Oregon Must Have the Courage to Lead on Universal Health Care

When I get to Salem, one of my top priorities in the State House will be to work for a publicly funded, publicly accountable universal health care system that will provide quality care for every Oregonian.

By Jennifer Williamson of Portland, Oregon. Jennifer is an attorney running in the Democratic primary for HD 36 in West Portland. Jennifer is endorsed by Planned Parenthood Advocates of Oregon and the Oregon Nurses Association. For more information, visit JenniferForOregon.com.

We hear a lot about rising gas prices, high food prices and, increasingly in Portland, rents that are out of reach. These are critical issues on the minds of my neighbors. But there’s another concern that isn’t getting as much attention as it deserves these days.

As I’ve knocked on doors over the last four months across House District 36, I continue to hear from voters that they’re worried about rising health care costs. Despite what the national Republican assault on Obamacare would have us believe, the truth is that access to quality care has declined for thousands of Oregonians and health care prices are out of control.

It’s a story Mitt Romney and Rick Santorum don’t want you to hear. The facts for our citizens are disturbing:

Every Oregonian deserves health care. But even though Oregonians already spend more than enough to get that health care, too many of us are left out and our families suffer.

There are health care systems around the world and even in our own country providing better care to more people for less money than we do here in Oregon.

With the constitutionality of the Affordable Care Act now under review by the Supreme Court, it’s more important than ever for Oregon to take the lead for its citizens. It’s time for Oregonians to once again be pioneers. It’s time for Oregon to learn from other countries and other states.

If we apply successful lessons to a new statewide, publicly-funded health care system, we can ensure every one of our citizens has access to the care we need. The truth is we don’t have to spend more, we just need to spend smarter.

Oregon is unique. And not everything that works in other systems will work here. But we know we can do better – much, much better.

It takes courage to change an industry that is consuming nearly 20% of all the money spent in our state, and reform a system that is decades old. It takes courage to create a new health care system that provides for us and our families throughout our lifetimes. But Oregonians are courageous people.

When I get to Salem, one of my top priorities in the State House will be to work for a publicly funded, publicly accountable universal health care system that will provide quality care for every Oregonian.

I believe Oregon simply cannot afford to do anything less.

March 28, 2012
Posted in guest column.

    • 10:29 p.m.
      Mar 28, '12
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      While I've long been a supporter of single-payer, I've also long been skeptical that it will ever happen.

      If the Supremes strike down the mandate as an unconstitutional infringement on liberty, the irony will be that single-payer will be the constitutional alternative.

      All that aside, how exactly would a state create a single-payer system and avoid becoming a magnet for the sick?

      •
        10:30 p.m.
        Mar 28, '12
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        p.s. Full disclosure: My firm built Sharon Meieran's campaign website. I speak only for myself.

      •
        8:53 a.m.
        Mar 29, '12
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        I too would like to know how you run a single payer without attracting every person in the country who has been denied coverage elsewhere. What has been the experience of Mass. in this regard? While their coverage is the best, the cost of insurance there is also the highest in the country.

        Lastly, what prevents SCOTUS from overturning single payer if they decide to overturn Obamacare.

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          4:14 p.m.
          Mar 29, '12
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          In the SCOTUS oral arguments the opponents of the ACA with agreement from some RW judges that under the power of taxation that Congress had the power to create single payer like Medicare.

          However, states have much more under constitutional law to create single payer.Hawaii has had single payer for years, and Vermont has recently passed a bill to create single payer.

        •
          5:30 p.m.
          Mar 29, '12
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          John, not to nitpick but there are some important caveats to the statement that MA has the most expensive insurance... Relative to median income it is cheaper than here.

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          11:46 a.m.
          Apr 5, '12
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          Stop being scared of SCOTUS. It's an illegitimate institution -- at least two of the Justices are literally on the take. If we're going to recreate democracy, we're going to have to create conflicts of laws.


