Ineffable Ingenuities

Polite conversation omits the f-word from talk about the health care funding crisis, but “funding” health care is the only crisis we face. America trains the best doctors, builds the best facilities, invents all the best new drugs. Health care is not the issue; paying for it is. Dr. John Kitzhaber is talking again, but don’t expect him to repeat himself.

Oregon Health Plan was Kitzhaber’s Act I. It became remarkable not by showing what it could do but by stating plainly what it would not do. Setting limits on health care — rationing, if you will — was regarded as unseemly and inhumane. Discretion is the better part of valor. Burgeoning medical technology has shown his thinking was correct. Just because we CAN do something medically doesn’t mean we always SHOULD. Sustainability requires limits.

Kitzhaber’s stage for Act II was the Oregon governor’s mansion, where he learned limits of a different sort. What he calls “transactional politics” makes it difficult for politicians to campaign on a collective good for their constituents. “Healthier neighbors” doesn’t quite satisfy the “what’s in it for me?” question. So the Oregon Health Plan and other single-payer strategies slowly dismantle themselves by the myopia driving elections.

Now Kitzhaber is back with what looks like Act III: The Archimedes Movement. Check it out at www.joinAM.org. Archimedes invented a tool to make water run uphill and Kitzhaber is setting out to do nothing less. He argues that money is not the problem. Oregonians spend enough on health care to keep everybody healthy. If only those funds from private, business, and government programs could be distributed efficiently and effectively.

Costs and benefits being spread far, fast and fair? That’s the core competency of private insurance companies. Whether government learns to mimic their arbitrageuring techniques or private companies are licensed to bring their business model to every citizen, health care for all may soon be within sight. Then we can utter another f-word. “Finally.”