Representative Linda Flores: Health care rights and wrongs

Pess release from State Representative Linda Flores 2-13-08:

Health Care as a Constitutional Right is Wrong — Says Flores

(Salem) “It would be great if we all got a free house, free food, free clothes, and a free car”¦but we don’t live in Cuba and we don’t live in Camelot; we live in the real world and we need to look at a more realistic approach,” said State Representative Linda Flores (R-Clackamas) during floor debate on a measure to make “health care a fundamental right”. House Joint Resolution 100 passed on party line vote 31-29.

If HJR 100 is adopted by the Senate it would be placed on the ballot in November and would amend the Oregon Constitution. “Voters deserve to know what they’re buying into. How much is this going to cost? What are they getting for their money? And we’re talking about taxpayer money,” explained Flores.

This measure also passed the House by a narrow margin during the 2007 Session but died in the Senate. HJR 100 calls on the legislature to establish “a plan for a system designed to provide to every legal resident of the state access to effective and affordable health care on a regular basis.” One of the biggest concerns by Flores and others is that there are no definitions for terms like “affordable health care.”

Representative Flores is a member of the House Health Care Committee. Testimony in committee revealed the cost of providing access to medical care to all Oregonians could be as high as $20 billion dollars a year. She told her colleagues if the state is forced to make health care a priority, other programs might face budget cuts like education and public safety.

On the floor, Flores pointed out California was the most recent state to abandon efforts to move toward universal health care and there are several challenges pending at the federal court level. She added, “do we want Oregon to go through all this only to be tied up with years of litigation?”

The last time Oregonians voted on this type of proposal was in 2002 on Ballot Measure 23 which failed by a margin of nearly 80 % opposed. “I understand there is a new committee looking into these issues, but we’re buying a pig in a poke here,” said Flores.

Flores concluded by saying, “if our goal is to provide health care coverage, then we should utilize a system which encourages the best medicine to be practiced and prudently uses public resources to expand programs to those who otherwise don’t have access to good care. ” She emphasized a better way to expand access to health care would be to reduce mandates and other bureaucratic barriers and give individuals more choice in a competitive marketplace.

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  • Dian

    I definitely agree with her statement to reduce mandates and other bureaucratic barriers. Wow, I like this girl.

    I know dean will disagree. Ask me if I care.

    Government interference in our lifes is the biggest obstacle to affordable health care. They have removed competitiveness from the market. Being competitive actually reduces costs.

  • Fidel

    Perhaps we need a new Bill Of Entitlements to go with our Bill of Rights?

    That way we could force people to pay for everythig their less able neighbors can’t afford. In the spirit of fariness and equality.

    What wonderful concept.

    There sould be a name for it.
    Caring? Good? Compassionate? Brotherly? Community? Sharing?
    Collective? Socialism? Communism? Delusional? Stupid? Destructive?
    I’m getting closer.
    Have any suggestions, dean?

    • dean

      I hope you are both sitting down, but on this one I tend to agree with Flores, though perhaps for different reasons.

  • davidg

    This will get trounced at the polls, just like the measure on the 2002 ballot. It will be trounced mainly for the same reason: cost, though as Flores notes, there are many other good reasons for opposing this.

    This measure is structured exactly the opposite of the 2002 measure. That measure tried to set up an elaborate program; this measure is a simple statement of principle.

    Why did the government health care advocates change their strategy? There are two reasons. First, no one can come up with a workable program. If such a plan existed, the Democrats in the legislature could simply adopt the plan – there would be no need to put this measure on the ballot. The 2002 plan was unworkable, and no one has come up with anything better to take its place.

    Second, by inserting the statement of principle into the state constitution, the legislature hopes eventually to throw the issue into the laps of the judicial branch. Thus when the legislature fails to adopt a plan that meets the impossible requirements of this proposal, armies of trial lawyers will go to the courts to try to get the courts to create the program. The Oregon courts will have no qualms about trying to create the impossible – after all, doesn’t the constitution mandate such action?

