an intelligent contribution to the debate in this state" was my message.

    I believe Kitzhaber understands the need to have more intelligent debate. He has talked about the need to talk about not only what we want to do but what steps we use to get there. Here he says this:

    "Kitzhaber said the country needs a shared vision about what a health system should accomplish, an "accurate diagnosis" of the underlying problem and a clear description of the system that meets these objectives."

    Jack, are you saying you don't think it is possible to have a debate going on about legislation on Capitol Hill while at the same time an intelligent discussion is going on in Oregon which is broader than the Congressional debate?

    If that is the case, I believe you don't have enough faith in the intelligence of Oregonians. We've been talked down to for years. Too many public figures have said "Either you totally support X or you totally support Y, no other choices allowed and only subversives ask questions because we know where we stand!".

    Is that really the Oregon we want to live in? I don't think so.

    A wonderful fictional character, Leo from West Wing, in the 2nd season opener flashback to when Gov. Bartlett is running for President, is asked by Bartlett "why are you supporting me?". Leo answers "Because I am tired of it, year after year, having to choose between the lesser of who cares?!".

    Be it Bradbury, Kitzhaber, or DeFazio if he runs, I don't think Oregon Democrats will face "the lesser of who cares" this upcoming Gov. election.

    A very real newly elected President Obama was interviewed in Newsweek.

    "The American people, I think, not only have a toleration but also a hunger for explanation and complexity, and a willingness to acknowledge hard problems," Obama said. "I think one of the biggest mistakes that is made in Washington is this notion you have to dumb down things for the public."

    http://www.newsweek.com/id/197889/page/2

    Jack, are you in favor of intelligent debate? Or should we all just be obedient boys and girls and only debate health care based on the various bills being debated in Congress and never look at the wider picture?

    In other words, are you the intelligent person who sometimes shows up on this blog and elsewhere, or do you prefer to be seen as just someone who wisecracks?

  • rw (unverified)
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    Robert Harris: good question. A nice reminder to stay conscious of the terms and terminology.

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    "To the best of my knowledge, not one of them did it the way Kitzhaber suggestss, i.e., totally revolutionizing the way health care is defined and delivered."

    Perhaps they did it correctly the first time? If I understand what Kitz is driving at, he's talking about delivering wellness rather than treating sickness, and monetizing the system that way. In England they definitely do this--pay doctors more when patients are healthier, regardless of how many or how few procedures and tests are performed. So if the question is do other countries do what Kitzhaber is suggesting, and shouldn't we use a different delivery model predicated on wellness rather than sickness, the answers are yes, and that's a smart suggestion.

    All that said, we have neither the time, nor (clearly) the political will to come anywhere near a fundamental overhaul of the delivery process at this time. The crisis factor right now is the prospect of doubling costs in 10 years, and people without access. I'd rather have sick-care than nothing, if I can't get wellness care. The public option--at whatever level of initial and ongoing eligibility we find agreeable--addresses both problems simultaneously. Putting aside the smoothest way to transition out of private health care, the more people availing themselves of a cost-controlled option, the lower their costs will be...and the greater the pressure on private care to maintain competitive practices, else they lose more customers.

  • mp97303 (unverified)
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    THis is taken directly from Andrew Sullian's blog today. It was so good, I decided to post it in its entirety:

    A reader writes: I am a Canadian citizen, moving to the US for work next month and your Sickbed Stories have pretty much got me terrified. I read every one of them and think…that probably wouldn’t happen in Canada. I am told that the organization that will provide our health insurance in the US has some of the best coverage in the country – but as your personal stories prove – there are just too many cracks in your system with too many people falling through them. Why not me one day? Our health care is delivered provincially and so I can only speak for British Columbia but I know the systems are similar across Canada. Basically, each person pays $54 per month for all essential medical services; you pay nothing if you make less than $20,000 a year. If you have a good health insurance plan through work, it will usually pay your monthly premium and cover you for additional services like eye care, physiotherapy, and psychiatry with annual limits on coverage (e.g. acupuncture treatments up to $600 per year) and subsidized costs on prescription drugs depending on the plan. There may be a small deductible for those “extras”, but you know beforehand what will be covered and what will not. For that monthly $54 (and with no additional insurance), I have access to a family doctor whenever I need one, to walk-in clinics where doctors treat individuals on a first-come, first-served basis, and to emergency or standard medical care in hospital. And whether it is a quick diagnosis and prescribed antibiotics for an infected spider bite (me) or radical chemotherapy treatment, months of hospitalization and surgery for life threatening cancer (one of my closest friends) – there are no bills for that care. You simply present your Care Card where you are receiving treatment identifying you as a resident of the province, and you are entitled to whatever care you need as determined by your doctor – not “the government” and not any insurance company. Of course, this care is not “free”. As Canadian citizens, we all pay for this incredible privilege of universal health care through our taxes, which are slightly higher than in the US. But I think about those MasterCard commercials from a few years back – "Piece of mind knowing that you and your family will never be financially ruined by health care bills? Priceless." There was a long, hard political fight for universal health care in Canada. Man, was it worth it.

