Health Plan

The question of socialized healthcare is one of the most hotly debated issues in politics today.  President Barack Obama has made it a platform of two presidential races and the national incarnation of semi-socialized healthcare reform has been aggressively debated by members of all political parties since the President’s Patient Protection and Affordable Care Act was passed.  With the spotlight so intensely focused on the national stage, it is easy to forget that, in a Union of states, there are smaller political bodies that have the right and responsibility to consider and even implement policies like socialized healthcare as an experiment in improving the lives of their own citizens and as an example to the rest of the nation.  Oregon is one state that is currently in the process of socializing their healthcare system and an analysis of their efforts and progress will provide insights into the actual implications of socialized healthcare on a population.  Special attention will be given through the lens of Social Work.  The more established example of Massachusetts’ socialized healthcare policies will also provide a context of a more mature state-regulated healthcare plan.

The goals of the Oregon Health Plan’s transition to coordinated care organizations (CCOs) are naturally very appealing.  M. Widman (2012) reported in the article “Coordinated care organizations could advance public health priorities” that Dr. Mel Kohn, the director of the Oregon Public Health Department, stated the priorities of the new policies are to address tobacco use, obesity, heart disease and stroke, suicide differences amongst genders, family violence, and community resilience after emergencies.  These are considered to be the major health risks for the Oregon population and all are considered to be either highly preventable or deserving of much more management than they are currently receiving.  By combining physical and psychological care, the CCO plan could much more efficiently address these most common and highly treatable problems (Widman, 2012).  If the question is whether or not these goals are just, then the response could just as easily be a question of how should these things not be priorities?

While there is little question of justice, the plan is not so clearly democratic.  While the simplest definition of democracy is satisfied so long as the people vote the policy into action, more complex interpretations must consider the voters who disagree but were outvoted.  For some, this policy will force a change of provider that may not be at all what the individuals want, “It is likely that you can still see your current provider through your CCO, but some providers may not be covered under the new plan” (OHA, 2012).  By increasing government regulation of healthcare, some options will be removed from the people of Oregon.  In this way, the policy is somewhat suspicious.  However, the final word is what the voters decide.

Though the purpose of the CCO is to provide affordable healthcare to all Oregonians with a relatively equal level of quality, the practical result may not be quite as ideal as that.  In terms of availability, the new policies would be most definitely and, strictly speaking, equal for all social classes.  The problem with this comes from those who could not already afford the available health care.  The Oregon Health Authority (OHA, 2012) claims that “nothing will change for premiums or copayments.”  This is excellent news for those who already have coverage, but it means that those from a lower socioeconomic class might have to struggle that much more to keep up with the new expenses.  There is also a concern of infrastructure that could perpetuate existing social inequalities, “the new organizations are more likely to be successful in counties with strong existing public health departments” (Widman, 2012, para. 1).  If this turns out to be true, then while the policy might eventually help those who previously had poor access to healthcare, it will first improve the conditions of those who already good access.

Despite these real-world limitations of the plan, the potential for improvement in the way of life for all Oregon residents makes it an appealing strategy.  Even if the rate of improvement is unequal, forward progress will improve everyone’s quality of life more than stagnation with old policies would.  The OHA’s (2012) simple goal was that “Coordinated care organizations will also be able to invest in additional services and supports to help people with chronic illnesses manage their health.”  This promise along with the combining of mental and physical health service could mean that many people would have access to types of care and treatment that they never could have hoped for previously.  Dr. Kohn is realistic and cautious about declaring the plan a success, though, “it’s too early to say if public health considerations are playing a key role in the new organizations” (Widman, 2012, para. 2).  Of course, the hope is that improvement of public health is at the heart of the CCOs, but the fact that the Oregon Public Health Department is wary about the intentions of these organizations is a good sign that regulations will continue to protect the Oregon population.