    Oregonians will reject this statement of principle just like they rejected the earlier specific program. It is just too costly. Using the constitution to open the back door for the judiciary to get involved will be seen as the surreptitious plan it was intended to be.

  • Friends of Meatpuppet

    This issue of commie state health care is dangerously close to the gay agenda that is plunging the California school system into chaos. Democrats knock it off! We do not want state sponsored health care. We do not want state sponsored anything! Just stop!

  • David from Eugene

    Like it or not, we currently have a de facto “right” to medical treatment. It has been established by requiring hospitals to treat anyone who comes through their doors regardless of their ability or willingness to pay. This situation is a major component in our current healthcare crisis. We need to develop a system that provides every legal resident access to effective and affordable health care. While we could and should develop such a program without HJR 100, it appears that it may be necessary to get the legislature to get to work.

    Regarding mandates, first permitting Insurance Companies to sell “Health Insurance” that does not provide any real level of health coverage would make our health care crisis worse not better. And while it is the responsibility of the individual purchasing an insurance policy to read and fully understand it before signing the contract few, of us are well versed in the nuances of insurance law or have the money to retain a lawyer with such knowledge to review the policy. By establishing a minimum level of coverage that a Health Insurance Policy must provide the mandates reduce the difficulty in getting a policy that provides real coverage.

    Second, eliminating them may result some people having higher not lower premiums. Insurance is a bet between you and the insurance company; you are wagering money (the premium) that you will need covered health care during the term of the policy. Actuaries working for the Insurance carrier have carefully assessed the likelihood that the policyholder will have a claim and establish a premium that reflects this risk. Which means by selecting a policy that only covers those conditions he is likely to get, he has put himself in an insurance pool exclusively made up of similar people greatly increasing the risk Insurance Company. Insurance Companies’ normal response to increased risk is higher premiums or refusing to cover the condition at all.

    Lastly, HRJ 100 does not call for free healthcare it calls for access to affordable health care. Besides our current system is passing the bill for “free” healthcare on to those who do pay.

    • dian

      ok, so what is affordable health care? That could be open to lots of discussion. What is affordable to you may not be affordable to me. We all know there isn’t an answer to that, not a good one anyway.

      You are correct very few of us are versed in the nuances of health insurance, but in order to get what everybody wants, it will take some action, by the government. Before that can be effective though, they need to look at the real world, not the one they want to have. They need to not be the end of it all as, it appears to me, they are trying to be.

      In my opinion, an excellent place to start would be with a basic policy, that will cover major medical. That would have to have a choice of deductibles because I may not be able to cover as high one as the other guy. Then there could be choices like there was ten years ago as to whether you want to pay for the gravy that comes with you policy.

      The next step is to educate people as to when a hang nail is an emergency. We are bombarded with advertisements as to all the ailments there are out there and a miriad of medications to make you feel good. If people used some common sense in their medical decisions, it could cut a lot of cost. Even my Dr laughed when I asked him if the ten most popular pills were right for me.

      There also needs to be a serious overhaul of tort laws to stop people from trying to get rich because their dr did not do what they thought he should. There are of course some legitimate claims too.

      My last thought is for the people who definitely are poor, I mean the ones that are, not just think they are. I wonder if the medical community would be more willing to volunteer some of their time helping out in say a community clinic. They won’t do that though as long as there is so much concern about lawsuits.

      Medical care just has to go beyond insurance.

      • dean

        Dian…you seem to be accepting some health care myths that if believed, make it difficult to reform the system in a good way.

        First, defining “affordable” is certainly possible as a percentage of income. We already do that on many things, like housing. Making decent health care fit what is affordable is way more difficult. And health care inflation is running 2 to 3 times the level of general inflation.

        Second, a major medical policy is one way to go, and is more affordable than a soup to nuts policy. This can work for those with lots of disposable income. But, experience indicates that chronic health issues and “general maintenance” go unattended under major medical plans. So if the goal is to actually have healthier people, this might not be the best solution.

