Reinventing Health Care

Article excerpt

Byline: The Register-Guard

Forget about John Kitzhaber's potential gubernatorial candidacy. If his revolutionary efforts to reform a badly broken health care system can gain traction where so many others have spun out, he might want to aim higher - maybe president. Of Google, or Starbucks, or some other icon of solid gold American success.

Kitzhaber's latest assault on health care's sorry status quo involves a radical restructuring of the way public money is spent - the dollars currently allocated for Medicare, Medicaid and the tax exemption for employer-provided health insurance. Kitzhaber believes that if the state could win federal permission to pool those public dollars - about $6.5 billion, in all - it could afford to provide basic health care coverage to every Oregonian. Without raising taxes.

The concept - and it's just that, at this stage - is that $6.5 billion works out to about $2,000 per Oregonian to cover basic medical needs. That amount wouldn't go far enough in the current system, so the Kitzhaber plan depends on top-to-bottom changes in the way acute care, chronic care and end-of-life care are handled by doctors, hospitals and insurers.

Hold on. Do not succumb to the temptation to dismiss Kitzhaber's ideas because they demand uncomfortable changes and aren't fully fleshed out. Keep reading.

It's old news that the U.S. health care system is cruelly unfair and embarrassingly inefficient. Americans spend more per capita on health care than any other nation in the world - by at least 40 percent - and they get far less bang for their medical buck. European nations provide universal health insurance to their citizens at roughly half the cost of American medicine. And it's better care. Most of Europe has longer life expectancies, lower child mortality rates and superior preventive care compared with the United States. For that matter, Cuba has lower infant mortality rates.

Meanwhile, refusing to let go of the myth that the American free market is the best model for health care delivery has really delivered this: 45 million Americans without any health insurance, and 9 million children who have no regular access to medical care. Lack of health insurance is directly responsible for about 18,000 deaths every year, according to the Institute of Medicine. This is outrageous and shameful, but what's incomprehensible is that so many Americans continue to believe that nothing can be done about it.

Thank goodness for people like Kitzhaber, who are convinced it's possible to pull off genuine health care reform if the stakeholders are willing to set aside their self-interests. …