Kitzhaber, Blumenauer: Health care policy reform top priority

Though former Gov. John Kitzhaber no longer holds an elected office, he still passionately works to reform the health care system so more Oregonians — and maybe even more Americans — can have coverage. On the federal level, he works closely with U.S. Rep. Earl Blumenauer, who also advocates for health care reform. The two discussed the opportunity for health care policy transformation during State of Reform’s afternoon keynote address last week.

While Oregon’s health system is progressive, there is still work to be done, Kitzhaber said. Oregon must take the next step in health care transformation before it can set an example at the federal level.

 

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Right now, Oregon’s health care system costs too much, the resources are inequitably distributed and that undermines the ability to invest in social determinants of health, such as living wages and economic opportunities.

“Our health care system reflects and amplifies the disparities and inequities in our society,” he said. “And COVID has brought that into stark relief.”

Black Americans are dying from coronavirus at a disproportionate rate, which is attributed to the social and structural inequities that make it more likely for them to have underlying conditions, such as high blood pressure and diabetes. Meanwhile, they live in poorer housing situations and have less economic opportunity.

“Universal coverage is needed and it needs to be affordable,” he said.

Yet, there isn’t a consensus on how we get there.

Single payer is one way to get to universal coverage, but there are other paths, Kitzhaber explained. The highest priority should be to help the thousands of Oregonians who are struggling right now.

The question is: How do we reduce the cost? Cost, he said, is what drives up the rate of those who are uninsured.

Kitzhaber believes the place to start making changes is in the places where the state is the primary payer, such as the Oregon Public Health Division, Public Employees’ Benefit Board and the Oregon State Education Employees Board.

He believes aligning payment methodologies so they are all uniform would save money and reduce the number of uninsured Oregonians. If the uninsured rate dropped from 5% to 2%, it would save the state $100 million per biennium.

The central question is: how to we move away from a fee-for-service system to a capitated system where integrated delivery systems assume full upside and downside risk for quality and outcomes in patient satisfaction, he said.

The conversation gets high-centered on the fact that neither Republicans or Democrats assume any change in the underlying health care business model.

“We either pay for it or we don’t,” he said. “This creates this false choice between cost and access. The lesson we learned from Oregon is that if you continue to pump money into an inefficient and ineffective system you will get the same results.”

Blumenauer said if we stay with the same system, we will just keep facing the same issues.

“Fee-for-service is a dead end,” he said. “We know that as a result of what’s happened with the pandemic these disparities — in terms of social determinants of health — are stark. They make a huge difference in terms of our ability to deliver the help that people want.”

We need to invest in things that make people healthy, rather than just dealing with the cost of care, he said.

“The COVID experience gives us reasons to be more generous in terms of funding the transition,” Blumenauer said. “But the fundamental fact is that we have to change the business model and we have to extract more value and we need to make sure that we are able to harness people’s creative abilities that people have because they know they are on a glide path that doesn’t work.”

The bottom line is that we know the destination, Kitzhaber said. The question is: How do we get there?

“If we can use this opportunity with all the pieces of the systems, not just health care, but education, economic development, transportation … we can use the ingenuity and passion and energy of this country to figure out that transitional path from where we are to where we know we have to get.”