JR, The only person worse than you is Bill R. What a couple of suck ups!

@ Bob- "What a couple of suck ups!"

I'm happy to be a member of that club. Thanks for the praise.

Kitzhaber is talking about health care, not just about health insurance.

Public option doesn't address the question of whether doctors are on fee for service model or whether they are on a salary. It doesn't address how chronic problems are treated or whether patients are treated well while in the hospital and then stabilized at home, or whether they are re-admitted to the hospital because there was no system to stabilize them at home.

Jack, how do you propose to stabilize patients with chronic conditions? Free market? Buying insurance across state lines as so many Republicans think is the answer to everything? Debating the role of insurance companies rather than how medicine is delivered?

You should run for Gov. so you could have these arguments face to face with Kitzhaber rather than on blogs.

Jack, although I disagreed with you on the other thread, I agree with you totally about Kitzhaber. I haven't been able to play the interview, but previously and in the last few days found Kitzhaber has "jumped the shark" on health care.

I have to disagree about Obama. His speech was tepid and he spoke in generalities average folks paying modest attention already do know. Advocates for this or that ideological position are another matter, but they each will find what they want to find in Obama's speech anyway. To borrow an even earlier pop culture reference, the health insurance reform battle may prove to be the leadership challenge which reveals Obama has "Peter Principle"'d out as a political leader. And that is the last thing any sane person should want, regardless of their ideological perversion, as we sit poised to enter the second dip of a "W" recession and we have troops mired in Afghanistan.

LT -

You certainly don't have to believe me, but I've already had the debate about health care and health insurance reform face-to-face with Kitzhaber a couple of times in the course of his Archimede's project and other extra-Archimede's health care advocacy about his proposals. There was a certain coldness in his attitude towards patients that perhaps has it's roots in being an emergency room physician who sees too much. Those were some of the most disheartening discussions I've ever had with a genuinely likable guy and a politician that I had generally admired for an ability to get something significant done like the OHP in a legitimately contentious political atmosphere. I actually couldn't and still can't figure out what has happened to him. Some say that we always revert to our true nature, given enough time. Others that the experience of those years took it's toll. I'd like to not think either of those things, but I have yet to hear an alternative explanation.

Ah, the shameless pumping of Kitz's candidacy starts ...

JJ--do you really think Stand Up is "shamelessly pumping"?

Stand up, having known Kitzhaber for a couple decades, he didn't seem any different to me the last time I saw him (speaking to Marion Demoforum).

He has never been everyone's cup of tea, and all of us have gotten older (he and I are just months apart in age).

This sentence, though, "There was a certain coldness in his attitude towards patients" I don't really understand. When he talks about keeping medically fragile people in their homes if at all possible instead of admitting them to the hospital, or how people who don't own cars and don't live walking distance from a store with a decent produce dept. (or public transit to one) and thus their level of health declines, I don't see the way he talks about that as cold. I have known people who only buy frozen vegetables because except maybe in the summer they don't have access to fresh produce where they live.

Maybe it is an "eye of the beholder" thing--I find Kitzhaber often is a breath of fresh air.

This sentence, though, "There was a certain coldness in his attitude towards patients" I don't really understand.

LT - One instance was after a speech to a crowd of over-50, and mainly over-70 health-care reform advocates (ie. falling through the cracks in today's system as their medical needs are increasing, to on Medicare with and without good supplemental insurance). The overwhelming majority were strong supporters of the OHP and had direct memories of the fight to create it and save it in the intervening years, including the bruising battle over the misguided tobaccos tax for funding SCHIP. (Which they knew Kitzhaber initially opposed as divisive and then flipped to support in a tepid way). They lived through and defended against all the fear mongering that the OHP is rationing, but also were quite aware of the problems of denied coverage with the privatization of Medicaid that OHP is. In other words, they knew the reality of what had come before, and I think they were wanting to hear how we were going to move forward to fix the problems in our system.

When Kitzhaber spoke to this group who were his age-cohort, and in real way had been allies in the fight since the 1990's, the room became quite less enthusiastic as he essentially talked about how "they" --- aging people and people who supposedly don't take care of their health whatever way some think they should --- were the big cost to the system and we had to figure out how to minimize the costs "they" imposed on the system. And he used dying salmon and his dying mother as examples of how life "just happens". It was almost if everyone had gone through the same extended battle to right wrongs in our system, and he had emerged with very different perceptions and attitude towards those with significant and increasing health care needs, which to varying degrees will eventually be all of us, that this supposedly has been about.

In followup meetings I can only say people were less enthusiastic about Kitzhaber and his Archimede's project too. They couldn't quite forget out if he cared about people as individuals, or just people and the system in the abstract. That may play well with younger people who we know aren't engaged in the health care debate because they still feel relatively invincible, but it just came across as kind of cold and dismissive to people looking at the short end of the genetic lottery, those who maybe hadn't had the most financial success in life with all the "bad" lifestyle choices that come with that, and for whom the years were starting to add up.

I even brought that up generally during the question-and-answer period, and more directly after the speech when he was talking to people individually. He acted like he didn't get the point. (And Kari, I could care less whether you believe anything I say, as with to other factual matter I have dealt with, there is plenty on the public record of Kitzhaber's recent speeches people can review for themselves and see if they feel Kitzhaber seems to increasingly be about seeing those who naturally have increasing medical needs as numbers to be balanced).

"the privatization of Medicaid that OHP is"

News to me that Oregon Health Plan is privatized Medicaid. On what do you base that statement?

As far as the rest of the speech, that does not sound like anything I have ever heard Kitzhaber say.

I wonder if others heard it the way you did.

