Dear Governor: Alan Yordy, PeaceHealth

“Dear Governor: About The State of Reform” is a collection of voices from across the health care spectrum, from four states: WA, OR, ID, and AK.  The book will be published in Sept.  Excerpts will appear here.


Dear Governor:

You are responsible for serving the same people we are.  Every single resident of your state will eventually need our services – for hospitalization, immunization, or anything in between.  And that starts us off on common ground as, in order to meet the needs of the constituency we share, we strive to work together to overcome our biggest obstacle:  how to reconcile the promises we’ve made and entitlements we’ve granted with the resources we have to fund those commitments.

What has the potential to divide us is our fiduciary responsibility – yours to state government, and mine to the nonprofit organization I lead. 

Neither one of us can fulfill our sacred obligation if health care providers can no longer maintain creditworthiness and critical access to capital that has allowed us to create one of the world’s best health care systems.  And this brings us back to the challenge of reconciling available funding with the promise of a health benefits package that is sustainable.

Health care leaders know how to achieve the so-called “triple aim” of health care – to improve population health, enhance the patient experience and control costs – but we can’t do it if the majority of our patients – those who are government-sponsored or who are uninsured altogether – rely on  subsidization by the private sector.  Under current law, the government is poised to expand Medicaid to cover more low-income and uninsured – a population we all agree deserves decent health care – while paying little more than half the actual cost of delivering that care.  Receiving about 50 cents for every dollar expended is more than unaffordable; it demands that we examine the justice of promising care to one population by requiring another to fund a significant portion of the cost of that care.

It’s tempting to let other issues, such as public employee benefits or private-sector pay, distract us from the fundamental problem at hand:  the cost of health care is more than we want to pay, largely because health care can do things it couldn’t do before. 

Clearly, we can find greater efficiencies in care delivery.  One recent study suggested that we could reduce the cost of care by 10 to 15 percent for the primary Medicaid population.  But the fact remains that, as much as we can criticize our outcomes when compared to other countries, we live longer and do more than we used to thanks to medical advances that largely originated in the United States.

The Pacific Northwest is home to a greater number of uninsured than most other states. 

According to one study, the uninsured rate ranges from 7th highest in the country in Alaska to 26th in Washington, with Idaho and Oregon falling between them at 14th and 20th respectively.  Clearly, this isn’t good.

We are also home to the highest percentage of Catholic hospitals in the country.   Coupled with other nonprofit hospital systems that dominate in our region, we have a unique opportunity to partner with the state in service to the public.  That is an advantage which I hope we recognize and use.

I believe the conversations about how to address the health care funding problem will be far more productive and successful if we can acknowledge some perhaps unpopular realities:

–          Prevention may cost us more than we are paying today in the short run.  It is the right thing to do, and in many individual cases prevention is less expensive than treatment of disease.  But we can’t expect our state and national health care bill to decline simply because we’ve added preventive services; in fact, some experts predict the opposite will happen.

–          Obesity is growing rapidly in the United States.  Roughly one-third of all adults are now considered more than 120 percent of their ideal body mass.  This trend is highly correlated to many other chronic diseases and will require public policy debate and intervention if it is to be reversed.

–          Health care will continue to become more costly as we continue to discover new, more effective treatments.  Unless we choose to halt progress and adopt an approach similar to other developed countries, which limit access to expensive technology, we must factor the cost of discovery into our calculations.

–          Most Americans have access to the health care system, especially in our region with its dominance of nonprofit, mission-driven health care organizations.  While patchwork in nature and unevenly organized, the system provides care to people in need regardless of their insurance status.  That doesn’t diminish the fact that the system is often confusing and difficult to navigate, especially for the most vulnerable among us.

–          There is room for improvement at all levels – quality, service, access and cost.  And great progress is being made on all fronts.  Quality continues to improve at America’s best hospitals.  Costs per unit of care will continue to stabilize as health care systems across the Northwest become more efficient.   It requires resources to implement the changes we want to see, and neither the government nor the private sector has them.

We will be successful only if we regard one another as partners, not adversaries.  We must earn and keep one another’s trust.  We cannot afford to fail, because too much is at stake for the organizations we represent and the people we serve.

Neither one of us, alone, has the solution.  Together, I pray we can find it.


Alan Yordy

Alan began his health care career in PeaceHealth’s Oregon Region in the early 1980s. In 1990 he left to become CEO of Mid-Valley Healthcare, and in 1997 he co-founded Samaritan Health Services in Oregon’s Linn and Benton counties. Alan returned to PeaceHealth in 1999 as Chief Executive Officer of the Oregon Region. He assumed his current systemwide leadership role in 2005.