January 6, 2011
In Oregon, a New Health Care Debate Awaits
By John Gramlich, Staff Writer
PORTLAND, Oregon - Oregon Governor-elect John Kitzhaber, a Democrat who will be inaugurated in Salem on Monday (January 10), is no stranger to the state's top political office: He was a two-term governor between 1995 and 2003. In November, he defeated Republican Chris Dudley to win an unprecedented third term as chief executive.
An emergency-room physician by background, Kitzhaber, 63, also is no stranger to the nation's health care system, which he sees as costly, ineffective and unsustainable. He intends to tackle the challenge right away in Oregon, vowing to "fundamentally change the way health care is organized and delivered" in his state.
Stateline caught up with Kitzhaber December 27 in Portland to discuss his plans, as well as the new federal health care law. An edited transcript of the interview follows.
Q. How does your background as an emergency-room doctor inform your perspective on health care policy?
A. When I was (Oregon) Senate president, making decisions at the legislative level that disenfranchised people from coverage, for a lot of my colleagues it was a sterile accounting exercise.
When I went back to my ER (after serving in the Legislature), I started seeing some of the people come in who actually had lost coverage because of our legislative decisions. One man in particular had had a massive stroke because he couldn't access medication for his blood pressure. It gave me a real interesting perspective about the relationship between policy decisions and what happens to people at the point of delivery.
Q. You've said that the new federal health care law is health insurance reform, not health care reform. Can you elaborate on that?
A. Most of that legislation - and most of the health care debate in America for the last 50 years - has been how to pay for health care. I don't think the problem is how you pay for health care. It's what we're buying. We're buying a product that is very ineffective, very inefficient, and doesn't have real impact on population health.
Our population health statistics in this country are a little bit better than Cuba's, and we spend huge sums of money. So, ultimately, we have to change the way health care is organized and delivered, and we need to recognize that the objective of the health care system is not simply to finance medical care. It's to keep people healthy.
(Regarding the federal health care law), I'm a big supporter of the bill because, at the end of the day, people do have to have a way to pay for health care. You do have to have financial access. But there's nothing in the bill that's going to control costs.
What we're hoping to do here in Oregon is fundamentally change the way health care is organized and delivered - to shift that focus from after-the-fact...to prevention and wellness and community-based management of chronic conditions.
If we can get more flexibility with how we spend those new (federal) dollars when they come in, we want to finance a different delivery model.
Q. What sort of flexibility, exactly, are you seeking from the Obama administration?
A. I'll give you a real quick example.
If you're a 90-year-old woman living by herself in an un-air conditioned apartment and you have congestive heart failure, and there's a heat wave and the ambient temperature in your apartment goes up to 105 degrees, that's enough strain on her system to put her into full-blown congestive heart failure.
The system today will pay for an ambulance to take her to the hospital and $50,000 to cure her. It won't pay $500 for a window air conditioner, which is really all she needs to stay in her home and out of the acute medical system.
We want flexibility to actually design a delivery model that's focused (on) and rewards prevention and wellness and community and home-based management of chronic conditions.
Q. Governor Jan Brewer in Arizona is asking for a waiver from the federal government so her administration can cut people from Medicaid. You also will be seeking a waiver, but you're taking a different approach.
A. You can cut people from Medicaid, but where do they go? They go to the emergency room, and so then you're paying for a stroke rather than managing their blood pressure. They don't go away.
The only way that saves you money ... is if you also pass a law that says, 'If you show up at the ER without insurance coverage, we'll let you die on the ambulance ramp.' That's the only way, and no one is suggesting that.
At the end of the day, (the uninsured) are going to get into the system, and they're going to get in through the most expensive care setting. It makes more sense to finance coverage but then force the system to become more efficient.
Q. What does it mean for national health care reform that so many Republican governors were just elected on a specific pledge to stop the federal health care law in its tracks?
A. I think it means that unless these governors have something positive to offer, their success will be short-lived. People want solutions, not slogans.
The fact of the matter is that the cost of health care is a huge burden for businesses, for families, for individuals and for government. To be against something is not the same as being for something or being able to offer solutions.
Q. President Obama was criticized for spending so much time and capital on health care at a time when the economy was foremost in people's minds. Do you see yourself facing that same challenge in Oregon?
A. I don't think (health care and the economy) are mutually exclusive at all.
The fact is, in the Oregon budget ... the cost of health care and the cost of corrections is sucking money out of education and investments in workforce development. So unless you can curb the cost of health care, your economic development efforts have a huge disadvantage.
Q. Does the public in Oregon have the patience for another health care debate, even if it's at the state level?
A. Oh yeah. If you ask people during this campaign, at the top of their list, obviously, job security is a huge one, but right under that is health care. People are really worried about having access to health care. They're worried about losing their health care when they lose their jobs. It's a huge issue.
It should not be a political football. It's too important. The cost of Medicare and Medicaid is driving our national debt. This (becomes) an issue of national security at some point, if we don't get our arms around it.
At the state level, at least in Oregon, we're much better positioned to have a rational, thoughtful debate about this than the political circus we saw over the last year (in Washington, D.C.).
Q. Why is Oregon different?
A. It's a small state. We've done some big and bold and controversial things with health care, and I think we've got some enlightened stakeholders here - whether they be on the provider side or the consumer side - and they recognize that we can only get this done if we do it together.