Oregon Governor John Kitzhaber. (AP Photo/Don Ryan, file)
Oregon Governor John Kitzhaber is sitting in a second-floor conference room in downtown Portland’s World Trade Center, explaining the raft of education and healthcare reforms he’s pushing. He’s wearing his signature pressed blue jeans, brown tassled loafers, a white shirt, purple tie and dark blue woolen sports jacket. His gray hair is neatly combed, his mustache carefully trimmed. When he wants to illustrate a policy point on healthcare, he gets up, strides over to a white board and draws a graph showing the trade-offs between the willingness of doctors to absorb economic risks and the amount of time they spend on each patient.
It’s mid-February. The next week, the governor will receive notice that his state is one of six to be awarded a prestigious State Innovation Model grant, worth up to $45 million, by the federal Center for Medicare & Medicaid Innovation, which was established under the Affordable Care Act. Oregon received the grant because of the reforms Kitzhaber’s administration has pushed regarding delivery of medical services.
In healthcare, Kitzhaber’s goal is to provide a financial incentive to doctors and hospitals to pursue less expensive diagnostic and treatment models, and to spend more time cultivating preventive and primary care relationships with patients. In education, it’s about encouraging educators, parents, students, healthcare providers and community institutions to work together to improve outcomes, rather than simply getting kids into the classroom and letting inertia take over. In both cases, it’s about recalibrating priorities. The governor, who’s known for approaching complex policy problems with the technical precision of an engineer, suddenly quotes the Roman philosopher and statesman Seneca: “No wind’s the right wind if you don’t know what port you’re sailing for.”
This is a story of focus, of a push by Oregon’s third-term governor (he held the job from 1995 to 2003 and was re-elected in November 2010, as the state struggled to overcome recession and fiscal crisis) to reinvent the way that government delivers core services, especially in healthcare and education. His aim is that, by 2025, 40 percent of the state’s high school students will go on to attend four-year colleges, 40 percent will attend community colleges, and the remaining 20 percent will graduate from high school or get an equivalency degree. Integrated funding mechanisms—some in place, some still under development—will back up these aspirations, and long-term timelines for reform will, the governor hopes, ultimately make Oregon’s population better educated and healthier.
Kitzhaber has particular credibility on these issues: he’s not only a three-time governor but a former legislator and emergency-room doctor. He has earned a national reputation for thinking holistically and eliminating compartmentalized policy and funding silos that ought to be dealt with as parts of a continuum. In all likelihood, that was why he was invited to sit in Michelle Obama’s box during the 2013 State of the Union address; soon afterward, he was addressing the National Governors Association about his reforms.
Only slightly tongue-in-cheek, Kitzhaber introduced into our conversation his grandiosely named Unified Theory of Everything. “The pathway to the American Dream,” he argues, in an e-mail he sends me shortly after we meet, “revolves around a job for which the individual is paid a living wage—enough to meet their basic needs—and an opportunity for upward income mobility. To create that pathway our public institutions (government) and our economy must be aligned around the same goal: to ensure an equal opportunity for all Americans to achieve their shared aspirations.” For Kitzhaber, poverty and ill health are too often the result of inadequate education; fixing these problems is what he calls the “left side” of his unified theory. On the right side, he talks about the need to invest in clean technologies and renewables, to open routes to prosperity that neither denude the environment nor leave millions unemployed.