Thanks for the clue. You got my attention. This could get done with the awesome coalition that could be assembled. I think you'd be able to draft an army overnight, from the purest lefties to the most luke-warm Dem...with some Reps added as well.

Amazing. A light at the end of the tunnel, and it's not a train!

This is great news, but why not SINGLE PAYER? I heard Wyden himself say that single payer would also be an option under his law.

If Mitch Greenlick is reading BlueOregon, I would love to hear his thoughts on bringing single payer or the public option to Oregon.

Didn't we have a single-payer ballot measure back in 2002?

http://en.wikipedia.org/wiki/Oregon_Ballot_Measure_23_(2002)

Richardson also noted the state anticipates a $2 billion shortfall going into its next biennial budget. If a public option were created, low-income residents would receive subsidies for coverage, which would have budget consequences.

I thought the federal gov't is providing subsidies (by 2014 anyway when the mandate goes into effect). So what's the state having to pay?

And why does the existence of a public option require subsidies for low-income residents? I don't see the correlation. Am I missing something?

Any public option without single-payer would have to clear the obstacle of adverse selection. That's where so many people with high expenses sign up that the cost to everybody in that plan becomes prohibitive. I don't know offhand how best to ensure a broad enough membership to avoid that problem.

Don't forget the individual insurance market. If the public option's premiums are lower than what I'm paying now, I'll be all over it.

Sen. Dr. Bates is a true leader on this issue. Thanks for the post.

Rather than the political re-making of history.

Sen. Dr. Bates is a true leader on this issue. Thanks for the post.

Actually, nothing could be further from the truth.

Bates and Westlund in the Senate, along with the Senate and House Democratic leaders, originally opposed any form of a public option in the SB329 legislation passed in 2007 that created the Oregon Health Fund Board that met all through 2008. And they spiked Kitzhaber's SB27 bill, which would have required the OHFB specifically study a publicly-owned alternative, when it along with other provisions as left out in the final SB329 even as the Democratic leadership disingenuously claimed they had merged the two.

The directive to study and propose legislation for a publicly-owned alternative, but not actually create a publicly-owned alternative, is in HB-2009, Section 9(L) that was passed in the 2009 session to create the Oregon Health Authority:

(L) Develop and submit a plan to the Legislative Assembly by December 31, 2010, with recommendations for the development of a publicly owned health benefit plan that operates in the exchange under the same rules and regulations as all health insurance plans offered through the exchange, including fully allocated fixed and variable operating and capital costs.

Note also, this not just a "public option", it is for a "publicly owned alternative". That language is not accidental. It in fact was the result of a year's very hard work by grassroots groups (from outside the Portland-Salem access, and in fact, outside of Bates' district) over considerable underhanded opposition from Democrats in the legislature, but with key Republican support. No small part of that opposition was specifically Democratic legislators wanting the meaningless term "public option" rather than the very meaningful "publicly owned alternative". And only agreeing to study the concept rather than mandate the OHA just create it.

Also, Ron Wyden refused to be publicly supportive, as did Merkley (Statistics suggest Novick could have beat Merkley on the strength of that grassroots support if he had stepped up to the plate.) Furthermore, Ron Wyden's Healthy American's Act, the key concept being strengthening the private insurance industry in the form of a mandate with no public option that has been largely adopted in the Federal plan, was publicly opposed by those working for this provision and a public option in Oregon in the OHFB process.

torridjoe has highlighted the key deceit in Wyden's bill and the passed bill: The waiver obstacle to a publicly-owned alternative. I don't know how much torridjoe was privy to or followed the work of grassroots groups to get the public option into the OHFB, but he is the only commenter here who seems to have insights into the real history and the problem.

The waiver is solely at the discretion of the Administration by Wyden's (and Bates?) intent, and not at the discretion of the state, and the Administration can make the terms of any waiver such that a state publicly-owned alternative is disadvantaged relative to private insurance plans in any number of ways. And all evidence so far has been that any such waiver would be so structured. So far, those with the expertise who were involved in the Section 9(L) of HB2009.

Finally, watch out for any plan based on the Oregon's SAIF model, preferred by Oregon's Democratic establishment, rather than Washington's L&I model. The former is an independent corporation that has no fiduciary obligation to the people of Oregon, while the latter is a public agency that is directly responsible to the people of Washington. And ignore anecdotal noise that Democratic leadership in Oregon will through out to support a SAIF-style solution. Study the real statistics and history of the two approaches.

torridjoe, there's your angle for evaluating a waiver application.

