Oregon's Sensible Health-Care Reform

THE American health-care system is broken. It is inequitable and unfair. It blatantly discriminates on the basis of age, gender, and income. It denies the most basic preventive services to some of the poorest Americans. Total dollars spent on health care annually continue to rise astronomically, but the health of our citizens is no better than those in countries that spend less per person on health care.At the federal level, there is widespread recognition of the need for change. However, there is considerable reluctance among some to take concrete steps toward change, as the history of the Medicare catastrophic health bill and the Pepper Commission both show. Oregon has attempted to change all that. The Oregon Health Plan will provide basic coverage to virtually every citizen in the state. First, this plan expands the Medicaid program to all uninsured people with income below the federal poverty line ($13,400 for a family of four in 1991). This includes people not now eligible under federal law, such as older children and working-age single adults. About 60 percent of those that will be added through this expansion are families with children - families that n ow have no health insurance. Second, the law requires employers to offer all full-time employees and their dependents, at a minimum, the same benefit package that is adopted under Medicaid. The final component of this plan provides health insurance to the medically uninsurable - those with catastrophic preexisting medical conditions. Oregon will share responsibility with insurers for coverage of these people through a risk pool. OREGON has recently completed a comprehensive public process to reach a social and medical consensus on the definition of "basic" care. Services have been prioritized according to effectiveness, social value, and cost, with a strong emphasis on preventive services. Funding decisions have been made on the basis of this priority list, and the resources available for health care will be used to give the most effective services to the greatest number of people. Critics of the Oregon Health Plan are concerned that we propose to ration health care. Well, it is patently obvious that we ration health care right now. We deny coverage of basic services to many people, while allowing access to all procedures, including many highly ineffective ones, to others. The Oregon Health Plan will expand the number of people who receive benefits and provide them with basic health care. We are ready to go forward with the Oregon Health Plan, and we have tremendous support for it within our state. All we need is a waiver of some Medicaid provisions. This can come either from the administration or from Congress. We are currently waiting to hear whether or not the administration will grant the waiver request. In the meantime, there are more than 400,000 uninsured Oregonians. The Oregon program may not be perfect, but it is clearly preferable to the current crisis. It is unconscionable to argue that actions should be delayed until a "more perfect" solution can be found. Oregon is a willing laboratory in which to test new ideas. The enormity of this problem nationally makes step-by-step solutions a necessity. Let's see what works in one small state before we commit the nation to a solution.