        Third, we are not over using health care at the hangnail end. 20% of Americans are using up 80% of the total health care expenditures. The big issues seem to be an aging population, very expensive care in the last year or two of one’s life, chronic problems like diabetes, tragic accidents, and so forth. We do not seem to be spending ourselves bankrupt on the small stuff, at least statistically.

        The tort issue is way overplayed. Several studies say at the very most medical lawsuits add 8% to the total cost, and most studies say it is way lower, on the order of 1 or 2%. The average payout on tort costs is lower here than in Canada, which has way lower costs overall. Tort reform is great for doctors and hospitals, but not necesarily for the rest of us if they decide they can get sloppy on sterilization.

        Our poorest citizens do get medical coverage through Medicaid. It is our working poor and increasing numbers of middle class who cannot afford insurance, and do not get it through their employers.

        Its a tough problem. The Clinton and Obama plans are both possible solutions, at least over the short term. Over the longer term, probably not since costs may continue to outstrip ability to pay.

        I doubt there is any good solution available at the state level.

        • dian

          it may be a myth to you, but to me it is reality

      • David from Eugene

        dian

        Affordable Healthcare is a healthcare system the total cost of which, including insurance premiums, co-pays, deductibles, drugs, tests and out of pocket expenses, that does not take an unreasonable portion of a household’s income. Exactly what that portion should be, and how we craft a system that can deliver an adequate level of care within it is part of the discussion that we as a nation need to have.

        As where to start, my personal take is to start the process by decoupling healthcare from employment and getting away from an insurance based delivery model. The idea that employees should get their healthcare through their employers is the product of World War II wage controls. Henry Kaiser could not pay his ship yard workers more so in an effort to attract good employees he established a system of hospitals and clinics to provide them with free medical care. The Shipyards are long closed, but the medical system is still going strong as is employment based healthcare. Why decouple? First it has fragmented the system, an individual cannot move without a gap in coverage between as he changes employers. Second it has decoupled the person getting the care from the cost of the care. Third it has put many of our companies at a competitive disadvantage to firms located in countries with universal coverage. Of course this is one of those things that are much easier said then done. Because it has been included in some negotiated compensation packages instead of a wage increases there is resistance in some labor circles to decoupling it as it would represent a major reduction in employees compensation. This is believed to be one of the factors in the defeat of the state wide health care ballot measure.

        Insurance is a great way to deal with the risk of some random disastrous event, like flood, fire, or auto accident. Things we know might happen but are extremely unlikely to happen to us. The insurance company calculates the odds of the random event happening, how much making us whole might cost them, and then it establishes a price. We pay and if fate picks us we are covered and if not the insurance company makes a much bigger profit. But health care is not like that, much of it is predictable, we know we need to see medical professionals on a regular basis, we know we will be, in addition the possibility of a major crisis, be subject to many smaller problems that will require treatment. We also know that in some cases a small problem now may lead to larger problems later. The Insurance model just does not work well in this situation, first, because they stand to make more money by not providing care then by providing it. Second because they quite rightly, will not accept the wrong side of a sure thing bet. That is the root of the preexisting condition problem. And lastly the insurance model doesn’t work because we can not afford the paying the profit of a middleman. We need to develop a different model.

        As to tort reform, I have a bias, a doctor killed my father. As long as the medical community will not police themselves we are going to have malpractice suits.

        As to volunteers from the medical community providing care to those outside the system, it is already happening. Eugene has two such clinics.

        • dian

          Definitely we need to take healthcare out of employment. It leaves too many holes and is a hard burden on the average business, who has to raise prices to cover the overhead.. Unnecessary inflation, don’t you think? If as Jerry says the government is out of it, the private sector will do a lot.

          But in order for the government to get out of health care, they will have to reverse a lot of the requirements, mandates, and let people decide for themselves what they need.

          dean and David, I do understand the definition of affordable. 🙂

          I understand your feelings losing your father, and I have no problem with requiring responsibility, even if it is through lawsuit. But look at the sheer number of lawsuits. I don’t think our medical community is that terribly incompetent. I just said some of it needs to be reined in. If I lose my feet because of diabetes, but refuse to follow a diet and exercise, is that my Dr’s fault? I think not.

