Carpe Diem – Seize the Day
This morning 450 hospitalized Oregonians are waiting to be discharged, with nowhere to go, and 223 are being boarded in ERs waiting to be admitted, but with no beds available. Oregonians are dying and suffering avoidable harm from this situation, which is due both to an acute workforce shortage and to misaligned financial incentives in a payment model that is no longer financially sustainable. This crisis offers Oregon a unique opportunity to both resolve the workforce shortage and change the payment model to stabilize the system and reduce the total cost of care.
Universal Coverage, Health, Equity, and Value: Moving Beyond a Divided Congress
The World Health Organization defines health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” If we could write a prescription for America that would surely be it. And if we could fill that prescription by spending more money on the U.S. health care system, we would already be there. Yet, fifty years of evidence tells us that the promise of health care for all Americans is not the same as a healthy America. In 1968 the U.S. was spending 6.2% of its GDP on health care. Today we are spending almost 18%, yet life expectancy has declined three years in a row, driven largely by inequality and economic hardship, particularly in working class America.
Oregon Coordinated Care Organizations
The Oregon coordinated care model was implemented in 2012 through “Coordinated Care Organizations” (CCOs), which operate under a Section 1115 waiver, first granted by the Obama Administration. A coordinated care organization is a network of all types of health care providers (physical health care, addictions, and mental health care) who have agreed to work together […]
The Oregon Health Plan
The Oregon Health Plan (OHP) was enacted in 1989 as part of a larger effort to achieve universal coverage in Oregon. The OHP is Oregon’s Medicaid program and operates under an 1115 waiver granted by the Clinton Administration in 1993. There were several key elements. Eligibility The 1989 legislation extended eligibility to all Oregonians […]
Legislative Concepts for 2021
The three legislative concepts discussed in this paper build on the Affordable Care Act and are consistent with, and enhance, President-elect Biden’s health care proposal as described in his campaign. These concepts also compliment the initiatives in the House Democratic Leadership health care proposal introduced last year. A centerpiece of both proposals is to expand […]
Vote No on Measure 110
As a parent, a doctor and former Governor, I urge Oregonians to vote “no” on Ballot Measure 110. I understand that a central motivation behind this ballot measure is to help reverse the disaster caused by the War on Drugs, which incarcerated people suffering from addiction and had a disproportionate impact on Black and Indigenous […]
Undermining Equity and Patient Protections
This week’s decision by the Oregon Health Authority (OHA) to allow Trillium Community Health Plan to begin enrolling Medicaid members in the Portland area starting on September 1 threatens to disrupt important care relationships in the midst of the COVID 19 pandemic. Of even greater concern is the fact that this decision seems to have been made in a vacuum that ignores both the need for patient protections in a very vulnerable population and the intensified call for equity in our health care system
Holding our Communities Together in the Pandemic
Without bringing some degree of financial support and certainty to the millions of Americans who have lost their jobs as a direct result of the necessary efforts to contain the spread of COVID 19, we risk unleashing the darker consequences of panic, blame and desperation that haunt those who cannot meet their most basic needs and see no hope for tomorrow—the loss of social cohesiveness and the disintegration of our communities.
Shelter at Home
I am adding my voice to those of my colleagues in the medical community, as well as many other Oregonians, in support of the immediate issuance of a strong and unambiguous statewide order to shelter at home. Given our current lack of both an effective vaccine or the capacity to conduct widespread testing for the virus, such an order offers the most aggressive intervention action available to prevent, or at least delay, hospital overload.
The Coronavirus in Oregon
The spread of the coronavirus in Oregon is a true emergency and yet it offers us an opportunity—an opportunity to remember that we are truly all in this together, that the virus does not respect income, partisanship or political ideology; and that by facing this challenge together, as a caring and compassionate Oregon community, we will surely weather this storm and emerge stronger and more united than when we began.