John Kitzhaber
For The Oregonian/OregonLive
Kitzhaber, a physician and health care policy consultant, was governor of Oregon from 1995-2003 and from 2011-2015.
Suppose your hospital closed, or didn’t offer inpatient services when you needed them? Suppose you had to wait six months to see a physician, forcing you to use the emergency room, one of the most expensive care settings, to access needed medical care? That’s already the reality for hundreds of thousands of Oregonians. It’s about to get much worse.
The infrastructure of our health care system is beginning to crumble, and we haven’t fully grasped the gravity of the situation. Over half our hospitals are operating at a loss, according to Oregon Health Authority data. In December 2023, Peace Health’s University District Hospital in Eugene in closed. Ashland Community Hospital will close its birthing center this spring, and stop providing inpatient services. Last year over 1,000 hospital employees were laid off. Across Oregon, medical clinics and practices, especially independent practices, are struggling to remain solvent.
This problem isn’t new. We’ve simply ignored it. Since 2019, the cost of family coverage increased 24%. Fifteen percent of Oregonians delay or avoid needed medical care because of cost, and the leading cause of personal bankruptcy in Oregon is the inability to pay a medical bill.
We’ve all seen this coming—but instead of confronting it, we’ve kicked the can down the road by shifting the cost to employers and into our $38 trillion national debt. For decades, insurers, providers, labor and consumers have blamed each other for escalating cost, and resisted working together toward the systemic change needed for a sustainable future. As long as we remain in our silos, refusing to see that we are all part of the same failing system, we will continue to perpetuate a zero-sum politics of scarcity, that creates “winners” and “losers,” but never a lasting solution.
Then, last July, Congress passed House Resolution 1, under which Oregon will lose $11 billion in federal Medicaid funds over the next decade. Congress’s failure to extend the enhanced premium subsidies in the Affordable Care Act market, will increase monthly premiums by up to $450 per month for 140,000 Oregonians, disproportionally impacting self-employed individuals, farmers, ranchers, and small business owners—particularly in rural Oregon. The intersection of escalating health care cost, and the loss of federal funds, poses an existential threat to Oregon: a threat to access, a threat to the stability of our general fund, a threat to the state economy.
A passage in Ernest Hemingway’s novel, “The Sun Also Rises,” comes to mind in which Bill Gorton asks Mike Campbell, “How did you go bankrupt?” Mike replies, “Two ways. Gradually, then suddenly.” That’s where we are with our health care system. The health care sector is one of the state’s largest employers, contributing over $38 billion each year to the Oregon’s economy—and it’s starting to unravel. If it does, the human and economic consequences will be staggering.
The accelerating crisis of cost and access overtaking Oregon’s health care system was decades in the making and cannot be turned around in the course of a single two-year state budget and legislative cycle. We need a multi-year strategy, guided by a clear vision of what we want our health care system to look like in 2033—the values we want it to reflect and the outcomes we want it to produce.
This vision, this “North Star,” must be established in the upcoming session of the Oregon Legislature. Why? Because with HR 1’s passage, we are past the “gradual” part of bankruptcy. Things are about to get “sudden.”
That means we must recognize this is no longer a revenue problem, it’s a cost problem. More money is not coming to bail us out, which creates the opportunity, and the imperative, to address the multiple factors that are driving the total cost of care in the first place. In the short term, that means taking administrative action to reduce the cost and complexity of the excessive bureaucratic and regulatory burden that is diverting resources away from clinical care.
In the long-term, it means addressing the complexity and misaligned incentives in how health care is financed and delivered, consolidating state purchasing power to negotiate better drug prices, recognizing the role that labor and workforce must play in crafting a solution, and having an honest conversation about the growing disparity between unlimited demand and the reality of finite resources.
It also means that—at least on this issue— we must get beyond partisanship. Our failure to do so will result in system collapse, with dire consequences for us all—for employers, labor, hospitals, physicians and insurers—but most of all, for Oregonians who need and deserve timely access to affordable medical care.
Health and health care are not partisan issues. At some point, all of us will need medical care. And over the many years I practiced in the ER, I never thought to check someone’s party registration before treating them; or wondered whether cardiovascular disease and cancer respected partisanship and political ideology. I assure you, they don’t.
If we can remember that, crafting a solution to the looming implosion of our health care system can actually serve to bring us together in common cause, at a time when we desperately need a way to rebuild the Oregon Community.