    Why the hell can't we have something like that here?

  • (Show?)

    I'm old enough to remember when the 1964 Civil Rights Act was making its way through Congress. At the time, many civil rights leaders were saying that it wasn't enough and that, in fact, legislation alone would never solve the racial problem in America.

    They were right, of course, but it was still critically important to pass the 1964 Civil Rights Act. That act, more than any other, set a new foundation for race relations in America. It established the principle that discrimination based on race, ethnicity, gender or age was not simply wrong or immoral, but that henceforth it would be against the law.

    I believe it is equally true today that health reform needs to start by establishing the principle that everyone in the United States is entitled to have health insurance (and in answer to the question by Robert Harris above, most of the world does provide universal health insurance, not universal health care).

    Once we establish this, I think we're in for a minimum of ten years of struggling with controlling health care costs along with the other transformative issues that Kitzhaber is raising. But I do believe it is a mistake to dismiss the issue of universal coverage and how we pay for it as a "sideshow."

    If history is any indication, we will never get a handle on those other issues until we first achieve universal coverage, or something very close to it.

  • RyanLeo (unverified)
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    If I remember correctly, Kitzhaber's original vision of the Oregon Health Plan is highly similar to the Public Option.

    The Oregon Health Plan was envisioned to cover every Oregonian. To do so in the long term, an employer mandate, which basically taxes small businesses who do not or cannot afford health coverage for their employees, was proposed. The tax receipts from this employer mandate were supposed to go to the Oregon Health Plan so that it could, theoretically, cover those small businesses paying the employer mandate.

    However, the employer mandate never passed in 1997 because it did not receive the waivers from the Employee Retirement Income Security Act (ERISA), thus OHP has continued as Oregon's bare bones version of Medicaid due to the long term funding (employer mandate) never getting Federal waivers from ERISA.

    So, as evidenced by the long history of the Oregon Health Plan, the "Public Option" where you have a government run health plan competing with private health carriers has been tried at the State level, with the employer mandate not getting the green light from the Feds.

    What strikes me about Kitzhaber is if he is working on such radical change in the delivery of health care, then why is he running for Governor?

    I could see a Senator Kitzhaber having greater influence on radically changing the delivery of health care than a Governor Kitzhaber.

  • Bill Bodden (unverified)
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    "Why the hell can't we have something like that here?"

    Because there aren't enough informed people who care enough to push for something similar to the Canadian and European models - all of which had better ratings in the World Health Organization Year 2000 Report. France, Italy and Canada were 1st, 2nd and 30th, respectively. The U.S. was 37th. Given the inflation in health care costs in the U.S. since then, it is probably a good bet we would now be 40-something on that list.

    "But I do believe it is a mistake to dismiss the issue of universal coverage and how we pay for it as a 'sideshow.'"

    The "sideshow" is several senators and representative in Congress funded by the insurance-medical-pharmaceutical complex to create a farce of multiple purported reforms that will either lead to no reform at all or a mess stacked in favor of diverting more taxpayers funds to the insurance corporations with no improvement in coverage for the people.

    If Obama and Congress had really wanted genuine reform they would have appointed a NON-partisan (not a bi-partisan) commission to develop a plan as I am sure was the case in other countries with more humane and civilized systems. But then Obama and key players in Congress were in hock to their campaign donors from related corporations so doing the right thing was a non-starter.

  • (Show?)

