John Kitzhaber

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 […]

This speech was delivered to the Oregon Medical & Dental Advisory Team April 24, 2025 When I was preparing my remarks for this evening, I went online and looked at your website, and was struck by this sentence: “Being a physician or a dentist is an Art … and a Science.  But the practice of […]

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.

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.

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.

The proposed acquisition of the financially strapped Legacy Health by the Oregon Health and Sciences University (OHSU), raises more questions than it answers. Before it is approved by the State, OHSU must provide a better explanation of why this transaction will be in the best interest of Oregonians.

Oregon has a long, proud history of health system transformation, dating back to 1989 with the creation of the Oregon Health Plan (OHP). For over 30 years, Oregon has been on the cutting edge of innovation, leading the nation in our willingness to challenge underlying assumptions, and to honestly explore the difficult questions involved with efforts to ensure access to health care in a world of finite resources.

Today, the framework of our health system innovation stands at a crucial point in its evolution …

Introduction The creation of Oregon’s Coordinated Care Organizations (CCOs) in 2012 was, in many ways, an unlikely event given the fiscal and political challenges facing the state at the time. When the Oregon legislature convened on January 10, 2011 the state was in the depths of the Great Recession; unemployment was high and the state […]

 The passage of Senate Bill 27 in 1989 created the Oregon Health Plan (OHP). Because it reflected a significant departure from the current Medicaid program it required federal waivers in order to be implemented.  In August 1989, Oregon Senator Bob Packwood, who chaired the Senate Finance Committee, proposed an amendment to the 1989 budget reconciliation bill […]