And this is a good example why no one should believe much of what Blue Oregon political flaks. Too often they either don't know the history or distort it for purely political reasons.

Also, if you really want to see a sound, sustainable, publicly-owned alternative in Oregon, you would oppose Kulongoski's and Kroger's grandstanding stunt, wasting the taxpayer's money, of filing an amicus brief on behalf of the current corporate welfare law.

Kulongoski was one of those Democrats who did nothing to support the work that led to Section 9(L) and in his passive-aggressive way, like the rest of the leadership, did everything they could that would insure that section never happened.

Instead you would hold Bates' and the Democratic leadership's feet to the fire and demand they direct Kroger to file a challenge to the mandate WITHOUT a publicly-owned alternative. Despite the semantic games Kari and others here have played, the current fine is not a tax you pay if you don't purchase private health insurance (or your employer pays if it does not furnish you with health insurance). It's not a tax because neither you nor the employer has any remotely connected benefit, ie. you still don't have a minimum level of adequate health insure.

If there were a mandate WITH a publicly-owned alternative, the tax would be a tax because the proceeds were used to enroll you in the publicly-owned alternative. The "mandate" in fact, from a legal perspective, would be the opportunity to opt-out of the publicly-owned alternative.

Furthermore, if the mandate is struck down Congress, under state pressure, almost certainly will have to revisit the publicly-owned alternative. If and when they have to do that, it is to the benefit of Oregon because it will make it more likely we can create a sustainable publicly-owned alternative tailored to Oregon's needs. And small-business friendly Republicans will find good reason to be helpful.

It's in the hands of Kulongoski, Kroger, Bates, Greenlick, and the rest of the Democratic leadership to prove they are not just playing politics here, and to actually make the right thing happen.

Those of you who have mindlessly defended this corporate bill, riddled with loopholes and no cost controls as it is, as a "start", well here's how you actually prove that: Put pressure on the DPO, the Democratic legislative leadership, and Kulongoski to put pressure on Kroger, including primary'ing him, to file federal suit against the mandate WITHOUT a publicly-owned alternative. Not by filing suit to defend this corporate welfare and a waiver system, which at the very least will cause Oregon to waste significant time and money. With the probable outcome of a lower quality publicly-owned alternative than would be the case if the mandate was allowed to stand only if there were a publicly-owned alternative.

Plus, don't you want your fellow citizens in other states where grassroots advocates have not been able to keep pressure on unreliable allies in the Democratic leadership as in Oregon to have the same access to a publicly-owned alternative?

Don't continue to be played as a fool like the Democratic leadership nationally and in Oregon has done, and their flaks have down, for their own political advantage for sometime now.

torridjoe - there's your second angle for assessing the whole Democratic charade nationally and in Oregon.

Posted by: The Truth | Apr 2, 2010 8:30:13 AM

Rather than the political re-making of history.

Sen. Dr. Bates is a true leader on this issue. Thanks for the post.

Actually, nothing could be further from the truth.

Actually, I think we'd all like to be further away from "The Truth".

Thw Truth should be renamed to, The Truth as I percieve it. Very slanted of course.

IF there were to be a public option, the model of SAIF is far superior to Washington's L&I for workers' compensation. L&I is one of the top 3 reasons Boeing is expanding the second &*& line in SC rather than in the Puget Sound region.

The individual mandate is being challenged at the federal level and if successful could be a major blow. Would an individual mandate for OR pass our constitutional review?

20 somethings are an excellent source of plan revenue to offset others plan costs. Unfortunately, ObamaCare's age 26 mandate will have most 20 something's remaining on mommy's and daddy's plans without adding a dime to the payer revenue side. That idea, while interesting is out.

I could agree with trying a state public option as long as it didn't cost me, or employers anything over what ObamaCare has us paying now. Which brings up the 1% tax enacted last year. Would that be repealed as unneccesay under ObamaCare?

Single payer in Oregon is a joke. How could Salem effectively design, implement and run single payer when they can't even design and implement their own state-wide computer system effectively?

I was too rough. I think Trooth's heart is in the right place. His characterization of Teddy the K is certainly spot on.

Kurt Chapman - you raise fair points and so I think they deserve consideration and answers:

IF there were to be a public option, the model of SAIF is far superior to Washington's L&I for workers' compensation. L&I is one of the top 3 reasons Boeing is expanding the second &*& line in SC rather than in the Puget Sound region.

