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.

Many of us in Oregon – elected officials, appointed officials and lobbyists alike – have been down the health care policy road many times.

We took that road to do what many other states did not do, which was to reform health care, not by a major re-write, but by incremental steps that improved the landscape. Many of the steps of progress occurred under the leadership of former Oregon governor John Kitzhaber, an emergency room physician by training.

Kitzhaber was good at the policy development process, though he tended to sully many of his solid achievements by the way he left office under a cloud a few years ago.

Well, health care policy – or at least a new proposal – made headlines in Salem last week.

Nearly 40 members of the Oregon Legislature introduced legislation, Senate Bill 770, which, they said, “would set the stage for universal health care in Oregon.”

There is little doubt but that the claim is overstated. As always, the devil will be in the details.

SB 770 would create a board and set up other components the proponents contend are necessary to establish the so-called “Health Care for Oregon Plan” to provide universal coverage throughout the state.
“Health care is a basic human necessity and it should be a right,” said Senator James Manning, D-Eugene, a chief co-sponsor of the bill. His definition of health care as a right has been proposed many times in the past, but never passed at the Capitol because, for one reason, the cost would be out of sight.

“We all need health care, and you can’t survive without it, “Manning added as he stated the obvious. “We’ve got to make sure that we get universal health care set up in Oregon so that none of us go bankrupt or die just because we get sick and don’t have health insurance.”

High-sounding and attractive words. I don’t know Senator Manning – he arrived in Salem after I retired – but I suspect he is genuine in his interests.

Among other provisions, SB 770 sets eligibility requirements for “Health Care for Oregon Plan.” According to a news release from the proponents, “those include being an Oregon resident, but those living outside the state who are employed full-time in Oregon also can use the program, if they pay into it. Immediate family members and dependents of qualifying individuals also will qualify, as the bill is written.”

During my 25 years as a state lobbyist, I focused on health care as a representative of various health care interests, especially Providence Health & Services, one of Oregon’s leading health care providers (which also has platforms in five other states).

One of my conclusions: Developing solid health care policy is VERY difficult.

Here are some of the important features of any new health care policy drive – features that would mark the difference between just words like “health care for all” and the fact of real improvements in providing increased health care services.

1. The first requirement is leadership from legislators with the chops to bring competing interests together to find middle ground. Though I have been gone from my lobby gig for a couple years, leadership does not strike as a frequent skill at the Capitol these days.
2. The second requirement is that right people need to be “in the room” to hammer out thoughtful proposals. For me back in the day, the best legislator at this was Neil Bryant, a centrist Republican from Bend who had the wherewithal to ask – read, demand – the right people to be in the room, plus tell those who did not want to compromise to stay away. Of course, whatever emerged from what was called “a work group” would have to pass public muster in public on the floors of the Senate and the House, as well as in the Governor’s Office.
3. The third requirement is implied above. Those in the room had to be willing to compromise – to give on some points, and to get on some other points. That’s the definition of compromise. No one side wins. Many today believe that compromise involves one capitulating to the other. No. It’s middle ground.
4. The fourth requirement is that there should be a focus on cost. Often, those on the left avoid considering costs believing that government should pay the bill, even though that means all of as taxpayers will be hit in our wallets.
5. The fifth requirement is that there should be a focus on methods by which citizens gain access to health care. And that means going back to cost issues, as well as assuring that there are enough qualified providers to do the job.

Instead of just uttering high-sounding phrases designed to make headlines, I wish legislators at the Capitol would focus on making new law that works, or, if they are not able to do so, avoid passing something based on just words and not meaningful action.

Too much to expect? Probably.