          I like the idea of a tax credit instead of a tax deduction for health insurance. As you probably know a credit is dollar for dollar reduction in the tax liability, where a deduction is only as good as the amount of other deductions you have. In my experience, most people don’t have that many usable deductions because of the high standard deduction. A credit is definitely the way to go. I believe that would actually cut some of the costs we pay through the government with the system we have.

  • Jerry

    All government efforts should be focused on our safety. The private sector can handle the rest.
    Get government off our backs and out of our lives – PLEASE!

  • Rupert in Springfield

    I gotta tell you, when I see no end of people who all of a sudden see nothing wrong with paying $1k and up for a flat TV, $400 for a Xbox video game, have cell phones for every member of their family and full boat cable out the wazoo, I get real tired hearing about “affordability” and “access”.

    We all know if we go up to anyone who claims they cant afford health insurance, the chances of them having to take a cell call on an I Phone in the middle of the interview are high.

    The fact is, health care insurance is expensive. The other fact is those of us who pay for our own get increasingly tired of this relentless crusade to get us to pick up the tab for those who choose not to. You want to lower the costs?

    Allow purchasing of insurance from other states so people can avoid these idiotic mandates.

    Allow individuals or businesses to organize in any sort of insurance pool they want.

    Establish mandatory sentencing laws for those who put insurance mandates on all of us, so that their cronies in whatever wacky medical profession can get more business. I don’t need the state telling me I just gotta have that acupuncture coverage.

    *If you think health care is expensive now – just wait until its “free”*

    • dian

      Yea Rupert

      • dean

        Rupert…what…you follow people around to see what they buy, and you check that against their incomes and health insurance plans? i mean…how can you make such a blanket statement? Some of us use cell phones as part of our business. If our business declines, we can’t pay our health insurance fees. Comprendo?

        A cell phone costs about $150. Annual health insurance costs $3000 to 5000 per individual if one can even qualify.

        Taking health care “out of employment,” as David and Dian advocate, makes perfect sense if we were designing a system from scratch. But we are not, and 58% of Americans presently get their health insurance through their employer (a number declining every year by the way). In many cases these are negotiated benefits through union contracts. Its not going to be easy to sever this and replace it with something else in short order.

        • dian

          You know dean, I have yet to see anybody make a comment here that you don’t come back and disagree. Some of have opinions and experiences.

          If your business is declining, get rid of the cel phone. We ran businesses for years without that convenience.

          You don’t have to follow people around to see what they buy. Look around you, that is unless you have your head in the sand. In that case you can only expect sand in your nose.

          • dean

            Dian…with due respect, I disagree when I disagree, not simply to be disagreable. There are many, many comments made that I don’t respond to at all. Could be I agree, could be I disagree but don’t bother, or could be I don’t care that much one way or the other.

            My business is not declining. Its steady as she goes. The cell phone appears to be a necessary adjunct since I am in the field frequently. My head is not in the sand, but I try not to draw sweeping conclusions about humanity from what I see standing in the checkout line at Freddies okay? I’m more into looking at evidence.

            Now for a rare correction. Ron Wyden has a proposal in Congress with equal sponsorship from Democrats and Repulicans that would decouple health insurance from employment, but also provide universal access through various measures. Its a bit too complex for me to go into, but it appears to have a chance for political success.

          • dian

            I’ll take a look at it

        • David from Eugene

          Dean

          Conceptually decoupling health care from employment is rather straight forward, the employer raises workers pay by the amount he is paying for their current health care coverage and the employee starts paying for it. Establishing a system that is not subject to gaming or abuse that the courts would accept is more difficult but is worth exploring.

