The time is right for the United States, Oregon and the communities of Lane County to pursue fundamental health care reform.
The time is right for the United States, Oregon and the communities of Lane County to pursue fundamental health care reform. As various reform proposals are brought forward, we all should become informed and help shape changes that are inevitable in the coming years.
Our health care delivery system has advanced and adapted, while the system for financing health care has become obsolete. The employer-based funding system of the 1950s simply is not suited for the complex health care system of the 21st century.
The result is an unprecedented number of uninsured and underinsured, unsustainable increases in insurance premiums for individuals and employers, and high levels of uncompensated care for health providers.
Other major aspects of the current problem include tobacco, drug and alcohol abuse; increasingly difficult mental health concerns; medical errors; the rising cost of medical technologies; disproportionate consumption of health care resources at the end of life; and the use of hospital emergency rooms to treat primary care problems. People need to accept greater personal responsibility for their health, while the health care system needs fundamental changes to improve access, quality and cost of care.
At least four reform proposals deserve Oregonians' attention: former Gov. John Kitzhaber's Archimedes Movement and its Oregon Better Health Act; the Oregon Health Care Trust Act, proposed by state Sens. Alan Bates and Ben Westlund; the Oregon Health Policy Commission's Road Map for Health Care Reform; U.S. Sen. Ron Wyden's Healthy Americans Act.
In Lane County, the 100 Percent Access Coalition is pursuing improved access to care. The broad-based effort involves health care providers, public agencies and private businesses working together to ensure the viability of our community's safety net clinics, improve the availability of medication through primary care physicians, enhance mental health referrals, and broaden basic health insurance options. Sacred Heart Medical Center and McKenzie-Willamette Medical Center actively support the effort.
The Archimedes Movement is particularly comprehensive in its approach. We respect Kitzhaber's valor in seeking constituents' varied perspectives in formulating the Oregon Better Health Act, which is currently being considered by the Legislature.
The proposal would cover all Oregonians through a defined "core" benefit, financed through public funds and individual contributions. It favors a market-based approach and creates financial incentives for providers to control costs and increase the quality of core services. Individuals could purchase coverage beyond the core benefit, with rates based on an explicit assumption of "fair and reasonable" payment to providers and "value-based cost-sharing" for consumers.
Most of the other proposals contain elements of universal coverage; a basic benefit package; incentives for quality and efficiency from providers; and a combination of public, employer and individual funding.
As we all become more involved in understanding how to effectively reform the health care system, there are important questions to consider:
Are we willing to accept a basic benefit package that may offer less than what we receive through our employers, if doing so would make the basic benefit available to more people? Are we willing to "buy-up" for services beyond the basic benefit? Are we willing to change unhealthy lifestyles? Are health care providers willing to become more transparent regarding the cost and quality of their services? Are we willing to be more prudent in the use of primary care clinics and hospital emergency rooms?
These questions raise challenging issues - but for real reform to take place, they must be answered.
The timing is right, but for effective reform to occur we must be willing to take increased responsibility for personal health. There must be a greater commitment by providers to delivering high-quality, evidence-based services in a cost-efficient manner. Local initiatives to enhance access to care must be continued. New state and federal financing systems must be adopted.
Fundamental health care reform will be immensely difficult to achieve, but is absolutely necessary if a new, better and sustainable health care system is to emerge.
Mel Payne is the chief executive officer for PeaceHealth in Oregon. Roy Orr is the former chief executive officer for McKenzie-Willamette Medical Center. This essay is the fifth in a biweekly series of columns on health care reform.
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|Publication:||The Register-Guard (Eugene, OR)|
|Date:||Mar 26, 2007|
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