The doctor was in today at McMinnville: John Kitzhaber, physician, former governor and current medical system activist, had diagnosis and a fair amount of prescription. And it put the rest of the health care talk and activity – by the presidential candidates and within Oregon’s government – in some perspective.
Kitzhaber, now on the road a lot spreading his message well beyond Oregon as well as occasionally inside, leads the Archimedes Movement, aimed at sweeping, systemic health care reform. His take (which we don’t entirely share) is that the new Healthy Oregon program recently underway, and proposals by presidential candidates (presumably mainly the two Democrats, though he didn’t get into a lot of detail on this) are useful in terms of getting people into the system, covered by some sort of insurance, but that’s a limited benefit. Kitzhaber’s focus, on the other hand, is on changing the system fundamentally.
His presentation makes a case hard to argue with – and most people probably would implicitly recognize most of it as true. Of the factors contributing to a person’s health, he points out, only about 10% is health care – the rest has to do with things such as a person’s inherited biology, environment and manner of living. Those factors are little addressed in health care, he notes. He points out too that an overwhelming portion of the costs in the health care system is spent in treating people with chronic conditions (such as diabetes, circulatory disorders and others); but all the system’s financial incentives are aimed at treating acute conditions. There’s no financial incentive to treat conditions and health factors while they’re small-scale, easy to handle and inexpensive; the real money only comes into play when they become massive and life threatening. You’ll search in vain, he points out, for new and expensive substance abuse or obesity treatment wings at hospitals, while heart wings and cancer centers are everywhere. “The system is set up to reward acute cases,” he said.
On top of that, the system is horribly inefficient in other ways, notably the lack of automation which keeps doctors from sharing patient information, and makes information handling enormously more expensive and drives up error rates.
Looked at this way, a picture of the system as it ought to be begins to move into focus: A realignment of incentives and efficiencies.
Our impression, from watching the development in Healthy Oregon (which Kitzhaber endorsed, and approves as far as it goes), is that it does start to move in some of these directions, and pieces of the Clinton and Obama plans do too.
But Kitzhaber’s unique contribution may be in the way he thinks about health care wholly and systematically. If universal health care coverage of some sort really does materialize in the next couple of years, that could be step one in making more sense of the system. Some of where Kitzhaber is going may be step two.
A side note: Kitzhaber has lost none of his flair as a speaker, and someone encountering him for the first time now would have no trouble imagining how he became a two-term governor still popular even as he declared Oregon to be ungovernable. If he chose, he’d still be the strongest political campaigner in the state. Not that he gave the slightest signal of any interest in a return to that arena.
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