The Politician-Doctor Weighs In: An Interview With Former Oregon Gov. John Kitzhaber
Oct. 18, 2006 — -- "It's really mind-boggling to think that we continue to cling to this thing, in spite of the fact that it's not working for any of us."
-- Gov. John Kitzhaber, M.D., on the U.S. health-care system
Dr. John Kitzhaber, a former emergency-room doctor, was the governor of Oregon from 1995 to 2002.
During his time in the state Senate, he wrote and implemented the controversial Oregon Health Plan, which decided which treatments would be paid for based on which were considered the best value -- price vs. results.
In January 2006, Kitzhaber began the Archimedes Movement, which describes itself as a plan for health-care reform aiming to create a viable goal of an equitable and cost-effective system.
In an interview with ABC News, Kitzhaber talked about what he perceives as an outdated health-care system in America.
Here's what Kitzhaber said to ABC News:
On the Lack of Universal Access in the United States:
"Every other industrialized country in the world has some form of universal access. In other words, people can get access to primary and preventive care. They can get access for emergency care. Sometimes they have to wait for nonemergency care, but people can actually get in and get their problems dealt with on the front end."
"[In the] United States, the growing number of people who don't have the ability to have health insurance often get their care through the emergency room, so instead of paying pennies to manage someone's blood pressure in the community, we pay tens of thousands of dollars to take care of their stroke in the hospital. So, that's our de facto system of universal access, and it's a lot cheaper obviously to keep people healthy than to take care of them after they become sick."
On How the Uninsured Raise Prices for Everyone:
"What people don't appreciate is we do have a de facto policy of universal access. It's called the emergency room, so the people who can't get in to see a doctor in a timely manner will go to the emergency room and then federal law requires that they be seen and treated."
"Then those uncompensated costs are shifted back to people who have insurance coverage by increasing their bills or increasing their insurance premiums. So, if you have a private insurance policy, about 10 percent of your premium is picking up the cost of people who are getting care in these other venues."
On Whether Our Current System Makes Sense:
"If we were to start over today with the public dollars we currently have in the system, which is over $900 billion a year, and looked at those expenses through the lens of the 21st century. … Would we allocate them in the same way and create what we have right now?"
"Would we set out to create a system that puts employers at a competitive disadvantage? Would we set out to create a system where a middle income working family with no coverage subsidizes the health-care needs of wealthy people over the age of 65? Does that meet our sniff test for equity? … The answer is clearly no!"
"No one would create what we have today, and it is astounding to me that we continue to cling to it."
On Making Tough Decisions About Who Gets Treatment:
"We'll always have more stuff we can do to people than we can afford. So, the central question in the health-care debate no one wants to look at is: 'How much claim should any one individual have for his or her health care on common resources of the society?'"
"Should 95-year-old grandpa's quadruple bypass surgery be paid at the expense of his 6-year-old granddaughter getting immunizations and a routine checkup at her pediatrician? That's the larger question."
On the Lack of Preventive Care:
"Most countries have a much higher emphasis on preventive care, on wellness, and other things that affect the health of their population."
"[Our system] rewards doing things to people. It rewards procedures. It's a system that sort of lies in the weeds until people are very, very sick and then rushes in with extraordinarily marvelous and expensive high technology to help you recover on the back end."
"We don't have a health-care system in the U.S., we have a sick-care system. If you get sick or badly injured or have an exotic disease, this is the best place in the world to be. If you want to stay healthy and stay out of the health-care system, this is not the best place to be."
On What Today's System Would Look Like If It Had Been Proposed As Legislation, Rather Than Evolving Unplanned Over Time
"You might have a section that says there should be no explicit policy objective adopted to guide the allocation of $900 billion of public health-care resources. No responsibility will be assigned for financing health-care needs of Americans who can't afford to do so themselves."
"Section one might read, 'All those over the age of 65 regardless of their income will be entitled to publicly subsidized health care. … All working people under the age of 65 regardless of whether they can afford health care for themselves or their children will be required to contribute a portion of their taxes each month to pay for the health-care needs of wealthy people over the age of 65.'"
"Yet another section … might read 'Medicare, the program for the elderly, is prohibited from covering long-term care services in spite of the aging of the population. Medicaid, the program for the poor, will be required to cover long-term care services. … The elderly who need long-term care services will be required to spend themselves into poverty in order to become eligible for Medicaid, at which point their needs compete directly with those of poor women and children, and in many cases their own children and grandchildren.'"
On the Factors That Determine a Person's Health Status:
"About 40 percent of what affects people's health status are behavioral choices and lifestyle decisions whether you smoke or drink, dietary considerations, exercise. About 30 percent has to do with your genetics, who your parents were. About 15 percent are social factors, whether you have a job, whether you have a house, whether you have a healthy neighborhood. Then 5 percent are environmental factors, which [means that] the U.S. medical system … has about a 10 percent impact on people's overall health status."
On the Problem of Baby Boomers and Medicare
"There's about 49 million people on Medicare today. There's 78 million people in my generation, and we're going to start hitting the age of 65 in 2011 -- five years from now."
"The demographics of the American population is really what's going to drive us over the edge. … When my generation fully reaches the age of 65 and becomes eligible for Medicare, the unfunded entitlement in the Medicare program alone will exceed $65 trillion."