Provider tax is plan's only flaw

We, the members of the Jefferson Regional Health Alliance, a collaborative group of health-care leaders in Jackson and Josephine counties, write to urge every Oregonian to evaluate and consider support for the Oregon Health Fund Board's recently proposed health-care plan. Further, we encourage all of our state legislators, regardless of partisan orientation, to collaboratively implement this plan (with one important revision suggested below) early in the current legislative session.

There are several urgent reasons to do so:

First, most Americans now agree that our health-care system is severely dysfunctional. Many frankly call it "broken."

Over one-third of us have no ready access to basic health care except through emergency rooms in times of crisis. Basic health care has become unaffordable for over half of us. As a result, there is significant and avoidable human suffering in almost every segment of our society.

A transformative change in our system is both desperately needed and politically imminent. We believe that 2009 brings the most promising opportunity in half a century for such substantial change, with multiple thoughtful proposals arising at both the federal and state levels.

Second, Oregon's response has been both thoughtful and practical, reflecting two decades of creative and realistic approaches to health-care dilemmas. Continuing that tradition, in July 2007, the Oregon Legislature charged a citizen board — the Oregon Health Fund Board — with creating a blueprint for a new Oregon plan that would provide affordable, sustainable, high-quality, basic health care for all Oregonians.

The board included seven members and 101 subcommittee citizen members (all volunteers), representing the breadth and depth of Oregon's diverse population. They worked diligently for over a year, confronting the incredible complexity of problems inherent in our current situation and constructing an integrated network of realistic solutions. Their final report, released three months ago, has been translated into several specific legislative proposals, now being considered by our Oregon Legislature.

Third, we think the board's plan is a remarkable document, creatively and realistically addressing most of the complex problems in the current system. It outlines a realistic pathway to universal access over 10 years. It calls for seven specific strategies to cut exorbitant costs while enhancing quality of care across our population, largely by gradually shifting the main focus of health care away from expensive crisis care toward a system centered upon scientifically based primary care, self-responsible prevention and appropriate palliative care. It proposes a plan to increase our rapidly dwindling primary care work force, a necessity if we are to effectively implement and sustain such a system. It is inherently flexible, allowing rational, evidence-based planning as well as future alterations, through an independent, nonpartisan, accountable citizen/expert oversight panel (to be called the Oregon Health Authority).

Thus, we assert our overall affirmation of the OHFB plan for health-care reform in Oregon. We agree with the Health Fund Board that transformative change cannot occur overnight and that rigorously cutting costs alone will not be enough to accomplish such great change.

Therefore, we accept the necessity for a new tax, "equitably shared by the entire population" and specifically dedicated to enabling basic health care for our most vulnerable citizens: children and adults near or below the federal poverty level. Many of us have great concern about one aspect of the board's plan: the severity (3-5 percent tax) and the very narrow focus of the proposed "provider tax" which (as currently written) would threaten the very existence of half of Oregon's hospitals. It also would potentially jeopardize the sustainability of the proposed new system. Therefore, we encourage the Legislature to broaden the base of this proposal — to establish a more modest tax upon the health-care transactions of a much wider spectrum of Oregon health-care providers.

JRHA members recognize an obvious certainty: that meaningful health-care reform will initially require some degree of sacrifice by almost everyone. Such sacrifice will be made exceedingly difficult by the realities of our current economic crisis. While we deeply respect the daunting complexities and financial uncertainties which face all of us now, we believe the long-term cost of inaction far exceeds the modest price of this sensible immediate action. The Health Fund Board plan is neither simple nor perfect. Still, we believe it is overall the most fair, reasonable, pragmatic and far-sighted health plan yet devised.

Members of the JRHA wish to commend and thank the volunteer citizens of the Oregon Health Fund Board for a job well done. We believe it is now time for Oregon citizens to support the plan and for our Legislature to enact it.

John Forsyth, M.D., is president and chairman of the Jefferson Regional Health Alliance, a collaboration of the leaders of the regional hospitals, safety net clinics, county public health and state higher education as well as leaders in medicine, business and philanthropy. On the Web at

Share This Story