The Oregon legislature is considering making health care a basic right, and putting it into the Oregon Constitution.
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"It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, medically appropriate and affordable health care as a fundamental right."
Democrats are pushing this because Trump and the GOP have made it politically necessary. They must resist.
The bill has unanimous support from Democrats in the State House of Representatives. Possibly some Democrats have reservations, but if so, they are lying low. Trump and the GOP have pushed the range of Orthodox Democratic Policy.
The bill has unanimous support from Democrats in the State House of Representatives. Possibly some Democrats have reservations, but if so, they are lying low. Trump and the GOP have pushed the range of Orthodox Democratic Policy.
Trump is a compass pointing at limiting health care access, so Democrats point the opposite way. If Trump says it, it must be wrong. In the bright light of Trump-disgust among Democratic leaders and voters, Democratic officeholders felt the time was ripe to codify what had been a general sentiment.
Health care as a right is now Orthodox Democratic Position. A Democratic officeholder in Oregon would have hell to pay to oppose this law. A lawmaker would sound Trump-ish. The lawmaker would have broken ranks, and none did.
Health care is a complex semi-right already. We do not have people left bleeding and dying on hospital doorsteps. They get emergency service as a right. Emergency crisis service is different from treatment for bronchitis, asthma, diabetes, removal of moles, colonosopies, back pain, arthritis, and all the other things that constitute health care.
One Democratic Senator called it "a moral decision" and credited his lifesaving treatment to having health insurance. The Democratic House Speaker Tina Kotek called the Constitutional Amendment "primarily aspirational" and "an important values statement about the importance of health care, particularly as you see at the federal level there are a lot of efforts to scale back Medicaid and Medicare."
Activists want action. Obama didn't do enough. Hillary was too centrist. Orthodox Democratic Policy wants to see action not aspirational values statements.
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| l'estât c'est moi |
A constitutional amendment moves this right to the head of every other priority. There could be reasons to attack the proposed amendment as dangerously expensive, and a huge source of litigation.
1. Obligation of the state. Health care becomes a primary obligation, putting it ahead of the mere day to day obligations of a state. Health care would step to the front of the line.
2. Resident of the state. Not citizen of the state, not two-year resident of the state, but just simply resident. This is a giant liability. A resident of a low tax/low service state like Texas, of whatever nationality and legal status, penniless and uninsured and uninsurable, can be driven to Oregon, set up in an apartment, change his driver's license and registers to vote here, and now is now a legal resident of Oregon. Oregon as destination for health refugees. Expensive.
3. Cost-effective, medially appropriate and affordable. This is a price guarantee and a medical guarantee, a dangerous combination. Oregon becomes provider of last resort, and giving residents a legal right to demand the service be "affordable" to them, which means that the state essentially guarantees to pick up every tab. There are very, very expensive chronic cases and procedures, perhaps prolonging life, and which now patients and families have a constitutional right to demand. Plan for lawsuits and complaints of death panels.
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| Alan DeBoer |
Democrats will worry about costs and implications later.
We have battle lines and the issue framed. The gravitational force of Trump affects Republicans, too. Democrats want an aspirational sentiment locked into the Constitution. Republicans see this as a case of the Republican minority showing fiscal maturity and realism by resisting Democratic excess.
Local Republican State Senator Alan DeBoer says he supports a single payer system, in theory and in general, but not this constitutional amendment. "It'll break the state."
DeBoer pictured here is watching Governor Kate Brown at work. He has progressive instincts, but Democrats have given him a role: watching Democrats, and trying to block and dampen Democratic excess.
Republicans have a plausible 2018 message: Elect Republicans to the legislature so that Democrats wont have a big enough majorities to do something that will break the state.
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A comment from plaintiff attorney Thad Guyer elaborates on the concerns I outline above. This could be a bad self inflicted wound, created out of the very best of intentions:
What an exciting new field of litigation against state, county and city governments. Once health care is literally an enforceable "constitutional right", the government must meet it regardless of budget limitations. Like education, the rural, the less affluent and illegal immigrant advocates will be able to sue to even out "unequal distribution" of the health care entitlement. Government regulated and funded "health care districts" can be ordered by the courts, and the legislature can be ordered to fund them. The sick will be able to sue to get education and transportation dollars reallocated to free or subsidized health care, the sick elderly vs. young families with kids. Hospitals and doctors could be named in the same lawsuits against the government to discharge unpaid bills. And best of all, Salem will have to pay for expensive drugs and ecpermental surgeries-- if the rich can buy it, then we will all have a right to it.
What a litigation bonaza for the national "health care law" lawyer groups. This could be the biggest thing for my profession since tobacco litigation. And you say it's only because of Trump that we are getting this? Awesome!
Thad Guyer
Attorney
5 comments:
In a way the U.S. is devolving into a Europe-like collection of individual states (California has been itching to secede for years).
The attempts to dismantle the federal safety net, and federal "entitlement" programs by Regressives has the effect of Balkanizing the states into de facto independent countries, and it's not hard to imagine a situation where DC blackmails them for services like the Coast Guard. After all why should Kansas pay for California's navy? Silly...?
"It'll break the state." is a cruel and self-fulfilling prophesy. A growing majority of people cannot afford healthcare and the cost of a bloated profit centered health care system are pushing the country into third world status.
What an exciting new field of litigation against state, county and city governments. Once health care is literally an enforceable "constitutional right", the government must meet it regardless of budget limitations. Like education, the rural, the less affluent and illegal immigrant advocates will be able to sue to even out "unequal distribution" of the health care entitlement. Government regulated and funded "health care districts" can be ordered by the courts, and the legislature can be ordered to fund them. The sick will be able to sue to get education and transportation dollars reallocated to free or subsidized health care, the sick elderly vs. young families with kids. Hospitals and doctors could be named in the same lawsuits against the government to discharge unpaid bills. And best of all, Salem will have to pay for expensive drugs and ecpermental surgeries-- if the rich can buy it, then we will all have a right to it.
What a litigation bonaza for the national "health care law" lawyer groups. This could be the biggest thing for my profession since tobacco litigation. And you say it's only because of Trump that we are getting this? Awesome!
it sounds like an important amendment the dems should be for is a stiffer residency requirement.
Oregon already has a constitutional mandate to educate its children. It has failed to fund K-12 education at levels most local school boards deem adequate to meet that constitutional mandate. "Uniform" it the word at the heart of the problem -- an education that's as good in the Portland School District as at a rural district in Harney County. At least twice in my memory since the property tax limitation of the 1990s, Oregon has been unsucessfuly taken to court to force funding to meet the constitutional test. I shudder to think where this state will be if both k-12 education and health care are constitutional mandates. Thad's colleagues will indeed have a bonanza.
See Art VIII Section 3. System of common schools. The Legislative Assembly shall provide by law for the establishment of a uniform, and general system of Common schools.
Tam Moore
Health care IS a fundamental right (as should be housing and food, by the way). Period. That fact is not debatable. Funding access to basic health care is a separate issue (for some people), but if we were not so busy subsidizing Big Business with our tax-supported social welfare system, there would be plenty of money to go around. A higher minimum wage would work wonders. But perhaps a better idea is a guaranteed minimum income (reverse tax, which is what conservative Republicans initially called it). Changing our priorities would also make it easier.
Separate but equal schools were certainly separate, but not by any means equal. We are at the same fork now with respect to health care as were with respect to equality, in general.
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