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Legislators take on health care system

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Friday, June 01, 2007
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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.

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