Last night on Nightline there was a story about Obama visiting the Mayo Clinic and why that clinic gets better ratings than UCLA and Johns Hopkins according to a Dartmouth study. It is about the way they are organized and how they deliver health care. Sounded to me more like the Kitzhaber plan than anything I have heard elsewhere in debates here in Oregon.

I am a strong believer in eye/ear of the beholder. I've been in situations where several people heard the same speech and heard several diff. reactions.

That's the way politics works, Stand Up, and if you choose to support some other candidate for Gov. that would be understandable.

But I make my decisions on what I see and hear with my own eyes and ears, not by second hand accounts. If that bothers you, tough luck. I've been reacting to politics like that for most of my adult life, and don't plan to change now.

News to me that Oregon Health Plan is privatized Medicaid. On what do you base that statement?

As you probably are aware, under Kitzhaber Oregon asked for and was granted waivers on how Federal Medicaid funds are spent to create OHP. Medicaid itself is an insurance program in the more general sense since few Medicaid providers in any state I know of are actually public employees.

In Oregon, the OHP program contracts with private insurance carriers to provide health insurance for the large majority of recipients. Something like 4/5-ths of OHP recipients receive their OHP/Medicaid benefit via private, non-profit Managed Care Organizations (MCOs), which are pretty much equivalent to HMOs. The state looks at the prevailing rates being paid for health care services in Oregon, which means they are looking what insurance carriers for non-OHP insurance have negotiated with providers, derives a contract price, adds on something like 10%-12% and gives the carrier a capitation payment per client who signs up with that carrier to pay the medical costs. From then on, it's between the client and MCO (private insurance entity) to work out health care issues. A patient whose carrier denies coverage has appeals rights to the OHP, but you had better believe carriers pay what they have to and deny what they know will be upheld on appeal for standard claims.

Of the remaining 1/5 of OHP clients, a fraction signup with Physician Care Organization plans in which providers essentially contract directly with the state to provide coverage under the same capitation payment system as the MCOs. A fraction signup with organization like Kaiser, Good Samaritan, and such that operate both a MCO-like organization chartered by the state, and who also employ providers. The remainder are on the open card.

So by "privatized" I am not talking about providers, which are private entities in most states in most cases as I already noted. I'm talking about the insurance function that is all Medicaid is. Oregon in the OHP has largely privatized that function. Does that explanation clarify the real nature of OHP?

The audience of knowledgeable health care reform advocates I described above were well aware that this is how the OHP they had helped to create and support works. They also were aware of how in the years since it was created the number of clients on open card has declined significantly as Republicans and some not-so-true-Democrats set out to increasingly privatize the OHP for their own ideological reasons. (Our new U.S. Representative Shrader amongst those not-so-true- Democrats as we have seem him repeat in the debate this year at the Federal level.)

These folks had been right there with Kitzhaber and after he finished his term to fight for the OHP and they were expecting a re-affirmation of values about health care that Kitzhaber does (never did?) not seem to unambiguously embrace anymore. That's why he's probably lost them as supporters.

By the way, the privatized OHP model is very close to what Westlund, Bates, and a number of other not-so-true Democrats hoped the Oregon Health Fund Board would create for all of us with the state-level Exchange model. A lot of the people Kitzhaber has lost were the people engaged in the battle to create a public option in the state Exchange to counter this total control by the private insurance industry. I don't know if you followed that but what they managed to get written into the law that creates the Oregon Health Authority (OHA) that the OHA must seriously study how a public option can be set up. Which is not say the OHA or Goldberg will carry that duty out with honesty and integrity. Unless there is something in that video I still can't play, Kitzhaber has not signed on that he as Governor will hold the OHA's feet to the fire to do that.

All you libs need to leave the country back to Kenya with Obama if you don't love America. Republicans are the only ones who care about the RULE OF LAW and we know no one cares about health care when BO has never proven he's legally president! This is a constitutional crisis. VOTE REPUBLICAN IN 2010 AND THROW THE USURPER OUT!

Jesse- you're insane and don't you dare question whether I love America, you miserable piece of waste.

CareOregon, the largest disbursing agent of DMAP dollars, is a primary player in the healthcare politics of Oregon. Ask Kitzhaber about it. And about that amazing Alaskan template they are funding demonstration clinic projects for. I was just thinking that while we babble about Obama's speech, national and diffuse and chortling over the fall of a really stupid, banal, sick little man who ran on the Right Hate platform... you folks clearly have zero knowledge of who is running things here, positioning, in terms of the shape of healthcare in Oregon in the future. They have been shaping this for six years now. And you don't know it.

So - anyone game? Let's dig in. Find out who is really and what is really behind the coming changes in Oregon healthcare. It's not sudden, and it was in the works years before Obama. And Kitzhaber has been part of it since inception.

It's good what they have planned. Good for all of us. But I'm just a little amazed nobody here seems to know anything about it - deeply interesting, and we in Oregon COULD make hx again the way we did with the Bottle Bill.

Jesse, my Dad fought in WWII, my granddad in WWI, I have probably volunteered more of my time to various civic projects (some involving combat vets) than you can possibly imagine.

If you are one of those "only people who agree with us" types, it seems you lost the last election.

But here is my question--which I challenge you to answer:

Where do you stand on health care?

1) Everyone is responsible for their own health care, and if they can't afford insurance and show up at the ER that's fine.

2) The system is broken and only Republicans have the answers. (If buying insurance across state lines is such a good idea, why didn't the Republican Congress pass the DeMint et al bill in 2005?)

3) Government should have no involvement in health care, and when you turn 65 you won't sign up for Medicare.

4) Something else.

ps, Ja.D - much as you seem to be a woefully simplistic version of Joe White and his ilk, I must say you are climbing my anti-anti-woman-invective star chart.

I admire your utterly gender-neutral curses.