By Senator Jeff Kruse
In general terms, it seems to be commonly accepted that we are in a “health care crisis.” Admittedly, our system is broken and in need of major reform, but I reject putting a crisis label on health care. My reason is very simple. By calling anything a crisis one is calling for government intervention to solve the problem and in health care government is more the cause of the problem than it is a solution. We only need to look at history to understand the point. Health care used to be a free market system with no government involvement (pre 1960’s) and it worked relatively well. Presidents Johnson and Nixon changed the dynamic forever with Medicare and Medicaid. With all of the advantages one can argue we have seen from these programs, the fact is government involvement and regulation have been the biggest factors in the ever escalating costs of the system. Health care may be the most regulated system in our country. From insurance mandates to determination of covered services, a conservative estimate of the cost of government required paper work is over 30% of the health care dollar. Next time you go to your doctor look at how many people there are in the office not dealing directly with patients and you will start to get an understand of the scope of this problem.
Many who choose to call this a crisis envision government solutions. No matter what label they try to put on this movement it still comes down to the government take over of the health care system. Maybe it is time to take a hard look at an existing government system, and I choose our neighbor to the north, Canada. Clearly, the Canadian system does a better job of getting people in the door for a checkup or to diagnose a healthcare problem, but from there the system falls short. If, for example, it is determined you need an operation, you may have to wait in line a significant amount of time, as the system only allows for so many procedures a year. While insurance premiums in Canada may be only around $100 per month, most working Canadians are in a 50% plus tax bracket to pay for the system indirectly. As we watch both the Canadian and British health care systems imploding upon themselves it is becoming increasingly clear government is not the solution.
I have spent several years working with a wide variety of people trying to fix the Oregon Health Plan and for the most part those efforts have failed. I opposed Measure 50 in this last election primarily because it was just another attempt to put a small bandage on a large wound. I also opposed Senate Bill 329 (which passed) because it set up a series of work groups to study various aspects of the health care system (most of which have already been studied) but still pointing to government solutions.
I did support, and was a sponsor of Governor Kitzhaber’s proposed Senate Bill 27, (which did not pass) because it proposed taking a fresh look at the entire system. Clearly Medicaid and Medicare will continue to be a significant part of healthcare. However, we should be willing to critically investigate how these programs work as I am certain, we can do a better job of expending the existing billions of dollars a year in our budget.
So what is the solution? It is not an easy question to answer, but to find a solution we need to start from a new place. The concept of free healthcare quickly becomes unaffordable and a system run and regulated by a third party tends to be unresponsive. We need to move back to a system where medical decisions are made by the doctor and patient.
We need to look toward models like, Health Savings Accounts where the individual has a financial stake in their own healthcare. If we truly want people to move toward preventative health care they need to have a financial stake in the results, and if we want health insurance to be affordable we need to once again make it a simple major medical plan.
In a Health Savings Account type system a person’s day to day medical needs would be paid directly out of their individual account and if a serious event occurred it would be covered by insurance. This system will work well in both the private sector and the public sector. Additionally, if we could get the flexibility in Medicaid and Medicare expenditures envisioned in Senate Bill 27, we could achieve further healthcare success.
Clearly, this is just the tip of the iceberg in the continuing discussion of healthcare reform. We also need to be looking at issues such as the lack of providers and tort reform to name just two. We need a health care system that is affordable, accessible and most importantly understandable. These should not be buzz words, but the actual goal we are striving for. I will continue to be committed to this effort.