    • David from Eugene

      Rupert

      You are already paying for those people who cannot or will not pay for healthcare. The cost of paying for those people is included in the hospital bill you or your insurance company is paying. Not only are you paying for their care but you are paying for the most expensive way of providing the care. A typical visit to an emergency room costs around $600 dollars (just the emergency room fee and doctor’s bill not including drugs, tests or specialists) vs. about $125 for a doctor’s visit.

      Exactly what mandate do you feel is idiotic and why do you think eliminating it would make your health insurance premium less. In this thread I have already explained why in some cases this may not be the case.

      And who said free care? I advocating for an affordable health care system. I fully expect that it will be paid for and that the cost will not be mixed in other payments.

      • Rupert in Springfield

        >The cost of paying for those people is included in the hospital bill you or your insurance company is paying.

        True, and most regrettable. I frankly don’t know how many of those are people who are indigent, and how many of them are simply people who chose not to buy insurance. For the latter group, I would have no problem of garnishing their wages with the same vigor we seem to go after “dead beat dads”. The government claims that vigorous collection of child support payments saves government money, I see no reason not to apply the same thing here.

        >Exactly what mandate do you feel is idiotic and why do you think eliminating it would make your health insurance premium less.

        As I stated, Acupuncture mandates I consider idiotic, Mental health care mandates are waiting in the wings. I see no reason why I should be forced to have acupuncture coverage if I don’t want it. I see no reason why I should have to carry mental health care insurance either. When the state adds these mandates, I see my insurance bill go up. Seems like pretty simple arithmetic to me, more coverage, which I don’t want, more money.

        >I fully expect that it will be paid for and that the cost will not be mixed in other payments.

        Well, it would be a “first” if government did that. Given the experience with the Oregon Health plan, I wouldn’t hold my breath though. Generally when government starts giving away other people money, more people show up to take it than expected.

        • dean

          Rupert…it could easily be the case that acupuncture saves on your insurance, expecially if the treatment displaces more expensive and less effective alternatives, like drugs.

          Truly indegent people are covered under Medicaid. Working stiffs who have jobs without health insurance, and wages too low to afford insurance (easily $1200 a month for a family of 4) are not uninsured “by choice.” They just can’t afford it. I believe about 60% of all Americans without insurance are kids in poor working families.

          Healthy young adults sometimes do choose to go without insurance and run the risk they won’t need something major. I did that myself until I turned 40 and got away with it. The risk is worth it to an individual who does not have much assets to attach.

          Vigorous collection of child support payments by government saves TAX money. Vigorous collection of hospital debts would save PRIVATE INSURANCE comapnies or hospitals money, not “the government.” Think about it.

        • Chris McMullen

          Sorry Rupert, but the gummint does a piss-poor job of going after deadbeat dads. At least in the county I live in. Once again, another government task that is better served by the private sector.

          Ironically, government collects from the law abiding by the point of a gun, but falls short on those who consistently break it.

          And Dean, please don’t insult everyone on this forum by pretending you look at facts. Your purported facts are only what you want to hear from selected left-leaning special interest groups.

          • dean

            The word is “evidence” Chris. Facts backed up by analysis so that they have meaning and context. otherwise facts are just random bits of data.

            Sorry if you feel insulted by that.

          • Rupert in Springfield

            >Rupert…it could easily be the case that acupuncture saves on your insurance, expecially if the treatment displaces more expensive and less effective alternatives, like drugs.

            Big whoop, I never said otherwise. However that is my decision to make, not Salem’s and not yours. One would think that if acupuncture saved a whole bunch of money, insurance companies would be inclined to it. I guess they are too stupid to know what’s good for them just like I am, but yet…..yet…..someone in Salem, who probably has no medical training and no knowledge of insurance, they know best.

            Okie Dokie

            >Healthy young adults sometimes do choose to go without insurance and run the risk they won’t need something major. I did that myself until I turned 40 and got away with it. The risk is worth it to an individual who does not have much assets to attach.

            Ok, well at least I have to give you some credit for acknowledging your irresponsibility. The point is, had you gotten into trouble, I personally would see no problem with attaching future assets, as would be the case in a civil judgment in many states.

