Shaping a better health care future:
OREGON'S HEALTH CARE SYSTEM
John Kitzhaber
The Oregon Better Health Act -- Senate Bill 27 -- was introduced last week in the Legislature, initiating a long overdue re-evaluation of the structure of our current health care system. The bill would create a process to ensure that all Oregonians have access to treatment for a set of essential health conditions and would realign financial incentives to ensure the transition to a more efficient delivery system.
Some legislators have asked why Medicare has been included in the bill. The answer is simple: It would be irresponsible not to include Medicare in light of the growing number of people who depend on this federal program. Today most older Oregonians rely on Medicare, as do many living with disabilities. Yet because of our aging population and escalating costs, Medicare will come under enormous fiscal pressure in the years ahead, raising the sobering question of whether it is financially sustainable over time.
Why? Because the 41 million people on Medicare today will soon be joined by 78 million baby boomers, who will start becoming eligible for Medicare in 2011.
Today Medicare accounts for about 9 percent of all federal income taxes, a number that will reach 19 percent by 2015 and 32 percent by 2025. Medicare's total unfunded liability is more than $65 trillion. So the question we must confront is how to sustain the program into the future -- which is exactly what the Oregon Better Health Act proposes to do.
The intent of the legislation concerning Medicare is clear: to look at the current program in light of the demographic trends and advances in technology that have taken place since it was created in 1965; to identify the medical needs of an aging population; and to ensure they are met with cost-effective treatments producing quality outcomes.
As it's currently structured, Medicare fails to meet many of the needs of an aging population. For example, almost all older Oregonians require supplemental insurance policies because Medicare alone is inadequate. Medicare also doesn't cover the long-term care services often associated with chronic conditions. So seniors who need these services must sometimes liquidate the assets they worked a lifetime to acquire, spending themselves into poverty so that they can become eligible for the state Medicaid program that does cover long-term care.
Not only is this unfair to older Oregonians, it pits their needs directly against those of poor women and children who also depend on Medicaid. Surely we can do better.
Endorsing the Oregon Better Health Act does not entail endorsing a new system or making any changes to Medicare. It means endorsing an open process, an honest effort to ask -- and to answer -- a number of central questions that are not currently part of the national debate.
Oregon is still a place where we can join as a community to discuss important questions that affect us all, even if they don't have clear-cut, easy answers. All Oregonians should participate in this process. Together we can shape our own future.
John A. Kitzhaber was governor of Oregon from 1995 to 2003 and is founder of the Archimedes Movement to promote health care reform.
