October 2000 • Post-Assembly Edition • Dallas
Kitzhaber's challenge
Apply Oregon's lessons to national health systemBY SHARON DICKINSON DENT
Oregon Gov. John Kitzhaber, M.D., had a crowd waiting outside the Assembly's main lecture hall after his keynote address. The Oregon Health Plan, launched in 1994, targets many of the same problems that plague the national health care system. And lessons learned in Oregon can help shape the debate in solving those problems, according to Gov. John Kitzhaber, M.D., keynote speaker at the Assembly's opening ceremony Sept. 200.
In Oregon, the health plan has led to a dramatic expansion in access, improvement in health outcomes, and a greater sense of hope among physicians and patients, Kitzhaber said. However, the state also has seen a repeal of the employer mandate, collapse of the managed care delivery system in some parts of the state and failure to achieve universal coverage.
The plan's successes stem in part from the state's attention to fiscal limits and the need to be accountable for difficult choices regarding appropriation of funds, he said.
"Oregon is certainly one of the few states that has explicitly acknowledged the reality of fiscal limits and has attempted to set priorities based on clinical effectiveness," he said. "This reality -- that consumer demand and medical technology are going to continue to outstrip the ability of the public sector to pay for them -- is something the national government is going to have to come to terms with if they hope to extend coverage to the 45 million Americans who have none."
Although congressional and presidential candidates are debating health care issues, the concept of fiscal limits hasn't been adequately addressed, said Kitzhaber. Instead, proposed policies -- such as prescription drug benefits and a patient bill of rights -- focus on improving services for those who already have coverage.
Kitzhaber said managed care tenets clashed with the plan's premise that covering the poor is a social responsibility.
What can physicians do to help the federal government learn from Oregon's experiences and move toward high-quality health care for all?
Kitzhaber said he empathizes with the climate of disempowerment that pervades the medical community, but he refuses to be called a victim. "To be a victim is to admit that there is nothing you can do about the circumstances," he said, drawing loud applause.
He encouraged physicians to recommit to the goal of universal coverage, a basic benefit package, the need to address rising costs and the proposition that caring for the poor is a shared social responsibility.
"We have the moral authority to put the mission back into medicine," he said.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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