Of course, there are two challenges to this comment. First, it is a case the "Fallacy of the False Generalization" (no pejorative intended there in "Fallacy", that's simply a term of art.) It is the general business climate, of which L&I is one contributing component, that results in the employment of several hundreds of thousands of people in the Puget Sound. Even in this economic slump, Seattle remains one of the centers of new business creation in the nation. Second, it embodies the "race-to-the-bottom" argument that because Boeing decides to go to SC where worker protections including workman's comp are far less, and therefore that is a justification for doing what SC does rather than what WA does. After all, the business climate SAIF is part of in Oregon didn't induce Boeing to build the plant here.

That said, and I hope taken in the spirit of intellectual debate it was intended, I agree with most of your other points. Notice also in what follows I distinguish between:

1) "public option" - which in Oregon now is a term used as a conceit for the state acting as an insurance agent for the industry and other entities offering insurance products. To date, this is how Bates and Wyden have actually used that term. Sadly, SAIF is closer to this than anything else because of it's fiduciary structure.

2) "single payer" - which in theory is a good approach. But we don't live "in Theory", we live in Oregon, USA. We would only get to a single-payer solution if people actually decide they want that as the result of an evolutionary process. The current HCR bill is NOT a first step in that process because it explicitly rejects that very premise. Rather, HCR is more than a continuation of our headlong dash down path 1).

3) "publicly-owned alternative" - an alternative like Medicare A+B+(mostly)D, L&I, etc. offered alongside offerings from the private insurance industry. The chance for individuals and businesses to "vote with their dollars" and let the market decide. The thing that the insurance and medical industry, politicians, professional health care advocates, organized labor, and everybody else with a place in the status quo, including Blue Oregon that really is a defender of the status quo, absolutely were together committed to make sure didn't and doesn't happen for obvious reasons.

The individual mandate is being challenged at the federal level and if successful could be a major blow. Would an individual mandate for OR pass our constitutional review?

If a mandate WITH or WITHOUT a publicly-owned alternative were struck down as unconstitutional on First (or less likely Fifth) Amendment grounds, then it's really hard to see how an OR mandate WITH or WITHOUT a publicly-owned alternative would be constitutional. Personally this seems to be the most unlikely outcome.

If it is struck down on Fourteenth Amendment grounds, then we don't know. The problem with the current Republican challenges is that they are really using this issue to challenge abuse of the Commerce Clause, something that needs to be done to be sure, rather than the real abuse in this bill because they actually kind of like welfare for the insurance industry. Nonetheless, In the current political climate, this may be a possible outcome. If that happens, OR may be free to do what it wants, pending further court challenges on other grounds.

If the mandate WITHOUT a publicly-owned alternative is struck down but a mandate WITH a publicly-owned alternative would be constitutional, then clearly OR could fashion a constitutional solution. I see this as the least likely outcome, only because right now few are fighting for it. (Word has it there could be progressive challenges on this basis coming though.)

As often is the case, there are actually three possibilities here, not just two.

The dishonesty by Kulo and Kroger and all the bogus progressives who want to defend the bill in court are that they don't really have a problem with welfare for the industry and there are cheap political points to be scored.

20 somethings are an excellent source of plan revenue to offset others plan costs. Unfortunately, ObamaCare's age 26 mandate will have most 20 something's remaining on mommy's and daddy's plans without adding a dime to the payer revenue side. That idea, while interesting is out.

You are exactly right. But if we had a publicly-owned insurance system everybody is insured in their own right and the healthy are contributing as part of the social contract it will also be there for them. Everybody seems to conveniently forget that Medicare is part of the SSI system, where SSI stands for "Social Security Insurance" and FICA stands for the "Federal Insurance Contribution Act". That's not just word play, the system is insurance as an unarguable matter of legal and substantive fact.

I could agree with trying a state public option as long as it didn't cost me, or employers anything over what ObamaCare has us paying now.

There is only one solution that indisputably does that: A national public insurance system which has the lowest overheads and the unified buying power to buy medical services --- from doctors, hospitals, drug companies etc. who remain for-profit private businesses --- at the best bulk prices. It's unarguable economics that it will save you and employers money. The "public option", probably SAIF-like, waiver-based monster that Bates and Wyden appear to be cooking up very likely could be fatally knee-capped from the get-go and just an extension of OHP and other public programs. Which now are largely passthroughs to private insurance entities as noted earlier.

