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Reportback on Tues, Feb 7th Town Hall mtg on Healthcare

Below are my vastly imperfect notes on the Town Hall meeting. It was filmed and will be aired on cable access and is worth viewing mostly for the audience's comments and questions... and for reference and posterity in these dark days of dwindling healthcare. I forgot to mention in the body of the article that Kate Brown suggested she would seriously consider mandatory health insurance like we now have laws mandating auto insurance.
Rep. Diane Rosenbaum, Sen. Kate Brown, & Rep. Carolyn Tomei invite you to:

Town Hall Meeting :

The Future of Health Care in Oregon

Tuesday, Feb. 7th, 7-9PM

3536 SE 26th Ave. (SEIU Hall just S. of Powell)

Speakers include

* Dr. Bruce Goldberg (Director, Oregon Dept. of Human Services)
* Maribeth Healey (Oregonians for Health Security)
* Jim Walton (President, Oregon Coalition of Health Care Purchasers)

For questions contact: Regan Gray 503-231-9970


Town Hall meeting filmed and will air on Cable Access.
NW Film Study Center also present, doing documentary.

Discussion questions posed by Rep. Diane Rosenbaum.


DISCUSSION 1: Re: universal access to basic healthcare: We are not closer to the goal stated in 1989 of "healthcare for all Oregonians."

* Bruce Goldberg:
- In discussion groups with parents of children with severe mental illness, surprised to hear there was not one of them who had not had to call Emergency Services at least one time to obtain healthcare for their children.

* Jim Walton:
- Has seen increase in premiums and deductibles, resulting in decrease in access to healthcare.
- Need to ask question: "Do we want same healthcare benefits for everyone?"
- Are some people willing to give up their higher level of coverage so all will have coverage?
- Seeing coverage of less and less dependents
- Also need to think about doctors' reimbursement structure and rates; it takes more the $26 per-visit reimbursement to cover costs of running practice.
- Reimbursement rates from Medicare (Relative Value Units - RVU's) are determined per county

* Maribeth Healey:
- OHP *did* work. It served over 1.4 million people
- insurance premiums increasing: 14.5% this year for her non-profit Oregonians for Health Security


DISCUSSION 2: Cost of healthcare probably fastest growing cost, after gasoline/oil.

* Maribeth Healey:
- Premiums increased 76% over last 5 years.
- There is a lot of $ in the system and a lot of profit.
- Technically non-profit organizations, heathcare providers and hospitals are making high profits:
- $54 million for healthcare
- $262 million for hospitals

* Bruce Goldberg:
- Every system gets its desired result.
- The healthcare system is profit-oriented.
- It's not just how $ gets distributed but what it gets spent on.
- Are expensive tests and prescriptions really necessary?
- Cost-shifting not same in any other market where price for same service or product vary wildly by purchaser.

* Jim Walton:
- Need to train consumers to be better (smarter) consumers.
- Promote healthcare purchasers coalition who are able to get commitment to stable price before purchasing.
- Promote evidence-based healthcare.

DISCUSSION 3: Solutions? Possible cigarette tax to cover all children?

* Bruce Goldberg:
- Where should we start?
- 12% of all children are now uninsured.
- 25% of adults under 65 are uninsured.
- Wants to cover children but doesn't want to see that be an endpoint... need to cover all Oregonians.

* Jim Walton:
- Offering coverage but doing it with the same insurance system will result in same problems we've always had.

* Maribeth Healey:
- 6 ballot measures going to legislature in 2007:
1. Tobacco tax: 60cents - to cover all children under 19
2. Measure 40
3. Measure 111
4. Fair Share - AFL/CIO
5. Expansion of Prescription Purchasing Pool
6. Public Review Board for insurance companies

* Bruce Goldberg:
- First question is not how we raise more $ but what we want to buy.
- What do we value?

* Jim Walton:
- One patient spent $1.5million on "The Hill" in 36 hours
- Winston Churchill was quoted: "Americans will do the right thing after exhausting all other possible solutions."
- Thinks we may finally be reaching that point


DISCUSSION 4: Given that we haven't made a lot of progress, how realistic is it to expect the legislature to design a universal healthcare system?

* Kate Brown:
- OHP costs got too big.
- How do we raise $?


COMMENTS FROM AUDIENCE (not complete; there were many, many people who spoke very well on various aspects of the "healthcare crisis." Reporter wishes she took shorthand. Consider this an open invitation to amend):

* girl_1: Contrary to what is often claimed, malpractice suits are small % of price driver (1.1%)
* girl_2: Would like healthcare vouchers employers can issue to employees, portable.
Especially good for areas with a lot of small business like Hood river.
* girl_3: Encourage workplaces to become certified breast-feeding-friendly
Requests Bruce Goldberg to set up forum on DHS site for women to post their stories re: breastfeeding and the workplace... having to choose between working and having a healthy child
* boy_1: Has had "wellness plan" through Regence Blue Cross Blue Shield for a long time through employer; recently has been told he no longer has access to services for some reason. Has had such great difficulty getting through to anyone who can explain what happened to him that he decided to come to the Town Hall meeting.
- [Later commenter (boy2) said it was likely the insurance company "re-interpreted" his coverage. Bruce Goldberg suggested going through the insurance co's appeals process and filing a complaint with the State insurance commission.]
* boy_2: Pointed out that the 2006 defense budget is now $6BILLION and that it is obvious we have the resources to take care of our own people if that is what we choose to do
- Said that it is unfair to continue to ask the common people with less and less resources to give more and more
- Said the solutions are clear but getting those in charge to implement them, to place the money where they say their values are, is the hard thing
* Note: man with flag on back of hat later thanked boy_2 for comments; fiscal responsibility seems an issue many different types of people can relate to
* boy_3: last commenter: chiropractor: We need better insurance oversight
Benefits can be "re-interpreted" which results in actual benefits change without contract change
- All of a sudden benefits can just be gone
- Laws that are already on the books governing insurance companies are not being enforced
- need insurance review board... that enforces existing laws
- Closing practice of 17 years because too hard to operate in these conditions


