By Teresa Keane

Anyone who is paying attention realizes that the American healthcare system is badly broken. Approximately 45 million Americans have no healthcare and the ranks of the uninsured are growing every year. Here in America, we tie healthcare to employment. We are the only democracy with such a system. As people loose jobs and healthcare, the costs are shifted to the backs of the insured. That is why our costs increase every year. The HMOs do not absorb the costs, the citizens do.

Several health plans are being proposed. John Kitzhaber wants to expand the OHP idea for all Oregonians. While we respect his efforts, this plan does not go far enough. OHP is rock bottom care. I don’t know a single employed person who would trade their current healthcare for OHP coverage. Therefore it is not good enough. The solution is not to give inferior care to the poor and uninsured. We must guarantee good basic comprehensive care to all Oregonians.

Bush wants to increase “Health Savings Accounts.” This is nothing more that a smoke screen that gives fees to banks and leaves the poor uninsured. Think about Bush’s new prescription drug plan; it was written by his corporate friends. The plan is a nightmare that decreases our senior citizens’ access to much needed medications.

The good news is we don’t need to reinvent the wheel. We have several examples of comprehensive healthcare plans from every other democratic government. They ALL provide healthcare to their citizens. The Pacific Green Party is proposing a model loosely based on the system in Holland. It is a public/private model that fits with our capitalistic system.

In the PGP model basic healthcare is provided to ALL Oregonians. This basic system includes comprehensive care including medical, vision, dental and mental health services. This system will not be tied to employment. Each person will choose a primary care provider that can be an MD, an NP or a Naturopath. All licensed professionals will be included as eligible providers. The primary care provider will act as the gatekeeper for referrals to specialists.

Supplemental private insurance based on a free market system will also be available. Individuals and businesses can add on insurance from a variety of private resources with various plans as an addition to, not instead of the basic plan.

Hospitalization coverage is as follows. The plan will cover 100 percent of a semi-private room with a co-pay starting at $5.00 per day increasing up to $25 per day based upon ability to pay.

Funding will come from the following sources: federal funds (Medicaid and Medicare, 85 percent), business taxes (payroll tax 5 percent), a progressive income tax (5 percent) and co-payments for services (5 percent). A tax on cigarettes of $2.00 will be added. These financial sources will be adjusted as needed to cover the cost of services.

Other taxes on things that impair health, like soda and junk food, can be considered.

The State of Oregon will contract with the Pharmaceutical Companies for the lowest possible prices. All drugs will be put into a tiered system based on cost and coverage. The first tier will be generic low cost proven effective drugs or brand named drugs with no generic equal. These drugs will be covered 100 percent with co-pays based upon a minimal co-pay of $2.00 per prescription up to a maximum of $10.00. The second tier will be more expensive generic drugs or comparable brand named drugs. Co-pays will increase to a minimum of $3.00 per prescription to a maximum of $20.00. Brand-name drugs will be in the third tier. These drugs will be covered on a exception only basis.

The plan will be managed by a group of interested parties including: unions, employers, providers, citizen organizations and patient advocates. This is a single payer system with targeted administrative costs at 4 percent of premiums.

In summary, tying healthcare to employment is a failed model. As people are unemployed and employers fail to provide coverage the cost of healthcare is shifted onto the back of those with insurance. Instead we need to select a time tested model from those that exist. This plan models the system in Holland voted the best in the EU. It provides good healthcare to all, irregardless of employment. In addition there is private insurance available to those who want to purchase it. Now we need leaders with the courage to tackle the problem and implement solutions.

Teresa Keane is a nurse practitioner and a faculty member of OHSU. She is also co-chair of the Pacific Green Party and author of the plan.