An unresolved element of Oregon's single-payer plans

The fogginess and nebulousness that surrounds a possible single-payer health care system in Oregon makes it hard to get too excited about it.

It seems distant and unsettled. And yet state lawmakers pushed ahead with more planning for it this session in Senate Bill 1089.

The idea is the state would become the health insurer. Most of the health insurance industry would be wiped out and be replaced by the government. You might pay an income tax and your employer might pay a payroll tax, instead of the premiums paid now. The assertion is that everybody would get good care, with no copays or deductibles. And supporters say the state would figure out a way to do it much cheaper.

But we would like to bring up again a part of health care that even planners of the single-payer plan for Oregon are not sure what to do about: It's called long-term service and supports.

That's medical and nonmedical care that people need when they can no longer take care of themselves. It's for things such as bathing, cooking, cleaning and making it to the bathroom.

Most of that care in the country is paid for by Medicaid and Medicare. Some of it is paid by private insurance and out of pocket. Some of the care is provided by friends and family.

It's vital, personal and expensive. It has been about one-third of all Oregon's Medicaid spending. And if all those benefits shifted to a state health system and everyone got them, it would be expensive and disruptive.

"Public spending would increase substantially relative to current spending if everyone received LTTS benefits," the Congressional Budget Office wrote in a document about designing a single-payer health system.

But one of the justifications for moving to a single-payer plan is to help remove inequities in the system. Long-term care and supports has inequities, just like the other parts of health care. So what's the plan for it?