    I'm with Jack on this one. Kitzhaber keeps talking about an ideal system. Maybe he read too much Plato at Dartmouth.

    The issue is how to get something through the political process that gives Americans universal coverage, insurance companies that cannot deny coverage or refuse to pay when you get sick, and a process to start reducing the cost. I feel that Kitzhaber looks at it at the local level and how he would like to run a community health network. He is right on that, but it is not the issue that we have to address first.

    I hope that he can get more focused on what can be done in Oregon. How do we defeat the referral? How do we fix the health care holes left after the Congress is done for citizens of Oregon? How do we deal with the kicker? I want to see his plan for being governor, not running his health initiative.

  • LT (unverified)
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    Jack, Thank you for your intelligent comment. I too remember the civil rights bills. It may have been a mistake to raise hopes that one bill passed in 2009 would solve all health care problems in this country.

  • Dartmouth Hater? (unverified)
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    Kitzhaber keeps talking about an ideal system. Maybe he read too much Plato at Dartmouth. Uh, ok?

    I liked what Kitz had to say today. The issue for some of us (no, not all of us and I'd don't speak for you) is not about getting just something through the political process but also getting something through that doesn't bring us right back to square one in 5 years.

    I hope that he can get more focused on what can be done in Oregon.

    Huh, last I check he's been pretty darn focused these past few years with his work on the Archimedes Movement, the work around SB27, the framing around HB2009, the Oregon Health Authority, and so on....

  • (Show?)

    Dartmouth Hater?

    Uh, I'm a Dartmouth '66. Kitz was two years behind me.

  • Bill Bodden (unverified)
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    "I'm with Jack on this one. Kitzhaber keeps talking about an ideal system. Maybe he read too much Plato at Dartmouth."

    This is a valid point, but the other point to note is that if we accept something with severe shortcomings we could be stuck with it for a long time. At the present time, for example, people are offended that there are 40-some (maybe now 50-some) million people (including about 20 million children) without health care coverage. If, as seems unlikely, we get a plan that cuts those numbers in half then we are likely to be in a mode of "only ten million children without coverage so it's not the big deal it used to be" and do nothing.

    The insurance-medical-pharmaceutical (IMP) complex is controlling health care reform just now so lookout for their Trojan horse.

  • Bill R. (unverified)
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    Kitzhaber talks like someone who has always had health care. So he wants to engage in this intellectual exercise while 45,000 Americans go without and lose their life. (Amer. Journal of Public Health- http://baltimore.bizjournals.com/baltimore/stories/2009/09/14/daily65.html )

    I'm getting less and less impressed with Kitzhaber 2.0 .

  • pdx_dem (unverified)
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    Bill R said - Kitzhaber talks like someone who has always had health care. So he wants to engage in this intellectual exercise while 45,000 Americans go without and lose their life.

    (insert sarcasm) Yeah! Down with Kitzhaber! He obviously doesn't care about people without insurance and wishes more people would die due to lack of coverage!(end sarcasm) Oh wait...whuh?

    To me, Kitzhaber talks like someone who has been a ER doctor, a state legislator, a governor, and a visionary. Someone who has seen the system work (or not) from all sides of the story.

    You know Ted Kennedy was someone else who probably always had health insurance? He probably didn't care about the 45,000 who died due to lack of insurance too. Oh wait...whuh?

  • LT (unverified)
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    Great video, Jake, as long as people realize it is satire.

    Saw Sen. Maria Cantwell on CSPAN at the Finance Comm. hearing saying that ending fee for service is a way to cut medical costs---that doctors are good people but if they have to see a certain number of patients every day, they may not have time to answer all patient questions.

    Then she said a public option would promote competition.

    Was Sen. Cantwell talking about an ideal system? Or was she, like Kitzhaber, saying there was more to reform than just whether we have a public option to force competition.

    And what did I hear on the radio today about Mass. ending fee for service?

  • (Show?)

    "the debate over the public option ... is a sideshow. It doesn't matter if we have a public option if what we're buying is the same product,"

    And, conversely, the debate over changing how health care is delivered is a side show as long as it's restricted to dribbles and pilot projects and the occasional larger system like Kaiser Permanente, while most private insurers encourage and pay for what Dr. K wants to change. He's posing a false opposition.

