Kitzhaber's Leverage on Universal Healthcare

06/01/2006 05:59 pm ET | Updated May 25, 2011

Ancient thinker Archimedes famously said, "Give me a lever and a place to stand and I can move the earth." Former Oregon governor John Kitzhaber, MD, is heading up a new universal healthcare initiative called "The Archimedes Movement," and he thinks he has his hand on that elusive lever.

The strategy the group is using is not unlike that employed by abortion foes in South Dakota: pick a friendly -- or potentially friendly -- test state, pass the law, force the federal government to take a stand, and have the fight. Kitzhaber's test state, not surprisingly, is Oregon, which has been a testbed for policy advances in this area before.

In 1989, then Oregon Senate President, Kitzhaber crafted The Oregon Health Plan (OHP), a controversial initiative that put Oregon at loggerheads with the federal government over Medicaid rules. The federal system, Kitzhaber says, is fundamentally unfair because it decrees that the only people currently worthy of publicly funded healthcare are the elderly, the disabled, poor women, and poor children. And even within those groups, coverage is limited not by health needs but by the state's Medicaid budget, with rules set by the feds. So a working-age man wouldn't qualify unless he became disabled (no matter how poor he was), and even then treatment for his disability or other health issues might not be covered.

Implementing OHP required waivers from the federal government, allowing Oregon to set up its own system for providing healthcare to its neediest residents. Those waivers were a pretty hot issue during the 1992 presidential campaign, and the two-and-a-half candidates were asked about it in their first debate. The OHP still exists, but it has been decreasingly able to cope with more than 15 years of unrestrained costs, and the state has had to slash both the number of people eligible and the level of care they'll cover. But it's still, arguably, more comprehensive than the federal system.

In a recent presentation to a group of Latino healthcare workers (and interested others, including myself) in Beaverton, Oregon, Kitzhaber said of not only Medicaid but the entire federal approach to health, "We couldn't design a system this bad, excluding this many millions of people, if we tried." He walked the group through an exercise where we attempted to write legislation describing the current system. In every hypothetical configuration, great numbers of our fellow Americans living and working below the poverty line were left out of the system, where Kitzhaber -- a former emergency room doctor -- said they'd end up relying on the E.R. as their only source of healthcare.

And that's just the working poor. The rest of the working class -- those fortunate enough to have employer-sponsored coverage -- coughed up 143% more for their monthly fees and deductibles than they paid in 2000. That upward trend in employee costs is meeting a downward trend in the number of employers who even offer health insurance. Between 2003 and 2004, for example, approximately 600,000 working Americans lost their employer-provided coverage.

The make-me-white-hot-mad moment was the story of Douglas Schmidt, a young Oregon man with epilepsy. His anti-seizure medicine -- at $13 a day -- was deemed too expensive by the state officials who decide how to divvy up limited Medicaid funds. When they cut him off and his resultant seizure damaged his brain beyond function, the state did cover the $1.1 million bill for his care between his emergency room visit and his death in November, 2003.

So what now? Kitzhaber's bottom line for Oregon (and, by extension, the other 49 stars) is universal coverage, based on the same "eligibility requirements" we use in the public education system. To be eligible for public education, you don't have to fit into any arbitrary category. You just have to show up. And if you want services beyond what the school provides, you buy them yourself. So the healthcare version would offer basic services -- whatever we collectively decide is "good healthcare" -- to absolutely everyone, regardless of how they might be labeled demographically. If you wanted to have your face surgically sculpted into a jungle cat shape -- which I think we'd collectively decide is "bad healthcare," bordering on malpractice -- you'd have to pay for that yourself.

What about specifics? As we say in the publishing biz, they're TK, or "to come." (Nobody in publishing can spell.) Kitzhaber's goal is universal healthcare coverage, but he says he doesn't know whether that will mean a Canada-style single-payer system, which he himself doesn't favor, or some kind of public/private hybrid. Those parts of the plan are being brainstormed in meetings across Oregon and online at

Count on the 2008 presidential election to put candidates on the spot -- again -- about Oregon's uniquely appealing healthcare system. If, that is, Kitzhaber finds a place to stand with all the leverage he's building.