California's insurance companies have their costly lobbyists in high gear, trying to gut or kill real controls over what insurance companies can charge, Kansas' governor won't accept federal grants to plan, much less enact, key federal reforms. Texas' governor thinks Medicaid and Medicare are wrong and may not even be constitutional. For anyone covering health care reform, all of that can make Oregon look like another galaxy.

The state recently made news by seeking federal approval to take its overall funding for health reform and turn it into a statewide health plan capable of covering everyone–instead of a customer-delivery system for private insurance companies. But such a waiver would have to get the approval of Congress–where House leaders still want to repeal all of the federal reforms. So for now, the state is still thinking outside the "insurance policy" model to get more effective health care to more people. The details are in an inverview with Oregon state health adviser Mike Bonetto in the new issue of Governing magazine. 

The core of Oregon's new idea is to make sure that everyone for whom the state purchases insurance gets all health care–mental health, pediatric care, surgery, maternity–from a group of doctors, nurses and hospitals that coordinate every step of that care. No more triplicate X-rays for the same broken thumb. No more patients at the emergency room once a month for lack of a chronic-illness caseworker. No more psychiatrists who prescribe potent drugs but don't talk to the internist about it. All of this fractured care is both expensive and dangerous, which is why the concept of "coordinated care" is such a buzzword now. What's different in Oregon is that it's actually likely to happen, on a pretty big scale.

The plan would cover the state's teachers, state employees and members of the Oregon Health Plan–the state's broadened version of Medicaid–in total, close to 1 million of the state's 3.8 million residents.

Here's the real out-of-galaxy part of the story: The state's Legislature passed a bill to start the process, at the polite request of Gov. Mike Kitzhaber (a physician himself). Health adviser Bonetto expects a collaboration with the Legislature to get the specifics passed in the next year or so. 

Contrast that with California: The state's insurance industry has killed several attempts over the last several years to even grant regulators the power to approve, modify or deny health insurance rates before they go into effect. It's not a radical reform–it's what a majority of states (including Oregon) already have. The insurers count on killing–or at least gutting–the latest attempt to pass such a bill, now one vote shy of full passage in the state Senate. 

So it's no wonder that California voters may be stuck–again–doing the job themselves. As Consumer Watchdog President Jamie Court revealed today in the San Francisco Chronicle, the nonprofit group is considering a voter initiative for the 2012 ballot that would not only regulate insurance rates, but also enact a public option for health care–the Medicare-for-anyone option that insurance companies booted from the federal health reform. A similar move worked in 1988, curbing auto and home insurance rate. The time may be ripe for another voter revolt against unaffordable insurance. It just shouldn't have to be a do-it-yourself job.