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Moving Outside

John Kitzhaber has been to the top in politics. He thinks he may be able to achieve more working from the bottom up.

As John Kitzhaber tells it, when he was deciding whether to run for governor of Oregon in last year's elections, he was brought up short by one thought. "Had I been elected," he says, "I'm not sure I could have delivered the things I thought were important."

This is a man who had already served two terms as governor, from 1995 to 2003, so he knew the powers and limits of the office. But that wasn't what concerned him. "It had become increasingly clear to me that the system is really broken," Kitzhaber says. "There are good people in it, but the structures we rely on to solve problems are not up to what we're demanding of them."

Kitzhaber, now 60, decided that the only way to make progress on crucial issues is to step outside the normal policy-making framework and press from below. And the issue he chose is the one with which he first made his name--health care. A one-time emergency-room physician, Kitzhaber as state Senate president in the late 1980s was the architect of the Oregon Health Plan, the groundbreaking state effort to expand access to health care for people below the poverty line.

This time around, Kitzhaber's aim is broader--to redirect the nation's entire approach to its health care system. His vehicle is the Archimedes Movement--named for the ancient Greek mathematician and inventor who apocryphally said, "Give me a lever and a place to stand, and I can move the earth." Over the course of the past year, in scores of meetings with hospital executives, doctors, insurers and others, Kitzhaber and his attendees hammered out what he calls "a shared vision of what we actually want the health care system to produce for us, as individuals and as a society." They boiled this down to a set of principles and then gave them muscle in a bill introduced in this year's session of the Oregon Legislature.

That's where the movement ran into the verities of American politics. Kitzhaber's bill, which would have created a system for funding base- level health care for all Oregonians, pooling all federal health care dollars available to the state, including Medicare, was eventually subsumed into another, less far-reaching proposal backed by two powerful state senators.

While Kitzhaber's first effort may have fallen short legislatively, says Len Nichols, director of health policy at the New America Foundation, he nonetheless deserves credit for helping put the issue into play nationally. "He saw a way to be catalytic," says Nichols, "and to use the state to provoke a federal conversation."

For his part, Kitzhaber has now decided to go regional. He is working to set up Archimedes chapters in Montana and Washington--states that, like Oregon, have U.S. senators who sit on the Senate Finance Committee--and to continue pressing for a redrawn health system. "People are looking for a vehicle through which they can express the concerns they have over a whole host of things," he says, "and I don't think they believe they can do it through the political process anymore."

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