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Posts published in “Day: April 15, 2008”

Another Senate round

Taken generally, there wasn't a lot of news out of the one televised Oregon Senate primary debate tonight - excepting a reference to a primary winner endorsement (more on that below). But it did offer a few indicators, just a couple of weeks or so out from the start of balloting. (The debate, we should note, was sponsored by KGW-TV and the Oregonian.)

There are four candidates in the Democratic primary; three were present this evening - House Speaker Jeff Merkley, Portland activist Steve Novick and Eugene realtor Candy Neville. Neville presumably was there largely on the strength of a recent poll showing her in a close second place to Novick, with Merkley trailing distantly. That result feels like an outlier, and the larger probability is that Merkley and Novick are in a fairly close race. But Neville's passion for certain subjects, primarily Iraq and veterans, came through as in earlier encounters.

She seemed nervous going in; in the first half of the program her answers were halting, and she blew at least one question (on bringing legislative bacon back to Oregon) completely. But she toughened as she went. Merkley seemed cautious and stiff at first, loosening up as he went. Novick was his usual blunt self and came across effectively throughout (his gift for converting wonkish data into plain speech was fully in evidence), though he seemed to exercise a little more caution tonight than on some earlier occasions when his sharp tongue caused him grief (as on bloggers and some other subjects).

Their issues answers were, overall, strikingly similar. (Just one question seemed to elicit genuinely distinct answers, a query on the proposed Cascade Locks casino: Neville was generally in favor, Novick leaned against, and Merkley wasn't sure).

And there was little attack mode. About halfway through, Merkley brought up some Novick snark against Hillary Clinton, Barack Obama and others, but that was about the only explicit direct shot fired. (There were some subtle shots back and forth, here and there.)

The most striking moment, though, was a reconciliatory note. A few days back, Novick was quoted after one encounter as suggesting he thought more highly of independent Senate candidate John Frohnmayer than he did of Merkley, that he "would be a better senator than Jeff Merkley" (although he did say he would endorse Merkley if he were the Democratic nominee). The resulting storm among Democrats may have given Novick pause. Tonight, he went somewhat out of his way not only to specifically throw his support to the Democratic nominee but also to encourage Frohnmayer to drop out of the race, and his supporters to back the Democrat. It felt like a sharp pivot, and it's not hard to imagine the reasons.

No great excitement or news. But suggestive of a race that's highly competitive as the final lap approaches.

Kitz on health care

John Kitzhaber

John Kitzhaber

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.