Editorials from Oregon newspapers
Albany Democrat-Herald, Jan. 21, on commission ruling that Gov. Kitzhaber can accept speaking engagement fees:
Last week's ruling from the Oregon Government Ethics Commission that Gov. John Kitzhaber can accept fees for delivering health policy speeches struck us as a curious piece of work.
In its unanimous advisory opinion, the commission said Kitzhaber can earn outside income as long as he does it on his own time, doesn't use state resources and isn't getting the opportunity solely because of his position as governor.
If the idea was to blur the line between what's proper and what's not, then mission accomplished.
Kitzhaber gave paid speeches on health care before running for a third term as governor in 2010 and, to be fair, the former emergency room doctor does have a national reputation as an expert on health care reform.
But considering that health care reform has been one of the hallmarks of Kitzhaber's third term as governor, it's hard to see how anyone can possibly make a determination that a speaking opportunity isn't coming his way "solely because of his position as governor." These two strands of his career now are so inextricably woven together that it seems impossible to tease them apart.
The executive director of the Ethics Commission said that the opinion puts the burden on Kitzhaber to ensure that any speech invitation he might receive is proper. But it's hard to see how the governor can ever meet that burden of proof.
If you're curious, Oregon gets a relative bargain in terms of what it pays its governor: Oregon pays $93,600. Only five states — North Dakota, Colorado, Tennessee, Arkansas and Maine — pay less. The average salary for a governor is $124,398. We suspect it's safe to say that Kitzhaber took a cut in pay when he left medicine for public service.
A Kitzhaber spokesman said last week that the governor routinely gets offers to deliver paid speeches but hasn't accepted any during his time in office. Considering the muddiness of last week's Ethics Commission ruling, that's a practice Kitzhaber should continue during the rest of his time as governor.
The Oregonian, Jan. 20, on why Oregon's coordinated care organizations should target obesity:
The discovery was startling if not definitive: High fructose corn syrup consumed at high dosages was found to mislead a person into feeling he or she was not quite full, inviting further indulgence of the kind associated with supersized sodas and, eventually, supersized waistlines. While the finding, published this month in the Journal of the American Medical Association, had all sorts of provisos attached, including a call for more research, it re-energized the debate about the roots of obesity.
That's especially timely as Oregon launches coordinated care organizations (CCOs) to treat folks under the Oregon Health Plan and which will, as part of the state's deal with the bankrolling federal government, closely track obesity. The reason is simple: Obesity is killing us. In Oregon, obesity rose 121 percent between 1990 and 2009 — this while 80 percent of Oregonians polled by health officials correctly assert obesity is "very harmful" to one's health.
Health care costs, however, tell it best: An estimated 70 cents of every dollar spent on medical treatment goes to the management of chronic diseases. And several of the big ones — cardiovascular disease and diabetes among them — are linked to escalating body weight that crosses into obesity territory. An estimated one in three adult Oregonians is overweight or obese.
But no tidy narrative tells obesity's story in the way, say, lung cancer tells tobacco's. If tobacco is elective, food and sugars and carbohydrates are not. And the devil, if the finding in JAMA holds up, might lurk in details such as the ubiquitous sweetener high fructose corn syrup, found not only in soft drinks but in off-the-shelf spaghetti sauces and so many processed foods. Could it be that federally subsidized corn growers have come up with the elixir that creates endless appetite?
It's not that simple. Neither is it conspiratorial.
John Purnell, an endocrinologist at Oregon Health & Science University with a research interest in nutrition, wrote the editorial accompanying the findings in JAMA. He is of the school that says you are not really what you eat but instead what you do with what you eat. In an interview, he explains: "If all you say you need to do is eat less, it's not enough. ... Weight is not always will power but complex physiology. What I tried to show in JAMA was that you could have a food component involved through its influence in the brain. ... What gets you to 350 pounds is not emotional eating. That's a physiologic issue."
Then what about diets and sweaty workouts? Purnell pauses. "The weight-loss industry makes it all behavioral," he says, "and that's what keeps them in business." But Purnell also underscores his view that lifelong habits around activity and whole foods consumption figure significantly into whether obesity ever is expressed — that the ties between life habits and all-powerful physiology are strong.
That view comports with others at OHSU's Bob and Charlee Moore Institute for Nutrition & Wellness, where Interim Director Kent Thornburg worries that unborn babies are genetically sentenced to the overweight inclinations of their mothers and thus predisposed later on to obesity. He laments that even the best obstetricians lack the training, time or financial rewards in their daily practices to dispense nutritional advice that goes beyond the obligatory take-your-folic-acid pill. Proper nutrition in the mother, Thornburg says, "is a powerful determinant in a baby's health" and vulnerability later in life to weight issues.
"Prevention is medical management," Thornburg says.
That, in our view, is where CCOs must play a key role in fighting the obesity epidemic driving so many of Oregon's runaway health care costs.
CCO providers are clinicians, not researchers, and so they won't pick the lock of obesity's underlying mysteries. But they can, by tracking the weight and nutrition habits of every patient who walks through the door, correlate those profiles with the outcomes of therapies and remedies they prescribe for myriad health problems. In that sense, CCOs could furnish a real-world database in which researchers will be able to further align prevention efforts with chronic disease rates and therapy costs. It will be up to each CCO this year to figure out where the rewards lie for practitioners emphasizing prevention.
Health care dollars saved, meanwhile, will be as pleasurable as pounds shaved — whether it's because fructose-laden soft drinks are curtailed or because hardwired inter-generational dispositions need to be overcome.
The (Bend) Bulletin, Jan. 22, on why Oregon University System's money discussions should be public:
Oregon's universities are struggling with a three-pronged problem: State financial support has been falling, rising tuition is causing unsupportable student debt, and the governor's 40-40-20 plan demands that more students earn degrees.
Seeking solutions, the Oregon University System is doing some hypothetical analysis of possible financial approaches, according to a report in The Register-Guard newspaper in Eugene. Unfortunately, they're doing it in secret.
OUS staff attorney Ryan Hagemann told the newspaper that state law allows the secret approach. But even if it's not illegal, such secrecy can be counterproductive.
Higher education is front and center in the public consciousness, with citizens vitally interested on a personal as well as taxpayer level. The recession has changed the conversation about student debt at the same time that jobs require more education. As taxpayers, we confront a vast array of demands for state resources.
OUS Chancellor George Pernsteiner asked university presidents to estimate the effects of certain limits, such as set tuition rates, enrollment levels and how much money would come from the state. The results were discussed privately in late December by the finance committee of the state Board of Higher Education, according to the Register-Guard. Pernsteiner refused to make them public, telling the newspaper he would release them only "if I were assured that it wouldn't be misconstrued and misinterpreted." In other words: never.
We think understanding is enhanced by more information, not less. Clearly and fully laying out the choices OUS is facing can help taxpayers and voters be realistic about the choices that must be made.
The state has already made a big investment in the governor's education plan, which sets the goal by 2025 of having 40 percent of Oregonians earn a bachelor's degree, 40 percent an associate or other post-secondary certificate, and 20 percent a high school diploma. We're a long way from those goals, and legislators will soon be making tough decisions about where to spend scarce state dollars.
The hypothetical scenarios prepared for the education board likely give context and meaning to otherwise confusing calculations. The public debate will be smarter if we get to see them.