JUNE 2007: SPECIAL REPORT, THE FUTURE OF HEALTH CARE
Sen. Ben Westlund was
one of several forces that brought health-care reform to
Salem this year.
PHOTO BY LEAH
NASH
|
Taking on the system
Business leaders say Salem’s health care reform effort is
a major step forward, but specifics are few and questions are
many.
By Abraham Hyatt
The senator has a little bit of the Southern preacher in
him.
Which means that sitting in a chair while proclaiming the
gospel of health-care reform is not a passive activity. He
jerks his arms. He lunges half out of his seat. He uses his
hands as punctuation marks. He uses them as scalpels and
paintbrushes, slicing the current state of health care into
pieces and then inking a vision for the future out of the
air.
Sen. Ben Westlund, the Democrat and former Re-publican from
Bend, is a believer. And this year — the year that
health-care reform is one the biggest stars of the legislative
session — there are a lot of believers. Whether
influenced by double-digit increases in cost or the growing
number of uninsured, this is the year the momentum to change
health care has reached a tipping point.
The biggest believers may be those who created the proposals
behind the various independent reform efforts: Westlund and his
Senate Special Committee on Health-Care Reform co-chair, Sen.
Alan Bates, D-Ashland; the Oregon Business Council; former Gov.
John Kitzhaber; and the Oregon Health Policy Commission.
It was the Senate health-care committee’s job to take
those proposals — all of which had similar aspects
— and weave them together. What came out of that
months-long process was Senate Bill 329-2. Introduced by
Westlund and Bates, it creates a seven-member,
governor-appointed board called the Oregon Health Fund, which
would create a plan and a funding source to insure all
Oregonians.
The Oregon Business Council and the Oregon Business
Association support the bill. Bates points to further support
from major companies — Fred Meyer and Harry and David are
two — and some Republicans, although not from party
leaders.
But the bill itself isn’t a magic bullet; it
doesn’t fix any particular problem. And so questions that
have the largest impact on business in Oregon, such as the
specifics of how reform will be funded, have yet to be
answered. Financial concerns mean Republicans such as Senate
minority leader Ted Ferrioli,
R-John Day, and House minority leader Wayne Scott, R-Canby,
don’t like it. Ferrioli disagrees, but Bates and Westlund
are confident they have the votes to get it to the governor,
who has already expressed support for the lawmakers’
efforts. By mid May, the bill had yet to leave the ways and
means committee.
What happens if the bill doesn’t pass? It’s safe
to say that no politician or business leader thinks health-care
problems are going to go away. Polling by Westlund and Bates
shows that Oregonians are more passionate about it than ever.
And so, as Kitzhaber put it, when the people agree that they
want something, sooner or later the Legislature is going to
have to give it them.
THE BIGGEST QUESTIONS, either about the bill or what the bill
could eventually create, revolve around funding. Finding money
for health-care reform was memorably problematic earlier in the
session when House Republicans shot down the governor’s
proposal to extend health coverage for children, which would
have been paid for by an increase in the tobacco tax.
As Westlund likes to point out, there is more than enough
money for reform in the current health-care system; it simply
needs to be used differently. Westlund and Bates’ bill
offers several possible sources: federal and public funds,
employer contributions and individual payments. That’s
too ambiguous for Duncan Wyse, president of the Oregon Business
Council.
“Where is money going to come from? There’s no
answer to that,” he says. “How can we be assured
that we’re going to see a reduction in cost? That’s
a very tricky piece of work.”
Once funding is accumulated, how will the financial pool
actually work? Can a regulatory approach create the type of
incentive that could lower costs? Will there be some type of
tax burden that’s placed on employees? As Lynn Lundquist,
president of the Oregon Business Association, asks, will the
state avoid a “socialized medical system?”
Ferrioli, who thinks that even forming the Health Fund itself
is a flawed idea because of how it takes power away from
consumers, says the bill itself is “socialized medicine
lite.”
