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Church speech revives health reform idea

Catholic Sentinel, June 17, 2004
Author: Ed Langois

In a speech last week at St. Philip Neri Church in Portland, Oregon’s former governor called for a “revolution of ideas” to overthrow current U.S. healthcare funding.

Gov. John Kitzhaber, an emergency room physician, called for replacement of a system he says has become “obsessed with the delivery of health care as an economic commodity at the expense of health for the American people.”

His proposal, which he compared to public education, would extend basic taxpayer-funded health insurance to everyone, cutting costs by limiting the procedures that are covered.

Such an approach will create a healthcare system with “equity and sustainability,” he told the audience.

Susan Francois, part of the social justice and peace effort that brought Kitzhaber to speak at St. Philip Neri, says that a campaign for better healthcare “fits into the foundations of Catholic social teaching.”

Working through the Metropolitan Alliance for Common Good, the parish is identifying people who struggle with prescription costs and plans to put them forward for a state pool-purchasing program.

“We have rights ourselves for healthcare and responsibilities to make sure that others have their rights to healthcare,” Francois says.

Kitzhaber, governor of Oregon from 1995 to 2003, has long taken heat for proposing the rationing of health care. Better to do it in the open and make it equitable than what happens now, he argued at St. Philip Neri.

“So instead of giving everyone coverage for something — as we do with public education — we give some people coverage for everything and others coverage for nothing,” the governor said. “Instead of explicitly making a list of benefits and drawing a line, we implicitly make a list of people and draw a line. That is how we ration health care today in America.”

Kitzhaber’s idea, paying for more people by refusing to pay for some procedures, was the heart of the Oregon Health Plan, which he designed. This summer, the decade-old plan seems to be emitting death groans.

During the 1990s, it extended coverage to as many as 100,000 people who did not qualify for Medicaid but still fell below the federal poverty level. Oregon lawmakers have been dismantling the plan during the economic downturn of the past four years. Now only about 50,000 people are covered. And just last week, state health officials announced they plan to drop about 25,000 more from the insurance by July 2005.

If the federal government approves a tax on Oregon hospitals, coverage for the 25,000 could be saved.

Oregon Health Plan Plus will continue to cover children, single parents and the disabled, as Medicaid has for decades.

The former governor, who saw his plan begin to crumble while still in office, says the overall healthcare crisis has become bad enough that his idea is again ripe.

“Lavishing expensive, often futile care on some while denying inexpensive and effective care to others has become the hallmark of a system which now consumes 15 percent of our GNP yet leaves over 44 million people without coverage,” Kitzhaber said at St. Philip Neri.

The nation should not apply market models to medicine, he said, because that makes human beings — those who cannot pay — “liabilities” instead of patients.

Kitzhaber, sensing popular frustration over high health costs and the scandal of the uninsured, appealed for a grassroots movement to resurrect the idea nationwide.

Calling the current system “politically and morally indefensible,” the former governor said that the political establishment will not take it on for fear of losing elections.

He called on listeners to challenge Medicaid and Medicare.

Retirees are now one of the wealthiest sectors, and it does not make sense to use Medicare to transfer money to them from struggling workers, the governor said.

Medicaid eligibility derives not from poverty but from category — it goes to some pregnant women, families with dependent children and those who are disabled. Many poor people go uncovered.

The former governor is critical of current drives to cover prescription drugs for older Americans.

“Why should we take the only group of Americans with an absolute entitlement to health care and spend $400 billion to finance the cost of their prescription drugs before financing basic health care services for the 44 million Americans with no coverage whatsoever?” he asked.

Like public schools, Kitzhaber’s version of a public health system would have everyone contribute to a basic benefit. As parents who want to enrich their children’s education pay for private schools or tutors, people who want higher-octane healthcare would pay more on their own. In education, no one gets cut from the system when the budget is tight, the governor said. Everyone endures larger classes and fewer amenities.

Now, the governor says, the health system approach is just backwards. “We respond to fiscal pressures by manipulating eligibility rather than benefits,” he said.

Kitzhaber called on the entire health system to look to the common good instead of treating some patients without consideration of effectiveness.

“In the public sector we are dealing with resources held in common and they should be used to benefit the larger society from which these resources come,” he said.

It would cost less to extend universal coverage than it does to force people into expensive emergency care, the former governor said. As an example, he cited Doug Schmidt, a Portlander who lost prescription benefits last year because of state cuts. He could not afford the medications that controlled his seizures and eventually had a crisis that landed him in intensive care for several months. He was then transferred to a nursing home and died in November.

“The cost of his anti-seizure medication was $14 a day. The cost of his care in the intensive care unit was over $7,500 a day and that cost was billed back to the state Medicaid program,” Kitzhaber told the audience.

“We are going to pay these costs one way or another – either implicitly or explicitly,” he concluded. “And by failing to do so explicitly the cost will ultimately be much higher in both economic and human terms.