Health Care Reform Moves Forward

This week, the legislature begins consideration of one of the more intractable public policy issues confronting Oregon--how to provide health care to 600,000 uninsured citizens.  The Senate Special Committee on Health Care Reform begins considering four serious proposals that come from: the co-chairs of the committee, Alan Bates and Ben Westlund; John Kitzhaber's Archimedes Movement; the Oregon Health Policy Commission; and the Oregon Business Council.

The resulting draft bill will include the best elements of each, said Bates, an Ashland Democrat. While the bill's goal has broad bipartisan support, it also faces potential sticking points....

"The health care system we have now is inefficient and often fails to ensure good outcomes," the Health Policy Commission said this month in a 55-page report. "Increasingly unaffordable health care jeopardizes Oregonians' health status and the state's economic future...."

The legislation is written in broad conceptual terms rather than nitty-gritty detail. Key decisions would come later as a proposed Oregon Health Fund Board designed the benefits package.

The four plans have several elements in common, including:

The first legislative proposal is Senate Bill 239, which Bates and Westlund have been promoting across the state

The system envisioned in SB 329 would establish a basic benefit package for all Oregonians. Pre-existing conditions would be covered, Bates and Westlund observed, "because everybody's in...."

The first step toward creating the new system would be passing legislation this session to create the health trust, which would then create the benefit package that would be available to all Oregonians.

Private employers could offer their own insurance independently, but they would be encouraged to join the program to increase the size of the insurance pool, and the benefit package would be rich enough to entice employers to enroll their workers.

A number of unanswered questions remain: how to control medical inflation; what will happen to the Medicare benefit under the Oregon plan; and how to handle undocumented workers.  Still, Bates and Westlund are hopeful to have a bill to the full Senate by mid-April.

Oregonian's comparison of the four plans (.pdf)
BlueOregon post on SB 27, an alternative to SB 329
Archimedes Movement, Governor Kitzhaber's group
Hope for a Healthy Oregon, info from Senators Bates and Westlund
Oregon Health Policy Commission Road Map for Health Care Reform (.pdf)
Text of SB 329

  • JTT (unverified)

    I found this very helpful. I think Sen. Bates and Westlund really have something going here. I saw them in southern Oregon last weekend, and the audience response to their plan was really enthusiastic. Although all the details haven't been worked out yet, it looks like a great direction to me.

  • Bulah Jo McCallaster (unverified)

    JTT: It does look like a great direction. Having Kitzhaber, Bates & Westlund on the same page on health care is a great omen for something to come out this session with one unified health care bill. The seniors I know who use Medicare would like to have that program "updated" if you will, to cover needs that people actually use, like long term care. I think for Oregon to just be allowed to have a discussion about those public dollars would be a victory in and of itself along with setting up the Oregon Health Trust. "Health Care for All, Not Just for $um." is what I say! :-)

  • Madam Hatter (unverified)

    OK. But what's up with this one?

    "Reliance on private insurers"

  • SummaryIsNotAccurate (unverified)

    This thread-starting item contains a blatantly incorrect statement:

    "The four plans have several elements in common, including:

    • Reliance on private insurers;"

    First, SB 27 is a framework for developing a plan, and is not a plan itself. Second, the framework does not contemplate anything that can be fairly characterized as a "reliance on private insurance". Under the SB 27 framework, if the people decided to do it, the OHF could contract directly with health care providers and avoid health care insurers entirely. The SB 27 framework does include a proposal to allow people to purchase supplemental health insurance.

    Don't believe me, read SB27. In addition, look at this table attached to this story in the Oregonian as one summary:

    Look at the first line under "Basic Plan" and you will see the correct statement under the Archimedes Movement column that the framework contemplates a plan:

    "Creates an Oregon Health Fund to pool state, private, federal spending on health care. Fund provides a core benefit for all Oregonians".

    For the AM plan, the OHF card is more like a Medicare card, which actually is a guarantee to the provider they will be paid.

    If you look at the column under the Bates-Westlund plan you will see the misleading statement (read SB 327)

    "All Oregonians can use money from the fund to buy health insurance."

    In general, if you are not eligible for publicly funded health care for the reasons and from the sources that now provide it, you have no access to money "from the fund" to buy insurance. The materials Bates and Westlund use in their road show, and their explanation, say that average folks are required to buy insurance themselves or lose their standard deduction on their state income tax if they don't. Under the B-W plan, as a legal matter, for working people the OHF card is a more like a Costco card, providing you a the opportunity to pay a regulated price to fulfill your compulsory requirement to buy health insurance, than like a Medicare card. B-W are more than a bit disingenuous in their roadshow in this regard.

    You can read the text for the OBC and OHPC to see that uninsured folks who are not eligible for publicly funded health care as we know it now, would have to buy their own.

    Blue Oregonians are owed full disclosure as to who wrote this piece and whether they are a B-W plan supporter. It is my observation B-W plan supporters have been engaging in PR spin trying to misrepresent the B-W plan as having much in common with the AM plan, when in fact that is not true. (I am not active in supporting the AM plan, beyond the fact a version of single-payer is a possibility under the framework set out in SB 27.)

    trying to co-opt support from the AM plan for the B-W pa

  • SummaryIsNotAccurate (unverified)

    JTT may have found the glossy piece put out by the B-W plan to be "helpful",

    but it is a little heavy on the spin, and light on the reality of the of the B-W plan SB 329. (Note in the previous comment that SB 327 s/b SB 329).

    At least it includes this, which supports what I said about how the Oregonian table doesn't accurately convey who pays:

    "3. From that fund, eligible Oregonians receive a Health Card to purchase essential services through an Accountable Health Plan.

