Health care plan: poison or cure?
Measure 23 supporters envision medical care for all; foes say Oregonians can ill afford the cost
Oregon has a national reputation for going boldly where few states have gone before. Think bottle bill, land use planning, the Oregon Health Plan, physician-assisted suicide, vote by mail, medical marijuana.
Universal health care could be the state's next frontier, if voters next month approve Measure 23, which would guarantee medical care for every single Oregon resident, including those with pre-existing health problems.
At least 13 other states are considering similar health care reform, but Oregon is the only state to put such a sweeping plan before voters.
The measure is tantalizing, promising to cover any medical service or treatment deemed necessary by a doctor or other health care provider. The wide range of services includes alternative therapies, vision and dental care, mental health care, prescription drug coverage, long-term care for the elderly, acupuncture, chiropractic services, medically related transportation, even massages.
The proposal, called the Oregon Comprehensive Health Care Finance Plan, would eliminate most health care expenses Ñ such as insurance premiums, deductibles, copayments and out-of-pocket doctor bills Ñ now paid by individuals and employers.
Instead, individuals would pay additional personal income taxes of up to 8 percent depending on their income. Families whose income was 150 percent of the poverty level or lower would not pay this income tax.
Employers would pay new payroll taxes ranging from 3 percent for small businesses to 11.5 percent for the largest employers. Currently, larger employers pay more than 11.5 percent of their budgets in health care costs, so they would see significant savings with Measure 23, supporters say.
Money currently spent by federal, state and local governments Ñ including Medicare and Medicaid Ñ also would help pay for the plan.
The plan, which would take effect in 2005, would limit administrative costs to no more than 5 percent of its budget. Currently, at least 25 percent of health care dollars is spent on paperwork and other administrative costs. This change would result in a huge money savings, supporters say.
Oregon's insurance companies and health plan providers would go out of business or find a niche, such as selling some form of supplemental insurance, said Dan Isaacson, the 22-year-old manager of the Eugene-based Yes on 23 campaign.
Opponents, mostly financed by the insurance companies, have collected about $600,000 to fight the measure, mainly with mass mailings and other printed materials.
They say a 'health care for all' plan would cost too much and could crush Oregon businesses.
'You can't construct this plan the way it is proposed and not need more revenue (than supporters are projecting),' says J.L. Wilson, director of the Oregon chapter of the National Federation of Independent Business. 'You are creating a system that is ripe for a cost explosion. The system can't be all things to all people.'
Measure 23 is one of the most ambitious attempts to deal with skyrocketing health care costs since 1994, when a panel led by Hillary Rodham Clinton tried but failed to establish a national universal health care plan.
As a result, Measure 23 is attracting national attention, with media coverage from The Wall Street Journal, The Washington Post, NBC Nightly News and more than 30 other media outlets around the country.
'Oregon's health care system is failing,' Isaacson says. 'We have about 20 percent of Oregonians who have no health insurance and another 20 percent who have inadequate insurance.
'A catastrophic injury or illness could lead to bankruptcy. And we have 25 to 40 percent of every single health care dollar spent on paperwork, advertising, millions in pay and stock options for CEOs,' he says.
'We can't continue with this type of health care system very much longer without having it collapse.'
Isaacson and other members of Health Care for All Oregon, the grass-roots group sponsoring the measure, are hoping to tap into voter angst about a health care system in crisis.
So far, voters seem uncertain about adopting a universal health plan. A statewide poll conducted for the Tribune showed 39 percent opposed, 36 percent in favor and 25 percent undecided.
Opponents admit the health care system is in trouble.
'What we have is much like the perfect storm, with a number of things coming to bear on the health care system,' says Michael Becker, vice president of public policy and community affairs for Regence BlueCross BlueShield of Oregon, one of the state's largest insurance providers.
'We have regulatory pressures, access issues, shortages (of nurses and doctors), expansion of medical knowledge and technology, baby boomers moving into older age, cost and the problem of the uninsured.'
But the 'single payer' system proposed in Measure 23, in which financing would come from a single fund rather than from insurance companies, would be 'the most profound change in public policy and economic policy that Oregon has ever undergone,' Becker says.
A 15-member 'finance board' created by Measure 23 would have the authority to raise income and payroll taxes and to issue revenue bonds if income falls short of what's needed.
'There's not a branch of government in Oregon that has that kind of power,' Becker says.
He adds: 'There is no health plan in existence, governmental or private, that has a benefit as rich as (Measure) 23.'
Wilson worries that the new payroll taxes would drive businesses out of Oregon and discourage others from moving here.
'I can foresee businesses with an ability to go elsewhere to exercise that option,' Wilson said. 'If you have payroll taxes that are double those of surrounding states, you would have to look at that as a bottom-line issue. We would be so far out of bounds relative to other states, you'd have to consider going elsewhere.'
Opponents also include Gov. John Kitzhaber, who says he has no problem with a single-payer system, but 'there's no cost control in Measure 23.'
'If it passes, I think what happens is, it goes bankrupt pretty quick,' he said in a recent interview with the Tribune. 'Any willing provider will get reimbursed for anything he or she thinks is medically necessary.'
The three gubernatorial candidates Ñ Democrat Ted Kulongoski, Republican Kevin Mannix and Libertarian Tom Cox Ñ also oppose the plan.
Even the Oregon AFL-CIO, which supports a universal health plan in principle, opposes this measure because it shifts responsibility for health care costs from employers to employees, says research director Lynn-Marie Crider.
'For workers who receive employer-paid health care as part of their benefits package, this is a major shift. These people are paying very little out of pocket, and (Measure 23) penalizes them by imposing substantial taxes on them for something they're not paying for now.'
Some individual AFL-CIO-affiliated unions, including Communication Workers Union Local 7901 and United Steelworkers of Oregon, decided to support the measure.
'Some of our affiliates felt the general principle is so strong, it would be wrong to oppose it,' Crider says.
The measure does have other, high-profile supporters, including former Multnomah County Chairwoman Bev Stein and Multnomah County Commissioner Serena Cruz, currently running for a seat on the Portland City Council.
The grass-roots Health Care for All Oregon campaign has raised about $26,000, mostly from hundreds of supporters, Isaacson says.
Both sides have produced studies that fiscally support their arguments. Health Care for All Oregon cites nine studies showing that single-payer financing would pay for universal health care for the same amount of money currently being spent on health care.
An analysis of Measure 23 made a year ago by Christina Daw, a health policy analyst who co-authored a similar study in Washington state, found that the Oregon plan's estimated revenue would be enough to cover medical care for all state residents even if costs spike considerably by 2005. Savings would be made by eliminating what she called 'excessive administrative costs' from multiple insurance companies.
Countering Daw's conclusion is a new study commissioned by the Washington, D.C.-based American Association of Health Plans, which found that Measure 23 could increase health care costs by as much as 30 percent.
Portland economist John Mitchell said he hasn't analyzed Measure 23 but is concerned that the plan 'sets the stage for lots of demand. Look at the list of things that are covered, including nursing home care. How will the finance board hold down reimbursement costs when we have all this demand?'
None of those questions trouble voters such as Portland resident Kay Abel, who intends to vote for Measure 23.
'I don't think people living in America, the richest nation on the planet, should have to do without health care,' she said last week at a North Portland neighborhood meeting whose topic was Measure 23. 'It's shameful.'