The intersection of rising healthcare cost and a massive loss of federal funds poses existential threat for Oregon: a threat to access, a threat to the stability of our general fund and a threat to our economy. Embedded in this crisis, however, is a profound opportunity to reimagine and redesign our current healthcare system into one that not only ensures timely access to quality affordable medical care for all Oregonians, but is economically sustainable and financially stable.
Final Recommendations to the Governor
From the Health System Sustainability Group Introduction This document reflects the consensus recommendations of the Health System Sustainability Group, in response to your letter of October 22, 2025. The accelerating crisis of cost and access overtaking Oregon’s healthcare system was decades in the making, and cannot be turned around in the course of a […]
Leaving Our Children Behind
The Oregon Legislature adjourned on June 27 without bringing the Child Success Act (SB 1167) forward for a vote. This legislation, which enjoyed strong bipartisan support, would have funded seven locally designed and locally directed Demonstration Pilots to show the value of primary prevention through investments in the first 1,000 days of life, from conception to age 2, when 80% of brain development in children takes place. The failure to move this legislation forward will cost the state billions of dollars in future biennia.
An Open Letter to Congressman Cliff Bentz
Dear Congressman Bentz, As a former 3-term Oregon governor and emergency physician in rural Douglas County, I want to emphasize the violence that the so-called “Big Beautiful Bill” will inflict on the people of your district and on the people of our state. Today, over 1.4 million Oregonians—and nearly 40% of your constituents—depend on Medicaid […]
Healthcare Trends and Leadership Priorities: Creating a Shared Vision for the Future
A Missed Opportunity
The current congressional debate over Medicaid funding offers an opportunity to rethink the structure of one of our most important institutions – a program to provide access to health care for vulnerable Americans. When our cherished institutions are under attack, our tendency is to rush to their defense.
This understandable reaction, however, precludes any space to ask ourselves whether these programs are still effective and efficient, whether the way they were designed in 1965 still makes sense now, over 50 year later, and whether they are financially sustainable.
Rethinking Our Approach to Complex Problems
Because many issues today are so complex and interrelated, I have come to believe they cannot be resolved without a different political approach. We need the capacity to look beyond the way the world is, to what it could be. We need the courage to imagine new tools that allow us to solve for multiple problems simultaneously in a way that broadens the constituency base for shared goals and, in the process, restores the sense of common purpose and shared identity that is missing from our politics today.
Avoiding the Falls: Succeeding or Failing Together
Like the efforts of many financially struggling hospitals, the proposed OHSU-Legacy merger is, to some extent, being advanced in a bubble, focused primarily (and understandably) on the finances of these two institutions, as though they are immune from what is happening around them. Yet, it will be difficult, if not impossible, to solve the financial problems of one sector within our health care system—whether that is hospitals, medical clinics, payers, or the health care workforce— without addressing the structural flaws in the larger system of which all those sectors are a part.
The Politics of Transformational Change
It should be clear, after decades of tinkering around the margins, that creating a health care system that is both affordable and sustainable requires transformational change. To do so, we need to step back and start by looking at the system itself, by deciding what we want it to do, by identifying the outcomes we want it to produce for us—not just as individuals but as a society—and by defining its purpose. We then need to realign the financial incentives within the system to reward those activities which will achieve that purpose.
The single most important step in transformational change is to agree on the long-term outcome, on the vision, if you will. This will allow us to fundamentally change the nature of the debate, from “where we are going” to “how will we get there.
Early Childhood Investment Should be a Top Priority for Oregon Business
I attended a breakout session on Early Childhood at the recent Oregon Business Plan Leadership Summit. Having been involved in launching the Oregon Business Plan and Leadership Summit at the end of my second term as Governor in 2002, I’d like to make a few observations that are relevant to the summit in general, and to the relationship between early childhood investment and the Business Plan.
I appreciate that the 2024 Leadership Summit decided to include a breakout session on early childhood. I want to suggest, however, that if we are serious about the future health of our business sector, this should be a main stage topic, not a breakout. The downstream impact of early childhood trauma and adverse experience is draining the vitality from our business community, undermining the effectiveness of investments to rebuild our workforce, and saddling us with billions of dollars of avoidable cost.