*Reporter (girl_4): delivered excerpt of following points as best as she could:
- Intro: Citizen for ethical, practical solutions without necessary expansion of govt and more taxes
- In 2001, as OHP hovered on precipice of disaster, after voters said NO to giving OHSU up to $10million from the Tobacco Settlement
- Kate Brown co-sponsored a bill (SB832) giving OHSU $200million from the settlement (which is rolled into the General Fund)
- for their North Macadam (South Waterfront) expansion of luxury condos, more useless animal research, retail space and some clinical facilities
- During the debate re: SB832, Govr Kitzhaber said he wanted to make sure the research ceiling was not raised while the basic healthcare floor dropped
- but no mechanism was put in place to see that floor stayed put
- and here we are now. <!-- no floor. -->
- witnesses to the gutting of OHP and desertion of at-risk child and adult populations.
- we haven't just not progressed. we've gone backward.
- Even just considering the intent of the Tobacco Settlement, we have not put our money where we say our values are: prevention.
- In 2005, Oregon was slated to receive $288.1million from the Tobacco Settlement
- We spent $3.5million on Tobacco Prevention, 1.2% of recommended spending... down from 11% in 2002
- In 2006, we should receive $307.5million
- and plan to spend $3.5million on Tobacco Prevention, 1.1% of recommended spending
- Can we really trust the same politicians who worked so hard to give away our money to a big corporation to design and deliver a healthcare system to us without bleeding us dry?
- At one point, the Tobacco Prevention program was completely stopped because its remaining $5million was yanked back to the General Fund for the increasing slate of pressing needs
- it is said that expansion will create jobs.
- so does basic healthcare and social services
- If that can be done, why can we not recall the hundreds of millions of dollars we have given a quasi-private business (OHSU) to build a commercial expansion.
- and put it back into OHP... a system we know worked at a lower administrative cost than private insurance and served 1.4 million Oregonians?
- Get big corporations' hands out of the pot (General Fund)
- Our decisions need to reflect what we say our values are: transparency and evidence-based and preventive care
- That means we need to invest in basic healthcare, not "basic research"
- It really is a choice between the child and the monkey... just not in the way that you think.


Short summary on the Oregon State Legislature:


The 73rd Legislative Assembly
Adjourned Sine Die at 6:20am, August 5, 2005.

The State of Oregon has a Citizen Legislature consisting of the Senate, whose 30 members are elected to serve four-year terms, and the House of Representatives, which has 60 members elected for two-year terms. The assembly convenes every two years in regular session on the second Monday in January during odd-numbered years, a date set by statute. Oregon Constitution does not specify a limitation on session length, however most sessions last approximately six months. During the interim, legislators serve on interim committees and task forces that study issues likely to be faced during the next legislative session.

Oregon's representative form of government is governed by rules, laws, and procedures. Although the process is long, complex and dominated by committees, all laws begin as someone's idea.
arise 11.Feb.2006 20:46


I was there that night. One of the things that stood out to me was the foot dragging by the legislators. On the one hand they say they want improvements, and I believe they mean it, but at the same time they talk about the need to be realistic. Being realistic means accepting that the game is rigged and little positive change is possible under the existing rules and conditions. The legislators play by those rules, that is how they get there.

In contrast, the people there were quite ready to explore novel new ideas, plus some tried and true ones for improving healthcare. The audience and citizen commentors were passionate and articulate.

Kudos to the legislators for organizing this town hall meeting, but they also need to realize that the status quo is slowly or not so slowly killing us and that business as usual is no longer an acceptable choice for us and our children.

One person who stepped up to the mic, talked about how corporations pay fewer and fewer taxes while many of the proposals to improve healthcare are based on tax increases to citizens. Many people acros the state and region do not want to pay more taxes when they have the notion that they are getting ripped off, that big business pays less while making huge profit and they are asked to pay more while earning less and less.

For the Legislature to shrug and say we tried but people didn't vote for it, ignores the realities of the political game.

While oil companies are reaping record profits, the average citizen is paying more and earning less. Healthcare costs are skyrocketing while pahrmaceutical companies are earning huge profits. It is not uncommon today for a CEO of a large company to receive $100 MILLION in compensation, while at the same time workers are being laid off, losing health and retirement benefits and having their wages cut.

This is the broader political reality that the Legislature will not address because they are themselves beholden to it. Being realistic means accepting this political reality which is taking more and more for the few, while the many have less and less. We are supposed to accept this and argue between ourselves over the distribution of a dwindling slice of pie.

The general approach of the Legislature is to offer solutions that put more burden on the many, while ignoring the outright theft by the few.

There were many good points made by those who stood up to speak. One suggestion I liked was for every person in the Legislature to be on the Oregon Health Plan. All the people up on the stage admitted they themselves had excellent healthcare. Rep. Tomei likened her healthcare to a Ferrari and some peoples to a Honda. I got some news for her. Most people do not even have a Honda, more like a beat up old Chevy and many people are pushing shopping carts. How are people who are themselves having Ferrari healthcare, going to feel and act with the sense of urgency that many people feel knowing they cannot provide decent healthcare for their children?