The New Health Dialogue

Basketball junkies and nostalgic gamers alike know that Oregon is a land for trailblazers. That's because true Oregonians aren't fazed by microfractures in the knee of a 7-footer or drowning oxen in the Snake River. They've got more important issues, like finding a way to cover their state's 600,000 uninsured and make high quality health care affordable for everyone.

Fortunately, they've also got a plan, developed by the Oregon Health Fund Board and released last week for public comment. The authors of "Aim High: Building a Healthy Oregon" listed three objectives of their proposal:

• A healthy population
• Extraordinary patient care for all
• Reasonable per capita costs shared in an equitable way by the entire population.

To meet this "triple aim" the report laid out "eight essential building blocks" to reform:

• Bring everyone under the tent. The report calls for first covering all children and some low income adults through a tax on providers and insurance companies that would be complemented with federal matching funds. Properly implemented, the authors believe, the program could cut Oregon's rate of uninsured by a third.
• Set high standards, measure and report. Suggestions include the establishment of an all-payers, all-claims reporting program and the creation of an Oregon Quality Institute that would help promote evidence-based medicine and standards of care.
• Stimulate system innovation. This section emphasizes the need for more integrated care with a strong focus on primary care and steps to promote better prevention, chronic disease management, and shared decision making at the end-of-life. It also lays out several strategies for improving public health and the use of health IT.
• Unify and leverage purchasing power. The plan would develop public purchasing cooperatives to leverage the state's market power and it would alos create an Oregon Health Insurance Exchange to help consolidate the individual market.
• Train a new workforce. Recognizing the needs of a growing and aging population, calls for better licensing, monitoring, training, and recruitment for Oregon's health care workforce.
• Focus on health equities. Would try to address some of the social determinants of health with culturally specific approaches to disease prevention and reductions in barriers to care for the low-income.
• Advocate for federal changes. The authors argue that in addition to federal waivers and funding, Oregon must advocate for national policies that support its goals, such as changes in Medicare and Medicaid reimbursement policy and reforms in the tax code.
• Establish a new Oregon Health Authority. The authority would act as a "catalyst for change," implementing the steps laid out in the plan.

With a series of town halls meetings being held across Oregon to discuss the proposals, the plan has already gotten people paying attention. Portland's The Oregonian has given the initiative significant coverage with articles, blogs, op-eds and editorials. The issue seems to have hit home with individual Oregonians, like 26-year-old hairdresser Nikki Downs, as well. Downs, a single mother of two, has a congenital heart defect and will soon need a replacement heart valve -- her second. Already burdened with large amounts of medical debt, she's excited by the prospect of the real reform, telling Southern Oregon's Mail Tribune: "It's absolutely awesome, not only for me but for lots of my friends. They have health problems and it's impossible for us to get insured. We live in debt. I owe so much money."

We share her enthusiasm, and we hope other states (presidential candidates) will follow Oregon's trail in trying to address the interrelated problems of cost, coverage and quality through meaningful health reform.