      • 11:31 a.m.
        Mar 29, '12
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        I share Kari's concern, though I am a strong supporter of national single payer. Can we prevent becoming the nation's provider of last resort for the seriously ill uninsured?

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          4:08 p.m.
          Mar 29, '12
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          Tomas, You really didn't answer the question. Over time people do migrate even if not immediately.

          I am not right wing and I do support single payer on the national level, but I also want a system in Oregon that won't bankrupt the state or its citizens, so yes I want to know the answer to the question before I sign on at the state level. A failed state program will not help us get a national version.

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              7:53 a.m.
              Mar 31, '12
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              Tomas, MA doesn't have single-payer. You pay for it yourself, or via your employer, with low-income subsidies. Totally different.


              • 11:51 p.m.
                Mar 31, '12
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                Yes, but its Obamacare-like system covers nearly all of its residents. It's far better than any other state in providing health care for its citizens ... except possibly for Vermont which recently adopted a form a single payer insurance.

        •
          7:50 a.m.
          Mar 31, '12
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          I'm not arguing it's a fatal flaw. I'm arguing it's a problem that needs sorting out.

          How does Hawaii handle it? If I get diagnosed with cancer today, can I fly to Hawaii tomorrow and get state-funded treatment? Presumably not.

          In Oregon's case, we've got Vancouver just north. Not exactly "pulling up stakes" to move to Portland to get life-saving medical care.

          I'm asking what the proposed answers are... Waiting periods? Residency requirements? Barring pre-residency medical problems? (Ha!)

          Keep in mind that part of the argument for state-based single payer is PRECISELY to be a magnet - after all, if businesses can drop health care costs, they can be much more profitable.

          But making sure we avoid becoming a dumping ground is critical to making it a sustainable program.


          • 11:58 p.m.
            Mar 31, '12
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            That's exactly the point. It's a potential, and in my opinion minor, problem that needs to be addressed, not as a reason to reject health care reform out of hand.

            Your point about attracting new businesses is an frequently overlooked major selling point for a state run health insurance system.

      •
        8:40 p.m.
        Mar 30, '12
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        Saskatchewan started it in Canada- don't think it became a magnet. Then again, one would have had to move to Saskatchewan.

      •
        2:34 p.m.
        Mar 31, '12
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        If a small country like Costa Rica can do it so can the State of Oregon. We study how others have done it successfully, and then we copy that and do it here. The Democratic Party of Multnomah County is on record in favor of SINGLE PAYER. The elected representatives should pay attention and get it done.

      •
        4:51 p.m.
        Apr 17, '12
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        There has to be more to it than just insurance; we have to provide better care with better outcomes. In the end, if SCOTUS strikes down any/every kind of Healthcare, we will stil need to implement some kind of alternative to the current broken system. Maybe Oregon will have to soften its policy towards medical marijuana.

  •
    4:51 p.m.
    Mar 28, '12
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    Will single payer do anything to change the fact that 5% of the population uses 50% of the health care dollars. Seems to me that is the most pressing issue: how to meet the care needs of these people in a more cost effective manner.

    Source Link

    •
      6:11 p.m.
      Mar 28, '12
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      Michael, if it uses the same framework as the Governor's medical restructuring, then those 5% will certainly be targeted, those with chronic and recurring disease problems.

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      4:30 p.m.
      Apr 17, '12
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      As a Stage 4 cancer patient who joined the medical marijuana program after 7 years of treatment, I was able to reduce my Healthcare costs by 85%. Medical marijuana reduced my prescription drug use, my doctor visits and my ER visits. Medical marijuana addresses the two primary drivers of Healthcare costs: pain and chronic disease management. If you want to change the fact that 5% of the population uses 50% of the Healthcare dollars, create Safe Access to medical marijuana with a regulated system of supply.

  •
    6:09 p.m.
    Mar 28, '12
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    Absolutely! Please get your legislative colleagues and the governor on board.


