Surprise Contender in Oregon: Health Care for All

On a crisp fall morning, Dan Isaacson and Britt McEachern walk door to door in a neighborhood of tidy bungalows, eagerly selling their health insurance plan.

They promise a health care paradise: no deductibles or co-payments, free prescription drugs, choice of any doctor, free mental health care, dental, vision and long-term care.

“This is not an HMO,” they tell anyone who will listen. “The only one who will say you can or can’t have a procedure is your doctor.”

The catch? Oregonians would pay for that care through new income and payroll taxes. And the state would manage all medical coverage.

Isaacson, 22, and McEachern, 23, are managing a ballot initiative campaign to make Oregon the first state to guarantee medical coverage for everyone. Oregonians -- who already are voting by mail -- will decide by Tuesday whether to adopt Measure 23.

Because it calls for new taxes, Measure 23 faces long odds. But with roughly 13% of Oregon residents without health insurance (close to the national uninsured rate of 14.6%), frustration over health care runs deep in the state.

A recent newspaper poll found the health plan trailing by just 3 percentage points, within the poll’s margin of error. The plan’s sponsors, a grass-roots group calling itself Health Care for All Oregon, achieved that statistical dead heat despite being outspent 20 to 1 by the opposition, which is funded mostly by insurance companies.

Health Care for All Oregon was created by a handful of volunteers, including retirees, physicians and community activists. With a campaign headquartered in Isaacson’s 10-year-old Dodge Spirit and 3,000 volunteers, the plan’s backers have stunned their opponents, who thought the measure would never get enough signatures to make it onto the ballot. If the measure passes, Oregon will accomplish what the Clinton administration failed to achieve nationally when its health-care reform plan -- spearheaded by Hillary Rodham Clinton -- was shot down in 1994.

Under Measure 23, private medical insurance in Oregon would disappear. The state would pay medical bills, which are expected to total about $20 billion in 2005, when the program would begin. Oregon’s state budget is $16 billion.

To finance the program, individuals would pay up to an additional 8% in income taxes, capped at $25,000. People with income at or below 150% of federal poverty guidelines would be exempt. Employers would face a new payroll tax from 3% to 11.5%.

Backers of Measure 23 contend that the new taxes would be largely offset by eliminating insurance premiums, deductibles, co-payments and out of pocket drug costs.

Opponents say the mere specter of tax increases will be enough to defeat the measure. Even liberals routinely vote against tax increases in a state without a sales tax, said Mark Nelson, the lobbyist chairing Oregonians Against Unhealthy Taxes, the campaign against the initiative.

Nelson said eliminating private insurance would be too radical for most voters.

“Everyone believes we should continue to find ways to further cover the uninsured, but their method is to toss out the entire system,” he said.

Measure 23’s opponents also have warned that sick people from other states would move to Oregon and wealthy individuals or businesses would move away to escape higher taxes.

Isaacson and McEachern, hired to drum up support for the health plan, contend that Measure 23 would cut health-care costs through preventive care and lower administrative expenses. They say private insurance companies waste money on high salaries and extravagant offices. The charge that out-of-staters would flood Oregon is pure speculation, they say.

They nevertheless face constant reminders of the public’s suspicion. During an appearance on a conservative talk radio show, “one person said we are Satan and Measure 23 is the apple,” McEachern said. But even those critics, he said, will give the devil his due. “They’ll say that, but they won’t say the current system is working.”

If anything is more frightening to the public than a new government bureaucracy, it might well be the health-care industry. Measure 23 is offered at a time when health insurance and drug companies are routinely cast as villains in movies, television shows and books.

“People may not like us, but they hate the insurance industry,” Isaacson said.

McEachern likened the behavior of insurance companies to free advertising for Measure 23.

“The insurance companies end up becoming our biggest supporters. Every time they cut benefits and raise premiums, it helps us.”

By election day, insurers and other health industry donors will have spent about $1.3 million to defeat the health plan, Nelson said, adding that his group was late to begin fund-raising because its backers thought the measure would not get enough signatures to qualify for the ballot.

Isaacson and McEachern have less than $50,000 -- raised mostly from individuals -- to run their campaign. They say they’ve been paid about $1,000 each for their work over the last three months.

Dissatisfaction with the status quo is obvious in Isaacson and McEachern’s visits to homes, even in the affluent, somewhat conservative Eugene neighborhood they visited recently. Some told the pair they were unwilling to pay more taxes, but many others, such as Paul Armstrong, 60, spent more time talking than listening.

“I had 58 stitches on this hand and I paid for it myself,” said Armstrong, holding up a hand with faint scars running across his fingers, the vestiges of an accident with a table saw. A retired builder, Armstrong said he spent so much on medical coverage for his 24 employees that he could not afford insurance for himself.

Armstrong, a Republican, said he will take a chance by voting for Measure 23 because the risk of higher taxes and more bureaucracy seems less worrisome than the current system.

“It will be topsy-turvy getting it organized, but somebody has to start it. A lot of people now have no means whatsoever and really need help,” he said.

To turn the disgust with the system into votes for the initiative, the campaign is relying on personal contacts by volunteers. Their plan is to speak in person or by phone to 300,000 voters.

Although confident the measure will fail, Nelson acknowledges that it “sounds very enticing” to many voters. Senior citizens whose health-care costs are high, but whose incomes are low enough to be exempt from the new taxes, for instance, are potential supporters.

“When you put different populations together, you’ll have a sizable group of people,” he said.