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We're going to hear, now, from one politician who saw his vision for health care reform actually happen. John Kitzhaber was an emergency room doctor when he was elected governor of Oregon in 1994. He created the Oregon Health Plan, which expanded care by spreading Medicaid dollars over a larger group of people and rationing services. Now, Kitzhaber is running for governor once more, and health care is on his agenda again. He wants to make Oregon a model for the rest of the nation.

NPR's Jeff Brady has this profile.

JEFF BRADY: John Kitzhaber doesn't look like a stereotypical governor or doctor. His typical uniform is blue jeans, cowboy boots, and a belt buckle as big around as your fist. But when asked what he thinks of the health care debate in Washington, the politician and the doctor come out.

Dr. JOHN KITZHABER (Former Oregon Governor): I think they've fundamentally misdiagnosed the problem.

BRADY: Kitzhaber says the White House and Capitol Hill are too focused on access to health care. As a huge generation of baby boomers start signing up for Medicare, he thinks policymakers should spend more time on costs.

Dr. KITZHABER: I don't believe that what's going to come out of Congress is going to have any impact on the medical cost inflation, which is what's really crushing individuals and businesses, and really putting the country as economic risk.

BRADY: Much of Kitzhaber's plan centers on prevention - keeping kids from getting fat and reducing expensive emergency room visits. These days, he's on the speaking circuit around Oregon. Here he is in a big, echoey convention hall in the Portland area.

Dr. KITZHABER: Now, obviously, the system that I described doesn't remotely look like the U.S. system today.

BRADY: Kitzhaber says he still embraces some of the controversial elements of his Oregon health plan, including a list that rations health care services in order of cost effectiveness. Some things are covered, like maternity care and stop smoking programs, but expensive procedures with little chance of success are not covered.

Out in the lobby after Kitzhaber's speech, nurse Rosanne Marlo(ph) says she likes his take on health care.

Ms. ROSANNE MARLO (Nurse): We've got to tear the whole system down, and that's what I heard him say.

BRADY: So, not just do little things to tweak the system, you've got to change the whole - it's got to be a revolution, you're saying?

Ms. MARLO: Yes, that's what I heard.

BRADY: And do you believe that?

Ms. MARLO: Yes. They do.

BRADY: And do you think it can happen?

Ms. MARLO: No.

BRADY: Marlo says the health care system is so huge and complex, and there are so many different political views and entrenched interests, she thinks the level of change that Kitzhaber is talking about is nearly impossible. Still, it's clear, Kitzhaber has the health care industry's attention.

Mr. ANDY DAVIDSON (Oregon Association of Hospitals): Don't know enough to be nervous yet. I don't think our members knew enough to be nervous.

BRADY: Andy Davidson heads the Oregon Association of Hospitals. He says Kitzhaber's health care plan is still a work in progress. But, Davidson says, Kitzhaber is contributing something valuable to the discussion.

Mr. DAVIDSON: What seems to be missing, today, in the debate that's taking place, particularly in Washington, D.C., is a concept and a conversation with the public about what they're willing to do without.

BRADY: Specifically, what individuals are willing to sacrifice to make sure the health care system, as a whole, is viable. Last year, that point propelled cancer patient Barbara Wagner into the headlines. She received a letter from the Oregon health plan, denying her cancer treatment because it had less than a five percent chance of success. She told television station KATU that the same letter offered payment for the state's physician-assisted suicide program.

Ms. BARBARA WAGNER: I told them, you know, I said - who do you guys think you are, you know - to say that you'll pay for my dying but you won't pay to help me possibly live longer?

BRADY: The drug maker eventually gave Wagner the medication for free but she died a few months later.

Despite difficult situations like Wagner's, John Kitzhaber says Oregon is a good place to have this public conversation.

Mr. KITZHABER: I do think Oregon has a history of innovation in medical care. We've had discussions on how you prioritize, and limits and rationing, that most states haven't had.

BRADY: Kitzhaber predicts that within a few years most people will realize the fix being crafted in Washington right now won't work, and he thinks policymakers will then look to states like Oregon as models to craft national policy that will work.

Jeff Brady, NPR News.

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