Former governor sounds trumpet for universal health care

By DON McINTOSH, Associate Editor

Two weeks after national labor leader Andy Stern told a Portland audience the U.S. health care system is unreformable, a group of managers and Portland-area labor leaders heard the same message — from a former Oregon governor.

Two-term Democratic governor John Kitzhaber, who worked 13 years as an emergency room doctor in Roseburg, delivered a call for a health care “revolution” at an Oct. 7 breakfast at the Oregon Convention Center, sponsored by Kaiser Permanente. Kitzhaber, who was also Oregon Senate president from 1985 to 1993, is regarded as the father of the Oregon Health Plan, which uses federal Medicaid money to make health insurance available to low-income workers. Since he left the governor’s office in 2002, the program has withered on the vine from successive budget cuts.

“There’s a troubling proclivity in our society to ignore problems until they become catastrophes,” Kitzhaber said.

Today, rising medical costs are eating into corporate profit margins, slowing job growth, and suppressing wage increases, Kitzhaber said.

“We’ve reached a point where the average cost of family health coverage — over $10,000 a year — is greater than the total take-home pay of a full-time worker earning the federal minimum wage.”

Tinkering around the edges of the system isn’t going to work, Kitzhaber told the audience at Kaiser’s annual labor forum.

That’s because the assumptions that underly the current system are outdated, Kitzhaber said. Medicare was devised in the 1960s, when over half of the elderly were in poverty. Today, as a group, seniors are the most affluent. And yet Medicare isn’t means-tested; every senior is eligible. So the health care of seniors, many of whom are well-off, is paid for by tens of millions of workers, many of whom can’t afford health care for themselves.

Medicaid was added later, and pays for health care for pregnant women, poor children, the blind and disabled, and long term care of the aged.

Forty years later, there’s a growing gap in coverage — those who aren’t old enough or poor enough for the government programs, and aren’t lucky enough to have employer-paid coverage or affluent enough to afford it on their own. That gap numbers 45 million individuals in the United States, and 60,000 in Oregon.

Kitzhaber stripped the current system down to its essentials: an obsession with the delivery of “health care” as an economic commodity, at the expense of health.

The alternative to a national commitment to universal health care is the current system, which is increasingly inefficient, expensive and unfair.

When you it add it all up — Medicaid and Medicare, tax dollars for public employee health coverage and tax deductions for private employee health coverage, hospitals for veterans and clinics for the poor, money for medical and pharmaceutical research, overhead at public medical schools and tuition at private medical schools — the United States is already spending vast public resources on health care.

That should be the concern of every citizen, Kitzhaber said, because currently it’s not being spent well, or fairly.

Instead, he urged an explicit commitment to universal coverage, and suggested — as a model — the way public education is financed and delivered.

It’s something we take for granted: All citizens contribute to the cost of public schools, whether they have children or not. And every child, regardless of their parents’ income, is eligible to attend, for free. Parents who want to — and can afford to — can hire tutors or send kids to private schools.

When school systems have budget problems, they find ways to cut costs: shortening the school year, larger class sizes, fewer electives. They don’t say, “from now on, children from families earning more than $40,000 a year aren’t eligible to attend school for free.”

Why not adopt such a model for health care, Kitzhaber argued. The solution would require action by the U.S. Congress, but Kitzhaber predicted the political leadership to support it won’t come from the existing political establishment, but from organized citizens.

“Isn’t that naive?” asked one questioner.

“There’s no survival value to pessimism,” Kitzhaber replied. “After a quarter-century in politics, I don’t think I’m naive. But I am still idealistic.”

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