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Will Health Care Debate Lure Kitzhaber Back?

June 20th, 2009 by dk

National health care reform may soon shape Oregon’s political landscape for 2010. It’s a story about screws, salmon and summer.

When a screw penetrates a piece of wood, what direction is the screw traveling? It’s moving in two directions at once. The pointy tip is moving straight into the wood, while the thread is forcing the screw to spin. I learned from an engineering textbook that this is called a “dual vector thrust” and it’s why screws hold things together better than nails. Fortunately for me, this was explained on page five of the book, because I didn’t understand anything after page six.

Greek philosopher Archimedes documented the physics of the dual vector thrust in the third century before Christ. He used his design to make water travel uphill, which is a pretty neat trick when you think about it.

Oregonians know something about moving against the tide, pushing the rope, defying gravity. It’s not for nothing that wild salmon capture our imagination so deeply, boldly swimming upstream to spawn. What the Archimedes screw does mechanically, a salmon does instinctively.

Oregonians have earned a reputation for moving against the tide. The Oregon Health Plan represented the nation’s first attempt at rethinking how public health care funds are distributed.

State legislators and Governor Kulongoski have devised a clever and economical plan to add 85,000 new recipients to Oregon Health Plan’s rolls this summer. But beware. That which Salem giveth, Salem can taketh away.

When times are good or when the votes are there, the state has financed OHP’s expansion. When the economy slows, the needs across the state go up but the plan usually contracts. As anyone who has dieted or undergone physical therapy can attest, health care progress is more easily lost than gained. Getting well is like swimming upstream.

The Oregon Health Plan has succeeded better at treating acute conditions than chronic ones. It should surprise no one that it was designed originally by a state senator who was also an emergency room doctor.

That man, Dr. John Kitzhaber, went on to be elected governor of Oregon for two terms. He has not dismissed the idea that he may run for a third term in 2010. If he wades into political waters again, we can presume it will be because he believes a doctor and governor and fly-fisherman and Oregonian can help devise a durable solution to the health care delivery system in America.

A durable solution must join together two ideals — the inclusiveness of a single-payer plan with the inventiveness of competing private plans. Efficiency and effectiveness both matter and each contributes to the other. A durable solution requires a dual vector thrust.

Any simple and direct solution will not offer durability. The Oregon Health Plan was a beginning, but not the end. OHP has been an effective nail, but now we need a screw. Only a plan that balances public and private forces can endure the pressures that politics and business will apply to it in the years to come.

Congress and complexity don’t normally go together. So President Obama has shrewdly scheduled this debate for summertime. That’s not the time you’d expect such serious business to be undertaken, but it must be on purpose.

Obama’s Chief of Staff Rham Emanuel was a senior adviser to President Clinton in 1993, when the Clintons’ health care reform package was introduced. The “Harry and Louise” commercials credited with derailing that plan first aired in September, 1993. Emanuel saw how easily the public was frightened by a plan that seemed too complex for regular people to understand. But television commercials won’t have the same influence during the summer, when nobody’s watching television.

Summer itself offers the president another bully stick. Obama and Congressional leaders can make it clear to legislators that passing some sort of bill outlining the reform must be accomplished before they can adjourn for their summer recess. If you’ve ever been in Washington, D.C. in August, you know how powerful a motivator that would be.

Meanwhile, back in Oregon, a seasoned politician and avid fisherman will be watching the debate.

If Congress’s work is done by August and a promising national health care solution has emerged, I’m guessing Kitzhaber will announce from a fishing spot that he’s no longer feeling lured back into a public life. If the work has only begun and Kitzhaber believes Oregon’s experience and reputation could shape the ongoing health care debate, I bet he’ll take the hook.


Don Kahle ( writes a column each week for The Register-Guard and blogs regularly at

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  • 1 Rick Ray Jun 21, 2009 at 9:37 am

    Hello Don,

    Two things to add.

    First, John Kitzhaber doesn’t expect the current round of health reform coming out of D.C. to amount to much. You can see his thoughts on that here:

    Second, Kitzhaber’s been speaking across the country about the need to shift our health system from one focused on acute care to one focused on health, prevention, and chronic care. It’s all about the Triple Aim:
    1. Improve the overall health of Americans.
    2. Reduce the per-person cost of health care.
    3. Improve the individual patient experience in terms of clinical outcome, patient safety and patient satisfaction

    You can see a longer video of Kitzhaber on health reform here: