Tim Nesbitt: If this time is different, can we still count on an Oregon Way?

If our better angels prevail this November, there are a number of ways in which we should be well positioned in Oregon to act on Lincoln’s advice to “think anew and act anew."

Are we ready to “think anew and act anew”?

"Wagon on Oregon Trail. Rock Creek Station" by *Kid*Doc*One* is licensed under CC BY-NC-ND 2.0

“This time is different.”

I’ve thought so before. I’ve even written reports for governors that said so before, earnestly documenting the “fundamental changes” that we’d have to pursue and the “big ideas” that we’d have to take up in order to make the best of new realities. But when the economy rebounds, our attention shifts to doing better with what we have or putting more money into what we were doing before.

So when the coronavirus took hold earlier this year and we slammed the brakes on our economy, I wasn’t so sure about would be different this time. Now, six months later, this time really does look different. We’re not only struggling to control a lethal pandemic, we’re in the midst of a long-overdue reckoning with racial injustice, coping with Nature’s “I told you so” lessons from overheating our planet and, at the same time, beginning to doubt the durability, even the desirability, of our democracy.

In this context, the invocation of an Oregon Way can feel like a stubborn reassertion of Oregon Nice, of civility over substance and of hope severed from any practical strategy for change. Events keep pulling us to the extremes, while the extremes repel, and we carom into disputes over what we must renounce or reaffirm, restore or reinvent.

In my first post on this site, I’m sticking with the hope that we can regain common ground in what we are starting to call the aftertimes. But there are critical tests we’ll have to pass in short order. One is that we manage to maintain a functioning democracy in our nation. Another, here in Oregon, is that we succeed in sustaining a well-functioning legislature that refrains from walkouts to block legislation.

We’ll see. But, if our better angels prevail this November, there are a number of ways in which we should be well positioned in Oregon to act on Lincoln’s advice to “think anew and act anew” with new solutions for different times.

Let’s start with health care reform. 

"Microemulsion could allow vaccines to be stockpiled long-term" by Army Medicine is licensed under CC BY 2.0

Health care is Exhibit A on my list of issues where what’s different this time can help break through old deadlocks and accelerate changes that are long overdue.

Among the many things that this pandemic is teaching us is that no modern economy can function well without providing health care for workers and their families. Shutdowns exact a huge toll on businesses, our people and our governments. And, as we try to return to some form of the old normal, it is becoming increasingly clear that most employers, especially smaller, local businesses, can no longer afford to shoulder the burdens of health insurance for their employees, when exposure and reactions to the threats of infection remain so varied and unpredictable.

I am making the case here for health care for workers and their families as a subset of the case for health care for all. I don’t mean to retreat from the larger goal. But I see the fragility of our employer-based health insurance system as a problem whose solution is more urgent and more likely to lead to systemic reform.

Any system of health care coverage that relies on employer-based silos will be fractured by the vagaries of pandemics, now and in the future. What good are wellness programs or health savings accounts in the face of a Covid-19? We need large-scale testing, monitoring, isolation and treatment for those infected and broad-based immunizations when available. But these initiatives can only be financed and implemented on scales beyond the capacity of almost any employer to sustain. Further, the incidence of infection from both on-the-job exposure and off-the-job behavior is impossible to segregate, quantify and rationalize in an insurance-based system that eventually assigns the cost of treatment to individual employer groups and their employees. These problems become even more complicated when we consider the exposure of employers to civil liability for outbreaks in their workforces, an issue which has already begun to complicate the politics of economic recovery both in Congress and in our statehouses.

An incremental but meaningful step forward

Problems of this sort brought us the workers compensation system a century ago, which was designed on a state-by-state basis to mitigate liability for employers and finance a form of sick leave, treatment and compensation for injured workers. That’s one path forward that deserves new exploration today for the same reasons it was designed in the past – to keep our economy functioning by meeting the needs of employers and workers alike. So it’s not surprising that Oregon’s unions are pushing for an expansion of our workers compensation system to cover Covid-19 cases for essential workers. That’s the kind of incremental reform that can lead to significant restructuring in the future.

The other path is the one we’ve been slogging over for the last several decades, with the expansion of Medicaid and children’s health insurance programs and the holding action now being fought over the Affordable Care Act. Yes, we should celebrate gains in coverage here in Oregon. But we should also recognize that the price-controlled Medicare and Medicaid populations are shifting more costs to private plans and the individual insurance market.

A public option will be a good next step on this path for many, but it won’t change and may even worsen the cost shifting to the remaining health insurance plans paid for by employers and their employees. Those plans cover nearly half of all Oregonians today. But this employer-based segment of our health care system will become less tenable and a government-organized system more compelling in the years ahead – not just for true believers in the progressive world, but for employers, their workers and their families in all sectors of the economy.

Note: A government-organized system need not be single payer and could still be financed by employers. But I don’t see how any such reorganization of health care can work if it continues to rely on isolated employer group plans.

The upcoming election will either accelerate or retard the pace of change on the expansion-of-coverage path, but it is unlikely to change its direction. And the reforms needed to address the issues of liability and cost for employers and regain our economic footing could very well connect with the goals of that century-old system of government intervention in the workplace known as workers compensation.

If health care reform devolves in any measure to the states, as is likely to be the case no matter what happens in November, Oregon will have a head start on whichever path we take. Our workers comp system is one of the most cost-effective in the nation and should be able to accommodate an expansion of coverage for workers who fall victim to diseases like Covid-19. Then there’s the Oregon Health Plan, embedded in regional coordinated care organizations that enjoy strong support in red and blue counties alike, which can bring more cost efficiency and economies of scale to the transition from employer-based coverage. We may even find a way to combine both approaches to create a system of health care that is better than its fragmented parts. We could call it the Oregon Way to health care reform.