Health Care: Time to Talk

It sounded a little touchy feely, but more than a decade ago, when Oregon wanted to edge closer to universal health care coverage, the state held a series of town meetings. All the stakeholders--citizens, health care providers, advocates, legislators--met at forums around the state to talk about priorities. The meetings produced a consensus around expanding the base of Medicaid recipients, in exchange for offering a smaller package of benefits.

I tell you that to tell you this: Ron Wyden, a U.S. Senator from Oregon, wants to bring that process back. But this time, he's wants national town meetings (and online sessions) to discuss the key health care issues that need to be resolved en route to national health care reform.

A few days ago, at briefing sponsored by Health Affairs, Wyden ticked off what he considered to be the Big Questions these forums would have to deal with:

* What's a decent package of benefits? (That's the issue Oregon resolved.)

*How do you pay for it? (Oregon was markedly less successful here.)

* Do we want to emphasize preventive services over the acute-care orientation we now have?

* What do we do about end-of-life care? Wyden told us that physicians tell him that existing care is expensive, ineffective and does little to improve patients' quality of life.

These are not touchy-feely questions. Maybe a national discussion that takes place in states, cities and counties--and well beyond the Beltway--will offer some clarity on health care. Somehow, the U.S. spends $1.8 trillion a year on health care and still isn't able to provide affordable care for all its citizens.