PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as a Congressional press secretary in Washington, D.C., an Oregon state government manager in Salem and Portland, press secretary for Oregon’s last Republican governor (Vic Atiyeh), and a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

My involvement with hospital and health insurance taxes to fund low-income health care in Oregon goes back to 1993.

That was the year the health care taxes were first instituted.  The lure was to use the new “state” — money paid by hospitals and insurers — to serve as match to garner millions of dollars under Medicaid.

Since then, I have had questions about the merits of the tax, but back then, as well as today, I always have come to an uneasy conclusion:

This is the best solution available for Oregon.  You don’t have to like all aspects of the taxes…you just have to settle for them.

So, I say vote “yes” by January 23.

The lure of federal matching dollars has prompted more than 40 states, plus the District of Columbia, to engage in the tax scheme.  At various times in the last 15 years, it has seemed like the federal government was ready to turn off the spigot.  But, the approach has remained in place.

Here in Oregon, one of the reasons that the tax makes sense is that health care does not rise to the top of the political priority scale at the Capitol in Salem.  The top spot usually is reserved for K-12 education, which continues to draw a huge chunk of total state dollars.

The common plea from K-12 advocates is that it’s “never enough, but they are still at the head of the line for state money.

Next is either cops and prisons, or higher education.  So, health care and human services come in last among the major contenders.

That means the only way to assure care for low-income citizens is to resort to the hospital and insurance taxes.

Now, if I supported the “no” side of this debate, I’d say that hospital and insurance constitute bad tax policy.  Better to apply a tax across the broadest possible swath of taxpayers than to single out certain payers.

I might also charge that it’s often foolhardy to trust state budget makers in the legislative process because they often engage in sleight of hand that makes it difficult, if not impossible, to track sources of money in coordination with the final destination of those dollars.

But, I digress.  No point in making arguments for those who oppose the taxes.

Better to cite a source none other than Dr. John Kitzhaber, former governor of Oregon, who while he is under an ethical cloud, remains very knowledgeable about health care policy issues. Here is what he wrote for the Oregonian newspaper.

“I agree that funding for the Oregon Health Plan is a shared social responsibility, but jeopardizing health insurance coverage for 350,000 Oregonians to make that point is equally unfair and unnecessary.

“Let’s put this into perspective. We need a stable, long-term — and equitable — funding strategy for the health plan, which contributes to the state’s chronic structural budget deficit. As The Oregonian correctly pointed out, the governor and legislative leadership failed to address either issue. But defeating the ballot measure will only make it that much more difficult to do so in the future.

“Should the ballot measure be defeated, there will be a number of immediate consequences. First, 350,000 low-income, working Oregonians will lose their health insurance coverage. These people should not be punished because the short-term legislative funding is not as broad-based as perhaps it should be. Doing so would be to sacrifice the good for the perfect and leaving us with the unacceptable.

“Second, since the federal government matches every dollar the state spends on Medicaid, the Oregon economy will lose billions in federal funds. Enrollment in the Oregon Health Plan will decline by more than one-third, making it difficult to maintain the infrastructure of our coordinated care organizations that have made Oregon a national leader in reducing the cost of health care while maintaining quality and outcomes. This would not only be detrimental to those currently covered by the Oregon Health Plan, it would also compromise the integrity of a health-care delivery model that offers perhaps the best opportunity to reduce the long-term cost of care for both public and private employees.”

Kitzhaber is right. The only rationale vote is “yes.”