Health Delivery Reform
Can we pull it off?
BY DR. FRANK N. TURNER

In June of this year, the Oregon Legislature passed the Healthy Oregon Act creating the Oregon Health Fund Board. This board will design a plan for universal access to health services, and present its recommendations to the governor and the Legislature on Oct 1, 2008. The Legislature will act on the recommendations in 2009.

Many people are unaware of this important development. On Oct. 24 and 25 there are two meetings in Eugene about what is happening now in health delivery reform. Information about the meetings is at the end of this article.

What will this new law do for us?

Most importantly, the state of Oregon assumes responsibility for creating a health system that all of us can use all the time.

The law lays out a multi-tiered system for all which expands and strengthens Medicaid and SCHIP, creates a publicly run system of "accountable health plans" aimed primarily at the currently uninsured, but open to all. These accountable health plans are required to take all applicants, and to charge the same premium for all enrollees regardless of health status. Subsidized private insurance for some low income Oregonians and for those with pre-existing conditions will continue along with "safety net" clinics for some.

Private health insurance plans will continue as an option, competing with the public plans and with each other. The state may not force individuals with adequate private insurance to join a public plan. The Health Fund Board must create a suitable business environment so the public and the private parts of this system do not compete destructively. Neither Medicare nor the Medicaid long-term care system are changed by the law.

There will be an "individual mandate": All eligible Oregonians must have suitable access to the health delivery system, through either the public or private plans. For most, this will not be free care. Both individuals and employers will be involved, supporting the private segment, or the public segment, or possibly both.

The Oregon Health Fund Board website (oregon.gov/DAS/OHPPR/HFB) has information on meeting schedules, agendas, minutes, and public presentations. During the next year the board will design the Accountable Health Plans and the Safety Net, and consider questions of benefits, eligibility, delivery and funding.

What are some things to think about?

The overwhelming majority of us are ready for big changes toward more fairness, efficiency, and accountability. (See the reports of the Citizens' Health Care Working Group in the "appendices" for public surveys. citizenshealthcare.gov.)

The "conventional wisdom" is that we are not ready for a single-payer (Canadian) system. Other countries with more than one administrative system (Germany) seem to do OK. What features of these systems that we should incorporate into our own?

Individual choice is a consideration. Which choices are essential? We'd like to be able to choose our own doctors, treatments and to seek other opinions. What choices should be reserved for each individual to make?

We patients need to be "more responsible." What will citizens be responsible for? Will we have to do more than sign up and contribute financially? Will we be required to see the doctor regularly? Will we have to adopt healthful habits? What will be asked of doctors, hospitals, government, drug companies and insurers?

Why a community meeting? The non-profit consumer organization Oregon Health Action Campaign (OHAC) is dedicated to informing Oregonians about proposals for universal and expanded access developed by the 2007 Legislature.

We want meeting participants to come away understanding that there is a role for them and their communities in defining next steps: That implementation of Healthy Kids depends on a yes vote in November and that the Healthy Oregon Act offers many opportunities for public engagement and public hearings.

The October meeting for Health Care for All Oregon and We Can Do Better was held Oct. 24. Join us for a very special second community meeting from 6:30 to 8:30 pm Oct. 25 at the Eugene Public Library Bascom Room for "Finding the Road to Health Care for All 2007 and the Oregon Legislature." Presented by OHAC in association with We Can Do Better/Archimedes and Health Care For All Oregon. Refreshments and free parking. For more information call (800) 789-1599 ext. 16 or email Sandra@ohac.org

Frank N. Turner, MD, is a specialist in pulmonary medicine who now works exclusively with the Volunteers of medicine Clinic. He's active in several health care reform groups.