  • 6:14 p.m.
    Mar 28, '12
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    I would add it looks like the radical Gang of Five on the SCOTUS is ignoring "Stare Decisis" and exercising a coup d'etat over our national government, so it is timely for us to not be left with nothing in health care.

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    9:39 a.m.
    Mar 29, '12
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    I like the government in Health Care. The government has done a wonderful job bankrupting Social Security and Medicare. The USPS is on it's last legs. Everywhere the government seems to get involved in private commerce, rainbows and unicorns seem to follow. I want that kind of magic to work on Health Care too.

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      4:17 p.m.
      Mar 29, '12
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      Total fail in your points. Soc. Sec. and Medicare are not bankrupting the government. They are both entirely popular, and financially viable, and when the GOP and the SCOTUS get through destroying the private insurance industry's last chance through ACA Medicare is about all we will have left.

      •
        1:08 p.m.
        Mar 30, '12
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        Ha! ha! ha! I'm laughing at you. Where've you been? Soc. Security and Medicare ARE bankrupt and only financially viable in the same way that Bernie Madoff's investments were viable -- so long as he found the next sucker, the system could float.

        •
          2:24 p.m.
          Mar 30, '12
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          I know you find comfort in your tea party talking points. But Soc. Sec. is solvent for many years, and in 2043 solvent to 75%. When the cap on FICA gets fixed it will be solvent indefinitely. The CBO has said that ACA makes Medicare fully funded for an extra ten years. With some tweaking on the revenue side it will be solvent again indefinitely. And it is the only medical system around that actually has the capacity to control costs. The tea party solution for health care is to ration health care by income and cash on hand, in other words screw the middle class or in the famous chant in the GOP debate in Florida, "let them die." I realize you're here simply to be a troll and repeat provocative teabagger talking points so no one here can really take you seriously. The GOP wants to take away Medicare and Soc. Sec. and that program will guarantee President Obama four more years. (Incidentally your anti-ACA guy at the SCOTUS hearings admitted that single payer was constitutional, with a nod from the teabagger judges.)

    •
      6:56 p.m.
      Mar 29, '12
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      Geoff, check how the cost of Employee Sponsored Insurance (ESI) has changed relative to income. Or how many people are covered by it.

      Regardless of what happens with the ACA the traditional ESI system is failing, and has been for many years. The ACA is one way of dealing with that reality, single payer is another. They both have their challenges, but I'd take either over sticking my head in the sand and accepting the status quo.

      •
        1:14 p.m.
        Mar 30, '12
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        I agree ESI is failing. I disagree that ACA (which has a number of constitutional problems) and single payer are the only solutions. I've heard many interesting solutions that model health insurance on what was done in the long-term care market and, many others but, during the smash-and-grab 111th Congress, the only thing that was debated was ACA and single payer -- a tragedy firmly lodged on the shoulders of that Congress and it's lustful leadership.

        •
          7:10 p.m.
          Mar 30, '12
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          You mean this long term care market?

          Who's talking about unicorns now?

          •
            11:29 a.m.
            Apr 3, '12
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            bj -- I said "many interesting" solutions pointing to the FACT that we heard nothing other than ACA and single payer because of the smash-and-grab 111th Congress. If and when ACA goes DOWN, maybe we'll be able to have a real debate.

        •
          7:59 a.m.
          Mar 31, '12
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          Geoff, there are some 40 million Americans without health insurance. When they get sick, and they always do, we - you and I - pay for their health care. (Average $1000/year per insured.) And in the most-expensive way possible - at the moment of crisis, instead of with inexpensive preventative care.

          It's not conservative to allow free-loaders to mooch off the system, right?

          So, what's your constructive solution?


          • 11:46 a.m.
            Apr 3, '12
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            Kari, you are referring to "cost shifting". This magnitude of this argument is now in serious question.

