Single-Payer Health Insurance for Oregon

By Rep. Michael Dembrow
December 3, 2010

Rep. Dembrow is a Democrat that represents House District 45, which includes portions of Northeast Portland, Maywood Park, and Parkrose.

There are many good things we can say about health care reform at the state and federal level. Here in Oregon we passed the Healthy Kids Act, extending coverage to all of Oregon’s uninsured children, a really remarkable achievement. As a result of the federal reforms, children all over the country can no longer be denied coverage because of pre-existing conditions, and in a few years that will extend to everyone. Young adults can stay on their parents’ coverage until they are 26. Seniors see an end to the donut-hole in their prescription drug coverage. If things stay on track, an insurance exchange for individuals and small businesses is coming, and perhaps even some kind of public option for Oregon.

Despite these points of progress, though, many gaps will still remain in these plans. I see three problems in particular:

  • First, there will still be people who will be left out, and that’s going to continue to drive up the cost of coverage for the rest of us.
  • Second, for most people insurance is still going to be tied to employment. So if you lose your job, change your job, or drop below full-time at your job, you’re going to have to change your coverage or even worse--you’re going to lose your coverage entirely.
  • Third, for the most part our system will still rely on private insurance companies, who charge very high administrative fees, and whose primary interest is their own profits.

At best, what we’re going to continue to have is a patchwork system. There’s a real danger that people are going to fall through the cracks, middle-class families are going to pay more, and small businesses are going to continue to be hammered.

Fortunately, one of the best things that federal health insurance reform did was open the door to further experimentation by the states. Thanks in large part to work done by Senator Wyden, states can try out their own solutions, as long as they are expanding access to quality healthcare to more people more affordably.

I believe that the best solution to the three problems that I mentioned above will be a “single payer” system. This would be a system like Medicare, but extended to all. Everyone would pay into the system in a progressive manner, and it would relieve the burden on Oregon’s small businesses. Initial projections show that we could create a system that in total would cost no more than we are currently paying as individuals, businesses, and the state—but everyone would be covered, would have access to quality care by the provider of their choice, and the rise in costs could be contained.

One of the real problems with the Federal reform process was that advocates of single payer were never allowed a seat at the table. For reasons of politics and influence and strategy it was ruled out before it was even considered. That’s wrong, it’s bad government, and we need to try to make it right.

I would like to see Oregon taking steps to move in this direction. So I’ve partnered with a coalition of single payer advocates—Health Care for All Oregon, Physicians for a National Health Program, Jobs with Justice, and the Oregon League of Women Voters—to develop The Affordable Health Care for All Oregonians Act for the 2011 legislative session. To see the concepts behind the bill, go to the Health Care for All Oregon (HCAO) website. Senator Chip Shields has committed to introduce the bill on the Senate side, and a number of my legislative colleagues have indicated interest in co-sponsoring.

Obviously, getting to single payer is a long-term project. It's not just about moving a piece of legislation; it's a movement. It's going to require ongoing commitment, an enormous amount of effort, organizing, and education. It's a movement that needs to reach beyond the usual confines of the mainstream media. Please let me know if you’re willing to help.