By John Gramlich for Stateline, State Policy and Politics, The Pew Center on the States
Oregon Governor-elect John Kitzhaber, a Democrat who was inaugurated in Salem on Monday, is no stranger to the state’s top political office: He was a two-term governor between 1995 and 2003. In November, he defeated Republican Chris Dudley to win an unprecedented third term as chief executive. An emergency-room physician by background, Kitzhaber, 63, also is no stranger to the nation’s health care system, which he sees as costly, ineffective and unsustainable. He intends to tackle the challenge right away in Oregon, vowing to “fundamentally change the way health care is organized and delivered” in his state. Stateline caught up with Kitzhaber December 27 in Portland to discuss his plans, as well as the new federal health care law. An edited transcript of the interview follows.
Q. How does your background as an emergency-room doctor inform your perspective on health care policy? A. When I was (Oregon) Senate president, making decisions at the legislative level that disenfranchised people from coverage, for a lot of my colleagues it was a sterile accounting exercise.
When I went back to my ER (after serving in the Legislature), I started seeing some of the people come in who actually had lost coverage because of our legislative decisions. One man in particular had had a massive stroke because he couldn’t access medication for his blood pressure. It gave me a real interesting perspective about the relationship between policy decisions and what happens to people at the point of delivery.
Q. You’ve said that the new federal health care law is health insurance reform, not health care reform. Can you elaborate on that? A. Most of that legislation — and most of the health care debate in America for the last 50 years — has been how to pay for health care. I don’t think the problem is how you pay for health care. It’s what we’re buying. We’re buying a product that is very ineffective, very inefficient, and doesn’t have real impact on population health.
Our population health statistics in this country are a little bit better than Cuba’s, and we spend huge sums of money. So, ultimately, we have to change the way health care is organized and delivered, and we need to recognize that the objective of the health care system is not simply to finance medical care. It’s to keep people healthy.
(Regarding the federal health care law), I’m a big supporter of the bill because, at the end of the day, people do have to have a way to pay for health care. You do have to have financial access. But there’s nothing in the bill that’s going to control costs.
What we’re hoping to do here in Oregon is fundamentally change the way health care is organized and delivered — to shift that focus from after-the-fact ... to prevention and wellness and community-based management of chronic conditions.
If we can get more flexibility with how we spend those new (federal) dollars when they come in, we want to finance a different delivery model.
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