WIll Oregon Lead the Nation?

In my perusal of health care issues, I have noticed a couple of ripples in the pond caused by references to universal health care coverage. Both of them come from Oregon.

First, on December 10th a commission of the Oregon state Senate announced a draft bill intended to result in health insurance coverage for all Oregonians. Then, on the 13th Senator Ron Wyden, Democrat from Oregon, announced a plan he proposed that would provide health insurance coverage to all Americans not already covered by Medicare or military insurance plans.

Both plans have some points in common. Notably, both call for employers to move from individually purchasing plans for their employees to contributing a insurance pool through which insurance would be purchased. Both would also require some contribution by individuals toward expenses.

It’s no surprise that ideas on health care should come from Oregon. After all, one of the first experiments in government efforts to control health care expenditures was the Oregon Health Plan. Beginning in 1989, the Oregon legislature passed laws that expanded the number of people in the state who would be covered under Medicaid. To help control the cost of the expansion, through public hearings and legislation the state established a list of 700 prioritized services that would be covered under Medicaid. The critics were quick to cry “Rationing!”; but in fact they were correct. Health care was rationed, with the intent that this would be done intentionally and thoughtfully, based on health care needs, and not accidentally or pragmatically, based on ability to pay or to use the system. It was also in Oregon that the Death With Dignity Act was passed in 1994 and confirmed in 1997. This was the legislation that allowed, under certain specified circumstances, and with clear procedures and safeguards in place against abuse or collusion, patients in severe pain and chronic life-threatening conditions to request from their physicians fatal doses of pain medications. Both of these actions in Oregon have been watched closely, and both have been criticized frequently. One could argue that the most important outcome of the Death With Dignity Act has been the impetus it gave to the movement for palliative care for chronic and debilitating pain. In either case, however, it has been clear that Oregon has been a leader in experimental approaches to providing appropriate health care options.

It is too soon to know whether the Oregon Senate’s plan for Oregon, or Senator Wyden’s plan for the nation, will have a chance, either at providing insurance to more people at reasonable cost, or at making it through the sausage making process of politics. It will be interesting to learn the details, and to see how these ideas develop. However, it is good to see that the effort to provide universal health care coverage continues. It’s past time.