[This guest editorial, by We Can Do Better executive director Liz Baxter, was published on Feb 4, 2010 in the Eugene Register-Guard.]
Now that the Measure 66 and 67 campaigns are behind us, Oregonians may believe that the difficult revenue and financing decisions facing the state are also in the past. Passage of the two ballot measures allows Oregon to operate within the budget approved during the 2009 legislative session, but it doesn’t mean that those programs are funded at the levels that would allow us to improve the health, education and public safety of Oregonians, or lower the overall cost of these services.
We have lots of work ahead of us.
More than 90 percent of the state’s general fund budget goes toward education, public safety and health care services, leaving little flexibility when general fund dollars are scarce. Oregon, like many other states, uses some of its general fund dollars to leverage the ability to bring in federal dollars to support programs in Oregon. Health care is one of the areas where a combination of state and federal dollars is used to meet the needs of Oregonians.
In House Bill 2009, the Oregon Legislature laid the groundwork for all Oregonians to have access to affordable, high-quality insurance coverage by 2015. Achieving that will require some investments on our part. Further, simply giving everyone access to the current system won’t lead to improved health, which is ultimately our goal. We must do more.
To create the health system we want in the future, some things we have today will stay, some will need refining, and some pieces need to be built. One example is electronic health records. We have significant infrastructure to create if we want a system that allows the sharing of test results in real time, improves the ability to easily get information from provider to provider, and allows for a streamlining of billing, reimbursement and reporting.
We believe that both sides of the Measure 66 and 67 campaigns had Oregon’s best interests at heart, even though they disagreed on the strategies the state should take. We need to have a much deeper and broader conversation, one that allows us to talk about difficult trade-offs, especially in times of economic downturn. That doesn’t always happen during a campaign, but after a campaign seems like a good time to begin.
Oregonians have debated complex issues before, including how to prioritize health services for the Oregon Health Plan, death with dignity laws and medical marijuana. We are not a state that shies away from the complexities, and we are not naive. However, if we don’t have a way to weigh in on these tough choices, we are left with having others translate the trade-offs to us.
The public’s reaction to recent decisions by Congress about how it will refine the health reform bills has left many people confused, frustrated and perhaps ready to say “there’s no way they can fix this.
The reality is that Congress can’t fix the health care system without us, and without agreement on what we want the system to achieve. If Congress’ goal remains to make sure that all the current stakeholders don’t lose anything, we will continue to have the system we have today — only less of it, because we cannot afford it in the long run. If instead they want to create a system whose goal is health, the path to get there becomes clearer — as well as where the changes and investments are needed.
The Archimedes Movement (We Can Do Better), with its mission of civic engagement, has focused on health reform for the past four years, providing information and education for those who wanted to be engaged but didn’t know how. We believe that any sustainable solution requires public engagement before, during and after decisions are made. Ultimately the system that’s created is accountable to the taxpayers and voters.
It’s up to you. Build a relationship with your state and federal representatives; learn about how services that are important to you are paid for and how decisions are made; vote; and learn from those who disagree with you. You might find that you agree on the underlying principles and can learn from each other to develop strategies. We want a solution that works for all of us, not just some of us.
This isn’t the only lean economic year Oregon has ever faced, nor will it be the last. The challenges before us will include more tough decisions on how we allocate scarce public resources, and how best to prepare for the next recession or economic downturn. We are all in this together.
Liz Baxter of Portland is executive director of the Archimedes Movement (www.wecandobetter.org), a group founded by Oregon Gov. John Kitzhaber to promote civic engagement.
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