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Solving health care

A realistic, bottom-up way to create cost-controlled, near-universal care


Initiatives in other states to create universal or state-run health care have failed. They either wanted to do too much, leading to people fearing that it would fail, costing taxpayer money and taking down health care with it, or ended up as a last-resort plan with only high-cost patients.

At TriMet and other government agencies, health insurance and which side pays for it have been a major issue in contract negotiations.


First, put all government employees from the state level on down on the same plan, in the same pool. This would create a good base of relatively healthy participants and result in economies of scale and negotiating power. There is no reason why TriMet or other agencies should be buying their own insurance, as the care that bus operators, teachers, police officers and others need is the same.

Medicaid (in Oregon, the Oregon Health Plan) participants could also possibly be added in to further expand the scope.

Next, have the plan overseen by a board of half or all plan participants, who would have a vested interest in making sure it succeeds. The other members could potentially be chosen by the legislature to represent the state, which would be paying for it.

Furthermore, empower and incentivise the board to implement cost-saving methods, such as negotiating state-wide item prices with providers (with adjustments for cost-of-living and local demand) and guaranteeing payment, covering liability for those who agree to follow best practices, and forgiving student debt of those coming from in-state colleges.

Also work with members (both on a individual and employer level) on how to be healthy, by taking care of diseases and improving work places.

Once the plan is in place, open it to private entities and make it an economic development tool. Many companies would love to have health insurance taken care of and possibly save money. There should be a goal of citizens having a single health record for their entire life, which would help coordinate care.

In Montana, a Tough Negotiator Proved Employers Don’t Have to Pay So Much for Health Care — ProPublica

By Jason McHuff,