            >Vigorous collection of child support payments by government saves TAX money. Vigorous collection of hospital debts would save PRIVATE INSURANCE comapnies or hospitals money, not “the government.” Think about it.

            And collecting on a debt is bad why? I mean this is a major part of our system of law, Im not exactly sure what your issue with it is.

            I thought this whole argument was “well, you are paying for it anyway, these people simply go the emergency room, and skate on the bill….”

            Are you “thinking about it”? It is logically impossible to make the argument that “we all pay for it” when these individuals don’t pay the bill, but yet attempting to collect from them wouldn’t help alleviate the problem.

            At any rate, the concept of government using its enforcement powers to collect debit in private civil matters is not exactly new. If you doubt this, try not paying your rent or mortgage.

            Whatever quality of job government does in collecting debit, I would sure rather them do this approach, than to come to me for more taxes.

          • dean

            Rupert…the problem is your approach is punative, which unfortunately is typical of conservative thinking. Rather than supporting reforms to a broken health care system that actually improve health, improve access to health care providers, and lowers costs, you want to dun lower income people who have few alternatives. How much money do you think “the government” would be able to collect to return to private insurance comapanies by squeezing thousands of small turnips?

            I guess I would rather have a “big government” that helps people get health care in the first place than a “big government” that goes around collecting debts from people who can’t afford helath care. But hey…I’m a hopeless liberal.

            And on alternative health care approaches, like acupuncture, the western medical establishment has thrown up all sorts of competetive barriers to the practice over the years, making empirical studies of results dificult. Thus insurance companies have been slow to add these services. But by and large they are less expensive, that is not much disputed.

          • Rupert in Springfield

            >Rupert…the problem is your approach is punative, which unfortunately is typical of conservative thinking.

            Actually not true, my approach is fairness, which is typical of conservative thinking, your approach is larcenous, which is typical of liberal thinking.

            You simply want to take money from me, or others who are already being responsible, and give it to others, in order to build a voting block.

            I don’t want to dun lower income people with anything, I simply don’t feel like working harder to support those who either chose not to in school, or choose not to now. The way I see it, I generally work a 60 hour week and up just so I can have the pleasure of giving half my money to the government and pay my own way. That is the point where I give up, frankly 50% of my income is enough.

            >I guess I would rather have a “big government” that helps people get health care in the first place than a “big government” that goes around collecting debts from people who can’t afford helath care.

            So you would support government abandoning any enforcement of civil judgments? That’s astounding. I personally don’t see anything more altruistic in government throwing people out of their houses because they cant pay the mortgage, than I do in collecting payment from someone who chose to burden society by not getting insurance.

            >Thus insurance companies have been slow to add these services. But by and large they are less expensive, that is not much disputed.

            Re-read. I was never disputing efficacy or cost, I was disputing being forced to have it.

        • Jerry

          Forget accupuncture. I always feel better with after a 90 minute massage. That should be a co-pay of $5. Right? Why not? It is as effective as many of the other things being paid for…what a sad situation.
          Rub me down – that’s all I want – but I should not have to pay!

          • dean

            But Jerry…if therapeutic massage is included in whatever health insurance plan you have, then you ARE paying for it. Its not free, whether you pay the full hourly cost as a one-off or a co-pay as part of a premium.

  • dean

    Man without…I’ don’t know where you heard a story that Senator Clinton is proposing to do away with for profit health insurance companies. But she is proposing no such thing.

    The “medical industry” in the US at present is partly for profit, partly not for profit, and partly government run. The least efficient part of this appears to be the for profit insurance companies, with 30% overhead costs. In a flat out competition with a government insurance program (i.e. expanded Medicaid) private for profit insurance will likely lose, and for good reasons.

    Even if the for profit health insurance companies withered away, we would have a long…long way to go to reach communism. I would not sweat that.

  • Steve Buckstein

    Update: the special legislative session closed yesterday without passing the “health care as a fundamental right” resolution. The Senate never even held a committee hearing on this flawed idea.