    Cost-sharing is based on ability to pay"

    What it doesn't say is that SB 329 says that you are responsible for 100% of the premium if you make as little as 250% of the federal poverty guideline. For 2007, 250% of the federal poverty guidelines for a family of four is a GROSS income of $51,625. Today, I'm betting a family of four would be lucky to find basic health insurance with a reasonable deductible for less than $6000/year or 11.6% of your gross income.

    The more one looks at the B-W, OPC, and OHPC plans, the more questions one (should) have.

  • SummaryIsNotAccurate (unverified)

    In the last two comments "standard deduction" s/b "exemption credit"

  • Greg (unverified)

    Does the current Oregon health care reform plans really solve the health care crisis?

    Universal health care plans for Massachusetts and California are being hailed as “groundbreaking,” in part because the states are trying to do something the federal government has refused to move on. However, there are problems with these plans.

    First, and foremost, these plans still use health care insurance companies to handle the payments for health care services which adds 30-40% to health care costs and provides no oversight of costs and utilization.

    Secondly, these plans still tie health care coverage to employment, while creating a special funding pool to cover the unemployed and others who lack coverage.

    Further, many people who are uninsured or under-insured are working people who have been rejected by health care insurers for pre-existing conditions.

    How will creating a fund to cover these people force insurance companies to cover them? At what costs?

    In his new book, Healing Our Sick Health Care System – A Solution to America’s Health Care Crisis, Robert Gumbiner, M.D. answers these questions and more with real solutions and tested cures —not theories or conjecture--to fix our health care crisis.

    With over forty years of experience, Dr. Gumbiner has been a force in all aspects of health care as a practicing physician, a leader in health care management and education, and key developer of one of the largest managed-care staff model HMO companies in the U.S.

    In the book Dr. Gumbiner discusses:

    How the federal government could provide universal health care prescription drug coverage for everyone-at no additional cost

    How a universal health care plan, funded through employer and employee contributions could reduce the cost of providing health care and result in a healthier and more productive population

    How redesigning the medical education system and eliminating the profit motive of health care would eliminate the current shortage of doctors in the U.S.

    Read the press release below for more information. This is a very timely book.


    Contact: Greg Benedetti 856-489-8654, ext. 303 [email protected]

    HEALING OUR SICK HEALTH CARE SYSTEM A Solution to America's Health Care Crisis by Robert Gumbiner, M.D.


            Robert Gumbiner, M.D. is tired of "destined to fail" solutions from political and self-appointed experts to deal with the problems of health care financing and delivery that plague U.S. health care systems.
            In his new book Healing Our Sick Health Care System, Dr. Gumbiner offers real solutions and tested cures to our health care crisis. The book details how we can redistribute the same amount of money being spent for today's malfunctioning system to provide health care for everyone. Dr. Gumbiner explains how to eliminate duplication, errors, over payment and misuse of funds—all of which currently inflate health care costs.
        With more than forty years of experience, Dr. Gumbiner has been a force in all aspects of health care: as a practicing physician, a leader in health care management and education, and a pioneer developer one of the largest managed-care staff model HMO companies in the United States. Dr. Gumbiner is also a man on a mission.
            His mission is to effect policy change by sharing his extensive knowledge and experience—which include his first hand research of health care systems worldwide— to provide practical solutions to fix the current health care crisis and, in turn, to provide affordable health care to all segments of society.
            "My book is not based on theories or conjecture--and it is certainly not about me trying to capitalize on the current health care craze. I have lived and breathed these concepts since 1965 when I created one of the first HMO prototypes in California. I developed a forty-year model of how to run a large, successful health care system that can provide services to everyone. I believe the public needs to know this information."
            In Dr. Gumbiner's new book Healing Our Sick Health Care System, he offers real solutions and tested cures to our health care crisis, including:

    How we can redistribute the same amount of money being spent for today's malfunctioning system to provide health care for everyone.

    Essential information the public needs to know about the health care crisis, which is clouded by political rhetoric.

    Why previous plans offered or discussed related to the health care crisis were destined to fail from their inception.

            Dr. Gumbiner's commitment to fixing health care is indisputable. Throughout his many years as a practicing physician and a health care manager, he has written and published numerous articles on health care delivery systems in the United States and other parts of the world, published three books about health care, and has a special interest in exploring health care systems throughout the world
            Dr. Gumbiner was born in 1923, received his B.S. from Indiana University in 1944 and graduated from Indiana University School of Medicine in 1948. After graduation he enlisted in the Air Force as First Lieutenant in the Korean conflict.

    Early in his career he worked as a pediatric resident, public health officer, in an industrial trauma clinic, and for an early group prepayment program in Los Angeles Later he started a solo private practice and soon moved to developing group practices. Realizing the limitations of the group practice sector and because of his dislike of the system of collecting fees from patients for medical services, he incorporated one of the first prepaid group practices in 1965.

         In the late 1960's he established the first pilot project for the State of California for the provision of pre-paid health care to the MediCal/Medicaid government program to the poor. That was followed in 1985 by the first contract for prepaid health care for Medicaid, the federal program for the elderly on the West Coast. Dr. Gumbiner created the Family Health Plan, later called FHP, which spent its formative years as a non-profit organization, and developed into a public company with 55 medical centers, four hospitals serving one million people in seven western states.
        Currently, in addition to his interest of exploring world health care systems, for the last ten years Dr Gumbiner has been developing his passion for art as the Founding Chairman of the Museum of Latin American Art (MoLAA), in Long Beach, California and the Ethnic Art Institute of Micronesia. MoLAA is the only museum in the United States dedicated exclusively to the contemporary fine art of the Latin American countries.

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