Former Gov. John Kitzhaber said Wednesday that state and national efforts to expand health insurance coverage will fail unless communities take a hand in reshaping how medical care is delivered and reducing how much it costs.
The nation cannot afford to spend one of every six dollars it produces in goods and services on health care, he told a crowd of more than 150 at a Marion County DemoForum luncheon. He said that money can better be spent on improving public education and developing clean energy.
"I am concerned that unless we are able to shift the focus of this debate from an issue of coverage to the question of how health care is delivered, I think the financial crisis that we saw overtake our auto industry and our financial industry is going to overtake the U.S. health-care system," Kitzhaber said.
Kitzhaber spoke against the backdrop of proposals by Gov. Ted Kulongoski, his successor in 2003, and President Obama to expand coverage to people without it.
Kulongoski's budget proposes higher provider taxes on hospitals and health plans to recoup more federal Medicaid money, adding 80,000 children and 75,000 low-income adults to state-supported coverage. Obama's budget proposes more money for coverage during 10 years, but leaves details to Congress.
Kitzhaber was an emergency-room physician in Roseburg before his election to the Legislature — including eight years as Senate president — and two terms as governor. He was mentioned on the short list for appointment when Tom Daschle withdrew as Obama's nominee for U.S. health and human services secretary and chief health-policy adviser. The Cabinet post went to Kansas Gov. Kathleen Sebelius.
Kitzhaber remains active in the Archimedes Movement, which he founded in 2006 to press for changes in health care.
Kitzhaber's own transformation of a traditional Medicaid program into a broader Oregon Health Plan in the 1990s delivered basic services to all people under the federal poverty line. But spending cuts after he left office slashed the number of people covered under the plan.
"A state that simply seeks to expand health insurance coverage without reducing the underlying cost of health care locks us into a vicious cycle," he said.
He said one possible model is a "health community," which would combine not only doctors, hospitals and other health providers but also institutions such as schools and social-service organizations. He said they can ensure better care for children, whose costs of care are lower — and prevention, screening for and management of chronic diseases such as asthma, diabetes and heart conditions.
Kulongoski's budget proposes to lay the groundwork for a scaled-down concept of "integrated health homes."
Kitzhaber said 1 percent of the nation's population accounts for 35 percent of health-care spending — and 10 percent of the population, about 70 percent of the spending — because medical care usually intervenes only when there is an acute illness.
Examples of his model, he said, are Kaiser Permanente, Group Health Cooperative in Seattle and Health Partners in Minnesota.
"Envisioning and describing what it would be in Marion County does not require an act of Congress, or action from the Legislature," he said. "But it does require vision, leadership, a willingness to change — and above all, a desire to be architects of our own future, rather than simply victims and captives of the status quo."