            From a recent WSJ piece: "There's simply no evidence to support the claim that the insured bear the costs of caring for the uninsured ... either within state boundaries or across state lines ... A study conducted by George Mason University Professors ... and published in the journal Health Affairs in 2008, found that ... cost shifting raises private health insurance premiums by a negligible amount ... For the typical insurance plan, this amounts to approximately $80 per year ... Where did Congress go wrong? We traced its estimates of the magnitude of the hidden tax of $43 billion per year, or an increase in family premiums by an average of $1,000 per year to ... a non-peer-reviewed study commissioned by FamiliesUSA, a Washington, D.C., group long known for its advocacy of greater government involvement in health care ... Specifically, Congress ignored the $40 billion to $50 billion that is spent annually by charitable organizations and federal, state and local governments to reimburse doctors and hospitals for the cost of caring for the uninsured ... Moreover, the economics of markets for health services suggests that any cost shifting that may occur is unlikely to affect interstate commerce. Because markets for doctor and hospital services are local—not national ... The bad news for the new law's supporters ... doesn't stop there ... the likely impact of the law will be to increase, not decrease, cost shifting." Kari, read this

            Furthermore, your figure of 40 million includes those that are uninsured by choice. Not every uninsured person is a mooch (to use your terminology in describing people) many save and pay out of pocket for health services, others don't but, don't require a level of service that justifies to them the expenditure.

            •
              12:57 a.m.
              Apr 6, '12
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              Uh, oh-kaaaaay.

              So, you're arguing that the cost of caring for uninsured people isn't borne by insurance companies (and thus, their customers), but instead by federal, state, and local governments (and thus, their taxpayers.)

              And you're OK with that?!

  •
    4:23 p.m.
    Mar 29, '12
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    I predict if the SCOTUS further turns itself into a radical right wing agent of the GOP and throws out the ACA, a moderate Republican plan, then private market based insurance will die as there are fewer and fewer able to afford its growing costs because of cost shifting and lack of price control. The result will be two tracks, an overwhelming demand of Medicare for all on the national level, and creation of state based single payer options until that happens. If red states are abandoned because they can no longer provide health care for their own, the point will have been proven.

  •
    7:57 p.m.
    Mar 29, '12
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    Based on my experience with the Veteran's Administration, I don't believe in a national single-payer system. It's just too freaking big and subject to the kind of bureaucratic abuse and fraud we've seen too much of.

    I believe strongly in the Feds supporting and accelerating the creation of interstate compacts that supply single-payer insurance to those states' citizens.

    With their huge populations, CA, TX and NY could have their stand-alone insurance plans, but OR, WA, and ID could create their regional focused plan, as could MS/AL/LA/AR, or ME/NH/VT/MA/RI.

    The Feds would set the standards for service and cost and the regional single-payer corporations would provide the services.

  •
    11:09 p.m.
    Mar 29, '12
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    This essay by Dr. Peter Morici appeared this past week in the Statesman Journal, predicting blockage of health care reform by the Supreme Court would push us most assuredly into Single Payer- http://www.statesmanjournal.com/apps/pbcs.dll/article?AID=2012303240010

    Today's column by Eugene Robinson has an identical premise to it: http://www.washingtonpost.com/opinions/supreme-court-could-open-door-for-single-payer-health-care/2012/03/29/gIQAyNJtjS_story.html?hpid=z2

    Dr. Tim Johnson, medical consultant for ABC News predicted that despite all the fuss about health care reform, in the midst of the Tea Party bluster, America would one day, in the near future have Medicare for all, not out of choice, but out of necessity.

  •
    8:42 p.m.
    Mar 30, '12
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    Very glad to see all the Democrats on here who have honestly evaluated the Heritage Foundation proposal which is known as the ACA ("Obamacare", "Romneycare") and know, therefore, that it is not a solution.

    •
      3:48 p.m.
      Mar 31, '12
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      It is not a "solution" but it is a steppingstone to single payer, and it is survival for millions of Americans until we do have single payer, even though it does not meet the leftist purity standard. I don't believe state based single payer is a "solution" either. I do believe that some form of Medicare for all is a national "solution."


