Saturday’s Oregonian Editorial
An editorial in the June 15, 2013 Oregonian starts with:

“When the Oregon Legislature found the nerve to enact a law to overhaul health care delivery, it stepped off a cliff — into a great promising unknown in which medical treatment would shift from expensive intervention to thrifty prevention, clamping down on runaway costs and open in up spending for things like education.

Few folks disputed it was a bold idea. But neither did anyone think it would happen without pain or complication.

The decision to commit was made last year. But the pain part is going on right now.”

Good Words
I thought those words and phrases, “…overhaul, …off a cliff — into a great promising unknown, …pain part is going on right now”, captured quite well the scope, depth and turmoil of the reform process in which we are now engaged, both in Oregon and nationally. “Found the nerve…” is another telling phrase…this is a big deal and it took stepping out-of-the-box to make the decision to reform health care.

Salem Hospital Sues
The editorial from which I draw the quotes went on to discuss a law suit currently underway in which a Salem hospital was suing to keep an existing fee system in place or, in other words, perpetuate the expensive and often wasteful current fee-for-device system. (One of the provisions of the reform is to base medical fees on a per/person rate, which gives providers an incentive to focus on prevention.)

The editorial suggested that legislative attempts, while well-intentioned, to penalize the Salem hospital if it did not stop it’s attempt to undermine reform would probably have more negative consequences. So, legislation that seeks to solve one problem creates others. Another example of the turmoil, the “…pain part….”

Key Decison-Makers
Another contentious issue working it’s way through the Oregon version of health care reform is deciding who qualifies as a primary care provider. Primary care providers are those physicians who first see those in need of health care; they will play a pivotal role in steering reform toward prevention and education. Who all gets to be primary care providers…MD’s? DO’s? NP’s? DC’s? ND’s? etc. And whomever they are…who will have the “nerve” to transition from the traditional expensive testing, prescribing, and surgery model to a prevention and education model. There’s going to be some pain in working those out.

While Oregon seems to generally be taking constructive steps to move healthcare reform forward, there seems much less of a bipartisan effort nationally. For example, our U.S. House of Representatives has voted over 30 times to disband the underlying Affordable Care Act (ACA), also known as Obamacare. Those attempts, often promoted with scare tactics, have failed.

Into a Great Promising Unknown
So, moving onward, as the editorial said, “– into a great promising unknown…,” where to now? I am prompted to write this blog piece, as an interested party, to share some observations and to acknowledge that health care reform has great potential…and is going to take a lot of work. I think the issues are important; the solutions may well impact many professionals in our field. They probably will bear on our own health care. Sorry to say, I don’t have much advice in mind. Stay informed and keep asking questions…and find your own ways to support an open dialogue among all of the stakeholders…continuing to work toward a wellness culture and shifting away from the soon-to-be unaffordable pathology oriented health care.

Ray Siderius, Director, Oregon School of Massage

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