    Ironically he's particularly right on costs. A public option that just means buying more of what isn't working well for people won't be able to control costs because competition isn't the main issue in cost control. This inability is especially profound if it is structured to be like private insurance and prevented from using public sector efficiencies, as all current proposals require.

    Insofar as it gets some currently uninsured people more timely care by less expensive means (though the decline in expense will take the form of not increasing other people's premiums quite so much & thus be hard to see compared to the visibility of the expense in the public budget) which is likely to produce better health outcomes for those individuals and marginally improve population health, those are good things.

    So to is prohibiting exclusions on the basis of pre-existing conditions and restricting actuarial discrimination among classes of persons -- the the insurers probably will use those regulations to jack up premiums far above the actual cost to them.

    But a great deal of what the ex-governor wants to change is in fact driven by the cockamamie financing methods we use plus the incompleteness and fragmentation of the "system," which in fact Dr. K talks about if you watch one of his Archimedes videos or listen to him talk.

    Adding a public plan really does nothing to change those features of the financing.

    Only unified national health insurance that is tax funded will create the conditions needed to systematically change the way health care is delivered. H.R. 676, the Conyers -Kucinich bill, is more than just a financing bill. It explicitly addresses several of the issues Dr. K raises about delivery. Improved and expanded Medicare for all, single payer, national health insurance, call it what you will, it's the approach that has the power to change the overall approach to health care: 1) focus on public health = health promotion, disease and injury prevention; 2) primary care involving regular contact with health providers, which links backward to promotion and prevention and forward to disease management; 3) early stage intervention and management of chronic conditions, by timely diagnosis through primary care & coordination of care -- means sick people are less sick & have better quality of life, treatments can slow and in some cases halt or reverse progression of disease, and treatments are more effective and less expensive; 4) reward providers and methods that support that hierarchy of approaches and for producing better health outcomes, not for either providing or denying "services" per se.

    The connection to financing comes with the fourth piece: the creation of the incentives. Archimedes said he needed not just a long enough lever but also a fulcrum against which to push it in order to move the world. What Dr. K is missing is that proper national health insurance is the fulcrum he and the many who agree with him need in order to get leverage for their ideas.

  • Stephen Amy (unverified)
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    Hear, hear, Governor Kitzhaber!

    The so-called public option comes down to nothing but the government paying for a small part of what we already have, as Governor Kitzhaber said. Democrats should stop talking as if ths so-called public option is a "game-changer".

  • (Show?)

    Robert Harris asked, Do almost all other developed countries provide access to universal health insurance or do they provide universal health care?

    Actually, in France, Germany, and Switzerland, it's universal health insurance. It's a common misunderstanding - on the left and right - that Europeans all have "socialized" medicine.

    In the UK, the doctors are government employees.

    In Canada, the doctors and hospitals are private, but the "insurance company" is the government.

    In Switzerland, the doctors and hospitals are private and the insurance companies are also private -- but they're heavily regulated, much like utilities are here.

  • (Show?)

    Here in Korea the National Health Insurance Plan (NHIP) covers everyone and is paid 50% by your employer and 50% by the employee. My monthly premium costs about 56,200 won (depending on the exchange rate it would be about $60-70) for my half.

    I can go to any doctor or clinic I need to anytime. For instance, I hurt my arm and went to a oriental doctor to get acupuncture (if you haven't tried it it works nice for sore muscles and sprains) and paid 5,200 won per visit (about $6). Never does the doctor have to call an insurance company and as for pre-authorization or have I been denied treatment.

    My understanding is that all the procedures are under a set fee structure that is regulated to keep costs down.

  • (Show?)

    Actually turns out that in the U.K. the docs contract. Other providers (e.g. nurses) are state employees and the state owns the major facilities like hospitals and most clinics. Private medical practice is allowed, I am not sure about private health insurance.

  • billy (unverified)
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    notgoingtosay,How are we supposed to learn from other countries mistakes with universal single payer coverage when we cant even learn from our own mistakes and realize building onto a flawed system just because its been around longer is extremely stupid.

  • billy (unverified)
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    <h2>notgoingtosay,How are we supposed to learn from other countries mistakes with universal single payer coverage when we cant even learn from our own mistakes and realize building onto a flawed system just because its been around longer is extremely stupid.</h2>

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