Democrats share goal, differ on approach to health care reform

4/14/2007, 2:34 p.m. PT
By JULIA SILVERMAN
The Associated Press

SALEM, Ore. (AP) — Former Oregon Gov. John Kitzhaber has a reputation as a dreamer, the big-picture visionary who designed the Oregon Health Plan and has set his sights on making Oregon ground zero as the nation inches toward universal health care.

In contrast, his successor, fellow Democrat Ted Kulongoski, is an avowed pragmatist, a dealmaker who focuses on results in real time.

Ultimately, the idealist and the realist want the same thing: an Oregon where everyone has health insurance, where runaway costs are controlled, the quality of care improves and the emergency room is no longer the only option for thousands of residents.

But while Kitzhaber is backing sweeping changes that would catapult Oregon to the frontlines of health care reform, Kulongoski is advocating a more measured — and incremental — approach.

Kitzhaber says true reform calls for a re-evaluation of how dollars are spent under the financially shaky Medicare program, in order to test-drive a blueprint for national health care reform. Kulongoski's advisors say he's wary of dismantling the Medicare system, hugely popular among the powerful AARP demographic, for an unknown, without more concrete details.

"It's not just preaching caution for caution's sake," said Tim Nesbitt, the governor's deputy chief of staff. "People have to be brought along step by step. The public's not there yet. I don't think that's a lack of will for those of us who advocate incremental change. It's a smart way to do it, because those who advocate the big-picture, top-down reform can't get there all at once."

And Kitzhaber wants to start the clock ticking on an Oregon-designed overhaul of the health care system, to ensure that all the state's residents have access to a core set of benefits. That's potentially a big change from the current system of employer-backed health benefits that currently covers about 70 percent of Oregonians.

"This is a big idea. It's a bold idea," Kitzhaber acknowledged during an interview with The Associated Press this past week. "But I believe that the worst thing we can do is nothing. We have to weigh the risk of action against the risk of inaction. The course we are on is neither equitable nor sustainable, and the precipice we are moving toward is a lot closer than we think."

Kulongoski, in contrast, says over the next few years, the state should develop a "purchasing exchange," designed to let small businesses and the uninsured pool their buying power to bring down coverage costs. Long-term, the governor wants all Oregon residents to be required to have health insurance, just as all drivers are required to have car insurance; options for financing that system, though, are still under discussion.

Now, as talk about universal health care has quietly intensified at the state Capitol in Salem in recent weeks, a blueprint for future reform has emerged that's somewhere between their dual conceptions.

That plan is authored by state Sens. Ben Westlund, D-Bend and Alan Bates, D-Ashland, the chairs of the Senate Special Committee on Health Care Reform, who've been crisscrossing the state over the last few weeks to gather feedback on health care reform from Oregonians at town hall meetings.

Their plan sidesteps Kitzhaber's earlier proposal for a congressional waiver to reclaim the federal dollars spent in Oregon on Medicare, the program that guarantees health care coverage for all Americans older than 65.

And while it wouldn't entirely dismantle the current system of employer-paid health benefits, it does move more quickly than Kulongoski would in setting up a centralized fund to pay for core coverage.

Westlund and Bates' plan would set up a seven-member board, to come up with a list of core benefits and how to pay for them. Fiscal contributions could come from employers, employees from both the private and public sectors, and from individual premiums.

Recommendations made by the board would go to the 2009 legislature for review. The Bates-Westlund plan is now slated for public hearings, and could move to the full Senate for review by the end of this month.

Both Kulongoski and Kitzhaber offer praise for the other man's proposals. Kitzhaber said he's behind Kulongoski's tightly focused health care agenda for the current legislative session: persuade Republicans to go along with plans to raise the cigarette tax, and use the money to expand children's health insurance coverage; widen participation in the state's existing prescription drug pool and add back funding to the Oregon Health Plan, to restore coverage for some 15,000 low-income Oregonians.

Kulongoski's advisers, meanwhile, say Kitzhaber is setting an example, tackling problems that deserve a champion on the national stage. And in a letter sent to Kitzhaber, Bates and Westlund recently, Kulongoski said he agreed that employer-sponsored health care has become "increasingly fragile and unreliable," as businesses cut benefits to save money.

But there's clear distance, too, between the two political allies, evident in Kitzhaber's pointed observation that Kulongoski joined a lawsuit over Columbia River dams, though that's a federal issue, but remains reluctant to wade into Medicare.

"I don't think reform can wait," Kitzhaber said. "If we don't take it on now, we're going to be two years down the road."

Kulongoski's advisers, meanwhile, say the governor has no choice but to remain focused on what's doable this legislative session, especially with Republicans threatening to derail the cigarette tax proposal.

"Right here, right now, we can do something about that," Nesbitt said.