But Wyse and others say that the intent of the bill is not to
solve specific questions. Their must-have lists are topped with
ideas that are very familiar to the business community:
emphasizing public-private partnerships and creating a
market-driven system. As Bill Kramer — a health-care
consultant and a member of the Oregon Business Council’s
Health-Care Task Force — puts it, the point was to give
guidance to the seven-member board, but not limit it.
“There’s a lot more work that needs to be done.
This is a large segment of the economy; there’s a lot of
financial interests at stake,” he says. “Trying to
do right thing can be difficult when so much money is
involved.”
Even House Republican leaders, who have plenty of questions of
their own, sound willing to, someday, work to find a
solution.
“We’re not very favorable of [SB 329-2], to be
blunt,” House Minority Leader Scott says. “The main
reason for our differences is how we’ll be paying for it.
It’s not that we can’t work together.”
IF WESTLUND IS A BELIEVER, he can also be described as a
born-again.
He tells the story with the relish of a pardoned man: How, in
2003, he was co-chairing a health-care committee with his good
friend, Alan Bates, who’s also a physician. How he
ignored a crippling cough. How he ignored Bates’ pleading
to see a doctor. How Bates finally made an appointment for him.
How the doctor took an X-ray, and then called Westlund 20
minutes later to tell him to get to a hospital as fast as he
could because he had a partially collapsed lung and a tumor in
his chest. What he thought about while lying in a cancer
ward.
Today, Westlund has a clean bill of health. But that memory
returned earlier this year as he and Bates traveled around the
state listening to communities talk about health-care reform.
He was in a city in the south of state when a woman walked up
to the microphone. He remembers how old she was, her hair, and
how she was dressed. She had two jobs, a kid, no insurance,
cancer, and her medical bills were going to ruin her
family.
He says he was suddenly back in a cancer-ward bed and finding
some modicum of peace in knowing that, if he died, his family
would be taken care of because of his insurance.
“I’ve got to tell you, that hit home. It must be
insidious to be in a cancer ward and know your life is ruining
everything you hold dear.”
Westlund was already a convert to health-care reform. The
business community’s conversion was due to a convergence
of forces, chief among them the exponentially rising costs of
insurance premiums. (Lundquist compares it to inflation in the
1970s and 1980s and what that did to the nation’s
mindset.) Because of that, Westlund and Wyse say the business
and health-care communities have put more thought into reform
then ever before.
And the Legislature? Last year, former Gov. John Kitzhaber
said the Legislature couldn’t deal with complex
health-care issues because of partisanship and deal-making.
Since then, he’s watched Bates and Westlund’s bill
progress through the committee process and seen the current
governor’s initiative to provide heath insurance for
children hit a brick wall of Republican opposition over taxes.
The jury, he says, is out on whether anything has changed.
This year, Kitzhaber saw his own efforts toward Medicare
reform snipped from SB 329-2. (It’s currently a
stand-alone bill that also is in the ways and means committee.)
He thinks the Bates/Westlund bill could suffer for that
omission, and also because of the way they’re approaching
the funding issue.
While Kitzhaber thinks the overall momentum for reform may
have decelerated in the legislative process, he doesn’t
think it will die.
He attributes part of that to the business community, but more
to everyday Oregonians. “The momentum will continue, even
if there’s no action [on a health-care bill],” he
says. “The concern and consequences of what’s going
on are becoming more apparent to more people all the
time.”
THE END OF THE LEGISLATIVE session is simply the beginning of
a long road, says Westlund. Business leaders like Wyse say that
once the Health Fund takes over, health-care experts and
analysts, rather than committees, must direct the journey.
It’s a route that very well may get bogged down in
political infighting. Kramer calls for what he describes as a
“third path” that incorporates the philosophies of
not just the political powers in Salem but the business
community as well.
“When the history of this is written, it [SB 329-2] will
be seen as a watershed,” he says. “We have such a
high degree of agreement on goals, if we can just keep our eyes
on the prize and tackle these tough issues like
financing.”
The window to do that may be closing. Kramer thinks the
convergence that brought the state to this point happens only
once in a decade. If Oregon misses this chance, he says, it
could be a long time before it gets another.
Have an opinion? E-mail feedback@oregonbusiness.com
