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Panel looks at Oregon Health Plan

Care reform - A group evaluating the federal system talks to founders of the state plan

Saturday, September 24, 2005

The Oregonian

A national citizens panel trying to jump-start health care reform at the federal level came to Oregon Friday to gather ammunition.

In a five-hour hearing, the panel got an earful about lessons growing out of Oregon's effort to reinvent its own health care system 15 years ago, which led to the Oregon Health Plan.

"Where better than Oregon to come hear about what we are facing?" said Catherine McLaughlin, a health economist at the University of Michigan, who led Friday's hearing of the new Citizens' Health Care Working Group.

Its 14 members include doctors, nurses, health economists and caregivers -- but no registered lobbyists or elected officials.

"This is different," said Sen. Ron Wyden, D-Ore., who joined with Sen. Orrin Hatch, R-Utah, to sponsor legislation that set up the working group. "Citizens are going to drive this, not the Washington lobbyists."

Among panel members is Dr. Frank Baumeister, a Portland gastroenterologist, past president of the Oregon Medical Association and former chairman of the state Health Resources Commission.

By law, the group must make recommendations to Congress and the White House by next August, and Congress must hold hearings.

Wyden said he hopes the group will succeed where 60 years of efforts at national health care reform have failed. He characterized those failed efforts as "food fights between lobbyists."

This time, he vowed: "We're going to show where the money spent on health goes -- in simple, understandable English -- and walk them through the various ways that money could be spent to improve health care for all Americans."

Oregon plan's start

The Oregon Health Plan, begun in 1994, was the state's effort to expand Medicaid to include more low-income residents by giving priority to coverage of the most cost-effective treatments. The reform grew out of 47 "town meetings" in which citizens told officials what kind of care and coverage they valued most.

Dr. Ralph Crawshaw, a retired Portland psychiatrist who spearheaded that earlier effort, told panel members Friday that he envied their chance "to shape a distinct vision of America's future" by listening to "real people" tell their stories of pain and suffering.

Crawshaw also warned panelists that their task would be anything but easy. "You're going to be up late at night," he said.

Ellen Lowe, a 15-year member of the Oregon Health Services Commission, recalled visiting Laundromats during the 1980s and '90s to talk with low-income people about their health care needs.

"Granted, this wasn't a very scientific approach, but it broadened my view," she said. It showed her the importance of making health plans comprehensive, including preventive as well as emergency care, and dental and mental care.

John Kitzhaber, the former Oregon governor who championed the Oregon Health Plan, urged the panel to address the current system's skewed incentives.

"We have a policy that says we won't pay pennies to manage your blood pressure, but we will pay millions for your stroke after you have it," said Kitzhaber, a former emergency doctor.

Gathering information

Portland is the sixth city the citizens group has visited to gather expert testimony. Next month, it will outline the agenda for a series of town meetings around the nation between Nov. 1 and April 15. Based on testimony at those meetings, the panel and its staff will write its final report, with recommendations, for the White House and Congress.

Baumeister said the Oregon Health Plan's insistence on public debate and open decision making is the new group's model. "I believed in it at the state level, and I believe it should go to the national level," he said.

He sees bipartisan agreement that the health care system needs an overhaul -- given its soaring costs, inequality and the 46 million uninsured Americans.

"It's like New Orleans," Baumeister said. "For years, everybody said something's got to be done. Now, the levees have broken, and there's no choice.

"Something's got to be done."

Don Colburn: 503-294-5124;

©2005 The Oregonian