Opinion: Oregon's Healthcare System: A Looming Implosion
By John Kitzhaber
For The Oregonian/OregonLive
Kitzhaber, a renowned physician and healthcare policy consultant, served as Oregon's governor from 1995-2003 and again from 2011-2015. He presents a stark warning about the state's healthcare infrastructure.
Imagine a scenario where your hospital abruptly closes, or inpatient services become inaccessible when you need them most. Picture yourself waiting six months to see a doctor, forcing you to rely on the emergency room, one of the most expensive healthcare settings, to address your medical needs. This grim reality is already a harsh truth for hundreds of thousands of Oregonians, and it's about to worsen.
The healthcare system's infrastructure is crumbling, and we've failed to grasp the severity of the situation. According to Oregon Health Authority data, over half of our hospitals operate at a loss. In December 2023, Peace Health's University District Hospital in Eugene closed its doors. Ashland Community Hospital will soon shut down its birthing center and cease inpatient services. Last year, over 1,000 hospital employees were laid off, and medical clinics and independent practices across Oregon struggle to stay afloat.
This crisis isn't new; we've merely ignored it. Since 2019, family coverage costs have skyrocketed by 24%. Fifteen percent of Oregonians delay or avoid necessary medical care due to cost, and medical debt is the leading cause of personal bankruptcy in the state. The inability to pay medical bills is a pressing issue.
Despite the looming crisis, we've kicked the can down the road, shifting costs to employers and contributing to our $38 trillion national debt. Insurers, providers, labor, and consumers have blamed each other for rising costs, resisting collaboration towards systemic change. As long as we remain in our silos, we perpetuate a zero-sum game, creating 'winners' and 'losers' but no lasting solutions.
The situation took a turn last July when Congress passed House Resolution 1, threatening Oregon with a $11 billion loss in federal Medicaid funds over a decade. The failure to extend enhanced premium subsidies in the Affordable Care Act market will result in monthly premiums soaring by up to $450 for 140,000 Oregonians, disproportionately affecting self-employed individuals, farmers, ranchers, and small business owners, especially in rural areas.
The intersection of escalating healthcare costs and federal funding cuts poses an existential threat to Oregon. It endangers access, the stability of the general fund, and the state's economy. This crisis is decades in the making and cannot be resolved within a single legislative cycle. We need a multi-year strategy with a clear vision for Oregon's healthcare system in 2033, reflecting the values and outcomes we desire.
This vision, our 'North Star,' must be established during the upcoming Oregon Legislature session. With HR 1's passage, we've crossed the 'gradual' phase of bankruptcy. The situation is about to become 'sudden.'
This means we must shift our focus from revenue to cost. Additional funding won't bail us out, creating an opportunity to address the factors driving the total cost of care. In the short term, we must reduce bureaucratic and regulatory burdens that divert resources from clinical care.
In the long term, we need to tackle the complexity of healthcare financing and delivery, consolidate state purchasing power to negotiate better drug prices, and recognize the role of labor and workforce in crafting solutions. An honest conversation about the disparity between unlimited demand and finite resources is essential.
Partisanship must be set aside on this issue. Failing to do so will lead to system collapse, with dire consequences for employers, labor, hospitals, physicians, insurers, and most importantly, Oregonians who need affordable, timely medical care.
Healthcare is not a partisan matter. We will all require medical care at some point. During my ER practice, I never questioned someone's political affiliation before treating them. Cardiovascular disease and cancer don't respect political ideologies. Let's remember this and work together to prevent the implosion of our healthcare system, uniting as Oregonians to rebuild our community.