Would a state-level publicly-owned alternative, eg. the L&I model, HB2009 requires the OHA to design would meet could be successful? Honestly, we can only know it stands the best chance if we can stop Democrats who quit being Democrats long ago from playing games like Wyden and Bates may be doing. Bates can end this by simply saying he stands behind OHA carrying through on Section 9(L) of HB2009. And a successful court challenge which only finds a mandate WITH a publicly-owned alternative constitutional would do the most to re-arrange the legal and political landscape to create a national environment which is most conducive to the success of state-level solutions. Or even obviate them.

Single payer in Oregon is a joke. How could Salem effectively design, implement and run single payer when they can't even design and implement their own state-wide computer system effectively?

Well, the answer there is, if the same people and power establishment do it, you are right it will not succeed because they don't really have an interest in seeing it succeed. (Which is different from saying they would defend it if it does succeed and become the status quo.)

The truth is, whether you accept it or not because the documentary record is unequivocal, HB2009 Section 9(L) was the result of over a year of very hard grassroots work. Democrats elected officials worked harder than Republicans at undermining that work. So "Salem" by itself can't. But if the people actually force Salem to get the voices at the table who can, and they are out there as HB2009 Section 9(L) proves, "Oregon" can. And note, this isn't the alphabet soup of long-standing self-appointed advocacy groups (and blogs like Blue Oregon) who really just defend the status quo because they have a place in that status quo.

They even depend on "grassroots" opposition so they have a reason to deny those other voices a place at the table. Just look at how the Democrats in DC managed to sell a plan that originated at the Heritage Foundation to "progressives", because they could point at right-wing populism that had been co-opted by the same forces and say "it's us against them".

So after not only taking the time to respond to each of your points, but even agreeing you are correct on the substance in most points as far as they go, if you actually mean them, here's the reason you should support a publicly-owned alternative in Oregon: It's very good for small business and most of the kinds of businesses that employ most Oregonians. The political grandstanding by K&K, and apparently B&W, is not. And there may be more Republican support there for that reason than you believe. Of course, we also have to keep some of their misguided ideology and political point scoring out of it too. To do that, put pressure on Democrats particularly to do the right thing and not try to fall back to the same voices defending the same status quo.

Truth, thank you. I re-read your insightful post 3 times. We may disagree on which wc model is better, L&I or SAIF; but after working in both systems I certianly find that SAIF provides better service, more injured worker protections and better cost models for employers.

The rest of your post is something I agree with mostly and appreciate your in-depth background information. Unfortunately, most of the challenges will be on 14th amendment grounds and therefor provide little guidance. since both public option and single payer are not on the table, even 1st or 5th amendment challenges would not speak to those alternatives. I welcome the challenges personally. A bill of this nature should be scrutinized at the highest level (like the Patriot Act should have been chgallenged). then if it passes muster we have something, like it or not; imperfect or not.

The real problem is that politicians, like Orwell's pigs are more equal than the rest of us. They are genetically incapable of creating a system that helps everyone, is equally funded and is self sustaining. The much vaunted Japanese system is one such example.

Trooth(iness): I think you're confused about the difference between a state insurance exchange for the individual and small business market and the creation of a "public option". As I understand it, Bates et al. are interested in modifying OHP so it can accommodate a buy-in population that can use their own dollars, possibly leveraged with a federal match. This would be different from the exchange. I would imagine that there would also be an exchange for people to buy through private insurance companies, or a public corporation that is established as an entirely new insurance entity (to compete with BCBSO/Providence/ODS/HealthNet/etc)--the public option. I could be wrong, but that was my understanding from the original Senate Interim Commission work to SB329 through HB2009.

BTW- were you a part of the Archimedes Movement in 2007? Why the rage about the failure of SB27 to get enough support to get out of committee? I think Bates and Westlund worked really hard to incorporate almost all of Kitzhaber's proposal into the final bill. And why are you demanding that Bates express support for this specific provision in HB2009? He helped draft the bill and voted for it, didn't he? I just sense some bitterness that I can't understand.

Truth, thank you. I re-read your insightful post 3 times. We may disagree on which wc model is better, L&I or SAIF; but after working in both systems I certianly find that SAIF provides better service, more injured worker protections and better cost models for employers.

Happy to have had the communication with you Kurt Chapman. You appear to be one of the (few) people here who knows what actually is going on, and the bit of personal history you've provided here explains why. And I would get behind a SAIF approach if that's what it takes to get the OHA to deliver substantively on HB2009 Section 9(L). (And I suspect that is what the OHA would propose, anyway, because Oregon has experience with it.) So we actually would be on the same side there, with your knowledge providing the lead.

Trooth(iness): I think you're confused about the difference between a state insurance exchange for the individual and small business market and the creation of a "public option

HB2009 directed the OHA to create an exchange as well as re-organize the state "public" programs for low-income people. The U.S. Senate legislation now requires states to do both. Oregon HB2009 Section 9(L) deals with creation of a publicly-owned alternative that individuals who don't have employer-sponsored coverage that would be in the (state) exchange, and that employers could offer as a "benefit" to meet any state or federal mandate that survives court challenge. What makes Bates proposal less than it might seem is that he apparently is not advocating that Oregon seek a waiver to support what HB2009 calls for, but instead go through that waiver exercise to simply buff-up the status quo that actually extends the private insurance industry welfare bill Congress passed.

I understand it, Bates et al. are interested in modifying OHP so it can accommodate a buy-in population that can use their own dollars, possibly leveraged with a federal match. This would be different from the exchange

You assertion confirms my understanding. aAnd that was exactly my point. The announcement by Bates, who explicitly opposed a true publicly-owned plan in a meeting I once attended, and the spin here by Kari and Blue Oregon, are misleading by even calling it a "public option". But his proposal is completely in accordance with the definition of a "public option" I offered as a reflection of the current reality post-HCR. At this point, "PO" has been reduced to little more than a propaganda term meant to re-brand (and re-sell) private health insurance in a way that "progressives" and Democratic politicians like Bates can mouth as cover.

The OHP is largely, and FHIAP entirely, are systems in which the state is an agent for private health insurance providers. Moreover, the OHP is now a health-insurance ghetto since in large sections of the state, including much of the I-5 corridor, there is only one HMO-style private plan available to recipients because no one accepts open-card. At this point, it appears all Bates is proposing is opening up OHP eligibility, since he didn't mention at all HB2009 Section 9(L) and support for that. But that is a bad plan for individuals. And although small business would see some advantage if the quid pro quo was to relieve them of their mandate(s), in the end it is not really the best for small business because it is not the most cost-effective way to produce the best results for the workforce.

And in the current form of the OHP/FHIAP, it is just another way for Democrats to help private insurance companies to defend their windfall.

BTW- were you a part of the Archimedes Movement in 2007? Why the rage about the failure of SB27 to get enough support to get out of committee? I think Bates and Westlund worked really hard to incorporate almost all of Kitzhaber's proposal into the final bill.

I was not part of Archimedes in 2007 because "in Theory" and grand schemes for re-architecting the political system were not what a lot of grassroots health care reform advocates circa 2007 wanted to spend the limited time they had for political advocacy. The AM explicitly described health care reform in 2007 as just a good "kick-off" project for a different political agenda and we see how that has developed in the AM 2010 version. But there was plenty of contact between AM folks and a larger grassroots effort.

And you are only partially correct about what Bates and Westlund actually did. What they did was slightly reword SB329 to reflect some of the non-actionable verbiage and those actionable components of SB27 which were already in SB329, but omit much of the meat of SB27. One key point is that if the meat of SB27 had been included, the OHFB board would have in fact been a far more wide-ranging exercise that would have given the OHA a different action mandate rather than primarily just re-organize government departments as happened. Funny thing is that it was the grassroots people who then engaged with the OHFB process on many dimensions. The AM people seemed to have decided that working on practical, progressive, health care reform in Salem and DC in 2008-2009 wasn't quite the political organizing tactic they thought it might be, and headed down the path that has given us AM 2010 and their plan now to be some kind of national political something or other.

And why are you demanding that Bates express support for this specific provision in HB2009? He helped draft the bill and voted for it, didn't he?

You are less correct here. The Oregon Health Fund Board's charter was to draft the actual legislation the legislature would then handle like much legislation that originates from outside the legislature (which is a lot in Oregon). As already mentioned, it is because of knowledgeable and sustained work by grassroots groups that the bill includes several things, such as Section 9(L), that Bates and the Democratic leadership didn't like, but knew they had no choice but to support. Kulogonski actually tried to propose weaker, fragmented, parallel legislation, and with that tactic by Kulogonski as part of the debate, did in fact diminish and fragment the bill where they could. In particular, and not surprisingly, they put a lot more emphasis on re-arranging the deck chairs in government in ways that supposedly freed up more dollars to prop up the true status quo of a private health insurance based system. Just like in DC.

<h2>An accurate frame for the work of the Democratic leadership in Salem in early 2009 and is in DC in late 2009-early 2010 is not what they accomplished, but what they managed to thwart but spin as accomplishment.</h2>