    • 8:33 p.m.
      Mar 31, '12
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      For the present ACA is a "solution" for this little girl and her family. http://www.youtube.com/watch?v=zv26zzUMVjc&feature=player_embedded

      •
        3:54 p.m.
        Apr 1, '12
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        Are there any cases where a child actually reached their coverage limit and was denied care? From what I saw in this video, the existing health care system worked for this little girl.

        •
          9:40 p.m.
          Apr 1, '12
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          Seriously, really?? You really believe what you are saying? People run out of their annual and lifetime limits all the time. It's on a par with those people who think that because you can get emergency life saving care in hospital emergency room that constitutes universal coverage, despite the fact ERs don't treat ongoing disease, they only stabilize life threatening situations. They don't treat cancer, they don't treat heart disease, they don't treat kidney disease, they don't treat diabetes. But according to Scalia, ERs and hospitals really shouldn't treat anyone who can't pay. The accident victim should be left by the side of the road if they don't have insurance. This is the solution to the cost shifting problem. So you are on the same page with Scalia apparently. Everything is working fine, the system will work better if hospitals just stop treating people at all after they can't pay for it any more, when their benefits run out or if they have no benefits. The GOP comes from a different universe from the one I was born and raised in, where people matter and communities matter.

          •
            10:06 p.m.
            Apr 1, '12
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            Our system has plenty of problems. by bringing up Scalia I assume you are referring to his opinions, and those of millions of other people, on the ACA. Unfortunately ACA is not going to fix our problems. Being opposed to the ACA doesn't mean that everything is fine as it is, nor does it mean you want to deny people an ER visit if they can't pay. The act has serious constitutional problems that probably can't be resolved as written. If you want universal coverage, or some kind of additional safety net beyond what we already have, then establish a tax to cover it. Anyway, you really didn't answer my original question.

  •
    10:35 a.m.
    Apr 2, '12
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    @Bill Ryan: the ACA does expand Medicaid, which couldf be seen as a stepping stone toward single-payer. But the Heritage Foundation mandate would seem to entrench private insurance even further, moving us away from single-payer.

    •
      12:48 p.m.
      Apr 2, '12
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      Not so. The Vermont single payer program is passed within the ACA structure, which allows for such. ACA does not lock in states to only private insurance. My view, the cruncher, is the ACA requirement that private insurance confine profit and overhead to 15%. Most corporate insurers over the long run will not want that limitation and will get out of the business, making single payer of the state or federal type, not only desirable but necessary. So I see it as an evolutionary process with ACA as a transition point and survival until state or Medicare for all gets implemented.If we don't have something in the interim, millions of lives and family finances are in jeopardy.

  •
    12:54 p.m.
    Apr 2, '12
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    More reasons why ACA is needed now, not just in the future: For those who want the Affordable Care Act repealed- Do you really want children born with chronic health problems, or all Americans with prior conditions, to be denied coverage? Do you really want to take away cost-free coverage now provided for preventive medical procedures for seniors and eventually all Americans? Do you want to deny additional "donut-hole" drug coverage provided to seniors? Do you want to permit insurance companies to impose annual and life-time limits on coverage, deny coverage on technicalities(recisions), to spend over 15% of premiums on profit and administration, to charge women more than men for coverage? Do you really want to eliminate small business tax credits and competitive state based insurance exchanges giving more competition and choice? Do you really want to take away individual responsibility and continue make the insured pay the medical costs of the uninsured (We made auto insurance mandatory for that reason.)? Do you want to prohibit parents from carrying their adult children (to age 26) on their own coverage? And do you really want to take away insurance portability so that you lose your insurance when you move or lose your job?

    http://www.momsrising.org/blog/thanks-to-the-aca-my-daughter-is-safe-from-losing-coverage/#ixzz1q4n4NiM3

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