The following appeared in the Eugene Register-Guard on May 21, 2007, as part of a biweekly series of columns on health care reform.
Health care will be a major campaign issue in 2008, but if the debate is to result in meaningful reform, it must be framed around the true causes of the crisis, not around symptoms.
Unfortunately, most presidential hopefuls, as well as state reform efforts – including those in California, Maine and Massachusetts – have defined the issue narrowly as an insurance problem. In reality, the growing number of uninsured people is a symptom, albeit a serious one, of three more fundamental problems.
• Our current federal eligibility and financing structure reflects the obsolete circumstances of mid-20th century America rather than the realities of today.
• Today, we don’t define a health care “benefit” in terms of the health produced.
• Because financial incentives are misaligned, the system through which health care is delivered is inefficient.
These three factors result in the escalating cost of health care and, as a consequence, the growing ranks of the uninsured.
If health care “reform” fails to control cost, we will not have accomplished anything. And getting everyone “covered” without answering the question “covered for what?” will not control cost. Nor will coupling an innovative financing scheme to an economically unsustainable delivery system. To control cost we must treat the underlying causes of medical inflation, not merely the symptoms.
For example, any reform effort that ignores the economic and demographic realities facing Medicare will not be sustainable. AARP appears to agree in its May 2007 periodical The Bulletin: “With the first surge of boomers hitting 65 in four years, there’s a seismic gap between what’s been promised and government’s ability to pay. Two facts underscore the challenge of finding a solution.
“First, the problem compounds by the minute, as workers see employers trimming pension plans and retiree health benefits. Second, Congress is too paralyzed and polarized, and the administration too inflexible, to seriously confront the challenge.”
While we cannot hold our breath waiting for a solution at the federal level, Oregonians can come up with a plan that creates an explicit link between our work here in Oregon and the pressing need for health reform nationally.
We believe we can do this without placing anyone currently on Medicare at risk or compromising the benefits that contribute to their health.
Controlling unsustainable cost escalation depends on re-evaluating what we mean by a “benefit” and by restructuring the way in which health care is delivered. We do need coverage to ensure that all of us have financial access, but what we need access to is not the current system.
We need access to a system that produces health, not one that simply reacts to sickness; we need a system that organizes the delivery of care efficiently and pays for what works. We need access to a system that treats us fairly and does not pit equally impoverished citizens against one another – the old against the young, the rich against the poor.
Motivated by the belief that we can do better, the Archimedes Movement was launched in January 2006. Oregonians have worked together to create a shared vision of what a better health care system should look like.
The result is Senate Bill 27, the Oregon Better Health Act, now before the Oregon Legislature. This bill is the product of a remarkable process of engagement involving physicians, nurses, hospital executives, insurance and health plan executives, employers, organized labor, people on Medicare, representatives from AARP and more than 7,000 consumers from all across Oregon.
Passage of SB 27 will initiate an honest and long overdue re-evaluation of the current system and offer an alternative with which to replace it. It creates a vehicle through which Oregonians can develop a plan to ensure that all of us have access to care for a defined set of essential health conditions. And it will offer a proposal to implement the plan for consideration by the United States Congress as the basis for national reform.
I urge Oregonians to become a part of this effort by going to our Web site: www.wecandobetter.org.
We must seize the opportunity provided by the upcoming presidential election to force a conversation of substance. But without elevating the debate about health care above the question of insurance coverage, the opportunity will be lost, and the ranks of the uninsured will continue to swell.
Spending more money on bad medicine won’t lead to better health, for Americans or for the health care system. We can do better.
John Kitzhaber, an emergency room physician and founder of the Archimedes Movement, was governor of Oregon from 1995 to 2003. This essay is the seventh in a biweekly series of columns on health care reform.
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