Campaign for a Healthy Oregon

One-quarter of all Oregonians have inadequate or no health insurance, including 100,000 kids. Everyone else is stuck with big premiums that still come with deductibles and expensive prescriptions drugs.

We think if people work hard and play by the rules, they should have access to a standard, affordable health care plan. We can do it, if we get costs under control, rein in the premiums the insurance companies charge and make sure everyone pays their fair share.

The Governor appointed a board to come up with a solution this year. They're hearing plenty from the lobbyists from the insurance companies, so we're gearing up to make sure they hear from us.

We’ve done a lot of research on how we can do this, and all term we'll be educating the campus and key players across the community about our solutions. We need your help to make this work.

Problem

Health care costs are skyrocketing, leaving one quarter of all Oregonians without basic coverage. Over 300,000 can only get covered for part of the year, and over 500,000 don’t have any coverage at all. This includes over 100,000 kids.

Those of us fortunate enough to have insurance deal with rising premiums, rising deductibles and copays, and diminishing quality. What’s going on?

Root of the Problem: the Market Isn’t Working
In a normal market, consumers chose the product they want based on a combination of price and quality, forcing suppliers to compete, which naturally keeps prices in check. In the health care market, however, the doctor chooses the health care, but does not pay for it – eliminating natural price regulation. The patient usually doesn’t have the expertise to order her own care, so they don’t “shop around” like in a normal market.

Subsequently, hospitals, drug and insurance companies have the ability to charge more and engage in practices that drive up prices far higher than in other markets, and engage in practices that other industries would never get away with. They only insure the healthiest - and most profitable - people. They waste our premium dollars - on marketing to convince doctors to order expensive drugs and treatments, inefficient bureaucracies, and fancy capital projects. And they keep vital information about treatment success and infection rates from consumers, stripping us of even the most basic consumer tools.

Hospitals, drug and insurance companies are reaping record profits. For the rest of us, however, we get the following results:

Health Care Costs Too Much
Insurance premiums are rising faster than inflation, putting strain on private and public employers who offer health insurance, and on consumers who buy individual insurance. Consumers’ out-of-pocket costs – co-pays, deductibles and coinsurance – are rising as well.

This means that fewer and fewer people can afford a plan. With fewer people in the premium pool the rest of us have to pay even more.

And then all those uninsured people don’t get basic care, including prevention, treatment of illnesses in their early stages, and management of chronic conditions. Without this access, many get sicker and sicker and their treatment (now of a more serious and developed condition) ultimately costs the system more resources through expensive emergency care. This further drives up the cost of health care, which in turn prices yet more people out.

The vicious cycle of cost and access combines with other major cost factors – an aging population, a boom in medical technology and new treatments.

Quality Is Low
Health care is too often ineffective or unsafe. This happens in several ways.

Medical errors, over- and under- treatment, and hospital-acquired infections hurt patients and drive up costs.
Providers and health systems fail to use evidence-based guidelines for medical practice.
Lack of access to preventative care and chronic condition management automatically drives a portion of the volume of care toward its least efficient and effective treatment for the condition when it has become acute.

Too Many People Lack Access to Quality Health Care
In Oregon, the 2006 Oregon Population Survey (OPS) shows that one in six Oregonians had no health insurance coverage, about 576,000 individuals of all ages; 116,000 of those uninsured were children under the age of 19.

In addition to the currently uninsured, almost 300,000 Oregonians had experienced a health insurance coverage gap at some time during the prior 12 months. The report also indicated that working-age adults (18-64) are the most likely to lack health insurance, with one in five lacking health insurance.

Solution

The bottom line is that Oregonians should have guaranteed access to their choice of a health insurance plan. Health care should become more patient-centered, evidence-based and affordable.

We have done a lot of research and discussed possible solutions with everyone from patients' groups, to doctors and nurses; from small business owners to industry experts. Working together with a coalition of community groups and other allies, and we think we’ve come up with a way to start solving this problem.

In general, we think that we need a uniquely American solution to the problem, one that blends the private market with more government watchdogging. Americans should be able to stick with their current plan, and be able to choose from a variety of plans. We should also set a standard level of care that every American has access to. And we should use the government to watchdog the industry, and give consumers more leverage in the market.

Here are some specific ideas, and we are coming up with more all the time.

Reduce Costs

Cut costs of drugs and premiums and give consumers more market power by allowing the government to negotiate drug costs and insurance premiums.
Require 85% of premium dollars be spent on health care (rather than administration, advertising, profits). In addition, there may be a benefit to capping premiums, much like we do gas and electric prices.
Put more emphasis on preventative care.
Create tools to help consumers and businesses compare health plans costs and benefits.

Improve Quality

Set a reasonable standard of care and customer service that every health care plan must have.
Require public disclosure of death rates, infection rates, medical errors, and studies of the efficacy of medical treatments.
Ban gifts, travel and other undue influence by special interests over health providers and insurers regarding medical treatments.

Get More People Access to Health Care

Ban practices that allow insurers to deny anyone access to coverage, or that price older, sicker people out of coverage.
Allow more people to be eligible for the Oregon Health Plan.

Pay For It Fairly

Right now the only people footing the bill for this mess are consumers and the shrinking number of employers who still cover their employees. That’s got to change. EVERYONE – consumers and all employers, but also doctors, insurance companies, hospitals, and drug companies should pay to make all these things happen – based on what you can afford.
There should be no government subsidies to provide private health care unless we implement the cost and quality controls outlined above.

Current Opportunity:

Oregon is coming up with a big health care reform plan between now and October 2008.

In June 2007, the Oregon State Legislature passed the Healthy Oregon Act (SB329). This law mandates the development of a plan for making sure all Oregonians have access to quality, affordable health care. It required the governor to appoint a 7-member board, and the board to appoint committees, all to come up with the plan. It also sets strong goals and principles about health care access, cost and quality.

In September, Gov. Kulongoski appointed the 7-member Oregon Health Fund Board. The Board will be advised by 6 committees. OSPIRG's Laura Etherton has been appointed to the financing committee, which in addition to proposing the financing of the overall health care system, is charged with proposing a framework for a health insurance exchange.

Public input - through testimony, comments, letters - is a critically important part of the process.

Take Action

Oregon is coming up with a big health care reform plan between now and October 2008. We need your help to make this work.