Editorial: Global health care budget could be mess for Oregonians

Published Sep 17, 2013 at 05:00AM

When love of government control colludes with passion for health care reform, the likely outcome could be an insufferable mess for Oregonians.

And that’s where the Oregon Health Policy Board was flirting last week as it tries to answer Gov. John Kitzhaber’s charge to make health care better in Oregon. The board is supposed to make suggestions for the Legislature to turn into law next year.

The board maneuvered at the end of its meeting to a debate over policy options that need fleshing out. There were 10 up for consideration — bolstering insurance rate review, enforcing more spending on primary care, providing better tools for consumers to make decisions and more.

But Mike Bonetto, the governor’s health policy adviser, added a profound 11th item — a global budget.

In health care, global budgeting is a process by which an entity chooses and enforces how much is spent on health care and what it is spent on. That’s all public and private dollars. Bonetto was trying to spur a discussion about how that might work.

What lured him is the power of a global budget to make things happen. If the state were the only buyer of health care, it could effectively direct how insurers, providers and hospitals operate.

It could give the state a fixed rate of growth in health care. It could give the state the power to channel more health care dollars into primary care and wellness. It could be used to compel disclosure of pricing and costs.

“How do you get to that fixed rate of growth?” Bonetto said. “How do I get to this alignment of a fixed rate of growth with my self-insured partners? ... From the purchaser’s perspective, that’s what is going to be able to drive this.”

A few minutes later, Joe Robertson, the president of Oregon Health & Science University, added: “Just to piggyback on what Mike said: If there is one thing that we can do to bend the cost curve the most rapidly, it’s to facilitate the rate of adoption of global budgets. I think that would trump everything else that we’re looking at. Because if you look at what’s happened in the CCOs (the state’s Medicaid reforms), everything that we are discussing here we have been discussing for 10 years. We basically didn’t do it until all the money was in one bucket.”

It would be unfair, of course, to extrapolate from those comments that the Oregon Health Policy Board is hellbent on encouraging changes in Oregon and federal law to permit the state to put all Oregon health care dollars under state control. Bonetto, for instance, seemed to be looking for a way to get the benefits of a global budget without arm-twisting everyone and everything into it.

The board may not have an obsession to give government more power to control. But we heard no concern for unraveling markets. Oregon should not let calls for more government control of health care be the only voice that is heard.