Though it is too early to tell how successful the plan will be, the goals are most certainly in keeping with many of the values of Social Work.  The policy’s central aim is simple and straightforward, “This is a community government process that has health as its outcome – better health as well as better care and lower costs” (Widman, 2012, para. 17).  If these ambitions can be met, the program will satisfy nearly all of the Social Work values.  It is clearly aimed at providing service to the population in a competent fashion.  Improved quality and variety of care for the people would satisfy those.  It also upholds social justice and the dignity and worth of people by providing the same level of care to all in all fields of healthcare, both physical and mental.  It is always the hope that government policy will demonstrate integrity, but even if that cannot be counted on, the concerns expressed by Dr. Kohn as a representative of the Oregon Public Health department seem to indicate that a careful watch will be kept on the priorities of the CCOs (Widman, 2012).  The only hazy value is the importance of human relationships which may go unaddressed by this plan of action.  Speculation could be made either for or against this value, but the goals do not seem to specifically address it either way.

Oregon is not the first state to attempt government regulation of healthcare.  One of the most successful and most popularly cited previous examples of these policies is that of Massachusetts.  In combination with state policies to reform health care in the state of Massachusetts, a semi-private organization was formed, not unlike Oregon’s CCOs, “the [Massachusetts Commonwealth Health Insurance] Connector assists individuals and businesses in acquiring health coverage” (Lischko, Bachman, & Vangeli, 2009, p. 2).  This combination of state regulation and coordination of existing private entities resulted in a highly successful example of socialized healthcare.

The intended goals and eventual outcome of Massachusetts’ plan were not unlike those of Oregon.  At its heart was the goal of providing health care to all residents, though it pursued this end in a more businesslike fashion, “Other features of the new law which interact with the Connector include a requirement that most employers arrange for the purchase of health insurance by their employees on a pre-tax basis and an individual requirement to maintain health insurance coverage” (Lischko et al., 2009, p. 2).  While the central focus of Massachusetts’ plan was more oriented toward total health care coverage than quality and diversity of healthcare, as Oregon’s was, the theme of improving health insurance availability was the same.

Massachusetts’ pragmatic, businesslike approach to healthcare reform might seem somewhat cold when compared to the humanitarian goals of Oregon’s plan, the success of Massachusetts’ policies must be acknowledged.  When the state decided to form its plan, it considered previous failed efforts to regulate social access to health insurance, “Most of the purchasing cooperative or purchasing pools that were created around the country were not deemed successful at constraining health insurance premiums” (Lischko et al., 2009, p. 10).  The failure of these previous organizations was mostly placed on the fact that they were entirely privatized and were focused too much on the managing of costs and not enough on the managing of availability.  The Connector has been credited with being more inclusive of organizations and insurance-seeking citizens which makes it less risky for all parties involved and easier for the Connector to pressure the carriers to maintain lower rates.  Considerable credit is also given to the state policies requiring coverage since these lend government influence to the Connector (Lischko et al., 2009, pp. 10-11).  While the successes of the Massachusetts plan are mostly financial, which is admittedly necessary when it comes to deciding whether a policy is successful or not, the incidental improvements of the quality of life for the state’s residents who now have more comprehensive health care at more carefully regulated costs must also be considered a success.  The hope for Oregon, when compared to this example, is that the more human-centric goals of the CCOs can be combined with the fiscal responsibility demonstrated by the Connector in Massachusetts.

Socialized healthcare is a tricky subject in a country that has so long held out against socialization of any kind.  The optimistic goals of Oregon’s new policy may not be entirely met, and they may not be met at all, and if they fail then the naysayers about socialization will have one more example to point to.  But it should always be the goal of governments at any level to improve the quality of life of their citizens.  This is even more true from the perspective of social workers whose work could be much improved by more comprehensive physical and mental healthcare for the people they serve.  While Massachusetts is just one example of successful government regulation of healthcare, it serves as an inspiration to other states and proof that it can be done.  Only time will tell if Oregon has learned the lessons taught by Massachusetts’ successful Connector.

References

Lischko, A. M., Bachman, S. S., & Vangeli, A. (2009, May 30). The Massachusetts Commonwealth health insurance connector: Structures and functions. The Commonwealth Fund pp. 1-12. Retrieved from www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/May/Issue%20Brief.pdf

OHA. (2012, September 27). Oregon Health Plan clients and coordinated care organizations. Oregon Health Authority. Retrieved from www.oregon.gov/oha/OHPB/healthreform/docs/faq-ohp-cco.pdf

Widman, M. (2012, September 26). Coordinated care organizations could advance public health priorities. The Lund Report. Retrieved from http://www.thelundreport.org/resource/coordinated_care_organizations_could_advance_public_health_priorities