(A version of the following article originally appeared in Northwest Connection, vol 6 (no. 68), under the title “CCOs: Not just Wrong but Evil”.)

In late July, I made a guest appearance on the Jeff Kropf Radio Show (KUIK-1360am) to talk about the Coordinated Care Organizations that were to officially kicked off on August 1. Jeff had asked me to come on to talk about SB1580, which officially birthed CCOs.  During that appearance, I said, “This is an evil bill.”

I’ll stand by that statement. And I think by the end of this article, you just might agree with me.

You may have seen something recently that was circulating on Facebook—a form straight from the Oregon Health Authority that allows a child as young as 15 to be sterilized without parental permission or even their knowledge.

As shocking as it is, this isn’t new.  Back in 1995, the age of “informed consent” for sterilization was set at 18. Sometime over the next six years, it was changed and by the 2001 version of the Oregon statutes, the age of consent was dropped to 15 (ORS 436.225).

As of this writing, we haven’t been able to determine when, why, or how this was changed but apparently our leaders came to believe this sort of permanent, life-altering decision was something a 15-year-old can make. And do it without parental knowledge.

What it does reveal, however, is the mindset behind those in the Oregon Health Authority and their attitude toward life, parent-child relationships, parental rights vs. minor rights, and human sexuality.

Combined with the CCOs, it’s reflective of top-down, do-as-you’re-told, authoritarian thinking with the State firmly in charge. The exact opposite of what our Founding Fathers intended. It’s about gaining more power over more of our lives with the expansion of the Oregon Health Authority (and don’t you just love the blatant overtones of communism in that agency name?).

And make no mistake about it: that is their intention. The CCOs start with Medicaid recipients, move to swallow Medicare, then on to public employees, teachers, and the rest of us. In fact, the Public Employee Benefits Board recently announced they were looking for a new provider—one that would fit with the CCO model—and severing ties with Providence, which had previously used the model of allowing you to choose your plan and your doctor (Statesman-Journal, August 23, 2012).

Not anymore. Now it’s what the State dictates. This includes greatly expanding mental health. Keep this in mind, because mental health is a major focus of all of this healthcare expansion. But it begs the question: who is determining mental health? Can they say, “Gee, as a Catholic, you’re pretty rigid and judgmental—you need to be more tolerant”?

In 1938, Austria voted to join Germany—and by 99.7% of voters. From the outside looking in, Germany seemed ideal—especially for Austria, which was still suffering high unemployment and a stagnated economy due to the Worldwide Depression. But in Germany, nearly everyone had a job and everyone had access to healthcare. So they voted to unify with Germany.

And then one of the first things the Germans did was to take over the schools and drive a wedge between children and parents. Kids spent more and more time at schools, with more and more of their life revolving around the state-controlled schools, so they saw them as a home away from home.

And all children were forced to go off to Nazi Youth Camps. Except these weren’t about earning merit badges; it was state-sponsored indoctrination. Girl and boy camps were located close to one another and they were given plenty of opportunity, both formal and informally, to mingle. Many of the girls came home pregnant.

Why? Because the State knew that breaking that last taboo of innocence makes them less likely to respect the authority of their parents. Kids now see themselves as adults. And by extension the State provides access to all the good things in life, including jobs, health care, and opportunity itself. Parents and parental relationships mean less and less until it means nothing more than its sentimental value.

I mention all this because the ability of a 15-year-old to sterilize themselves is really just the tip of the iceberg. The Oregon Health Authority is currently and actively pushing to move into schools and have already laid massive plans to do so.

And as part of this push, they’re developing an army of organizations, agencies, and plans that will come between parents and children. Agencies like the CCOs, Healthy Kids, Healthy Kids Learn Better, and the Oregon School Based Health Care Network (SBHCN), to name just a few, and resources like Minor Rights and the Oregon Youth Sexual Plan.

To do all this, they’re working in close partnership with groups like W.I.S.E. (Working to Institute Sexuality Education) and Planned Parenthood.

Minor Rights is an interesting trek through the OHA mindset. The “resource” for educators lays out the rights minors have. That in itself is revealing, changing the dynamic between parent and child. The law protects you. You have rights. Everything we talk about is confidential—it’s the law—you don’t have to tell your parents anything.

Do you see how this immediately severs the child-parent relationship?

The vast majority of this little document is focused on children’s rights with little if any consideration for the rights of parents to be involved and to know what the hell State-sanctioned “providers” are telling your children.

In fact they have are specifically blocked parents from accessing information through a neat little maneuver. Normally, parents do have rights under the FERPA, the Family Educational Rights and Privacy Act. Except Oregon has maneuvered to place the School-Based Health Centers under HIPAA rules, which makes it far harder, if not impossible, to obtain disclosure.

That’s right. You can put your child on the bus in the morning and you have not a clue and barely any rights to know what happens to them when they get there.

In the Oregon Youth Sexual Plan, one of the strategies is to develop a “state-level coordination of youth sexual health promotion” (emphasis mine). “Develop” (meaning the state will train them) “and involve youth leaders… by engaging underrepresented group such as… lesbian, gay, bisexual, transgender, and questioning.” And this shocking statement: “Educate faith community leaders as ‘youth sexual health’ advocates.”

And then there’s also this from the OYSP: “Advocate and educate Legislature for universal health care.” Which pairs nicely with this from the School-Based Health Centers Network: “Ask your legislator to support the inclusion of SBHC’s in Oregon’s new CCO model.”

Why? Perhaps because CCOs are not beholden to public disclosure laws. And it’s a clear attempt to merge the Department of Education with the OHA. More power, and more direct control and influence over an even larger part of the population.

So is the CCO bill evil? For me, it’s hard to think that it isn’t. Not just because of what it most clearly is—the takeover of healthcare, putting more elements of society under government control, and removal of free-market principles—but because of what it can become. Remember, when you give control of your health to the government, they have a fiduciary responsibility to the taxpayer to ensure you cost the government as little money as possible. They can order you not to drink, not to smoke; to lose weight and even to force mental health counseling you. Own a gun? You can expect that “right” to be open for interpretation. And all of this opens the door for denial of service to our elderly and to indoctrination of our youth.

And don’t forget, we no longer have a state superintendent of schools. We gave that power to the governor.

Who also happens to directly control the Health Authority.

(The following post originally appeared in Northwest Connection, vol 6 (no. 65), June 2012.)

A Coordinated Care Organization (CCO) is Obamacare. Or it’s not. It only affects those on Medicaid—and only those on Medicaid. Except it doesn’t. But we have to do it and we have to do it now. Or maybe we could wait a year.

About the only thing that is for certain about CCOs at this point is that there are still a lot of questions about them.

In case you missed it, and most people did, healthcare is about to radically change in Oregon, thanks to Gov. Kitzhaber’s Healthcare Transformation. The same man who ushered in the Oregon Health Plan, which after two decades is widely recognized as at least a partial failure if not an outright failure, now brings you the Oregon Healthcare Transformation. But this time, it’s sure to work.

Here’s how it all happened. The CCOs were spawned into being in 2011 by HB 3650, which established the initial framework for the creation of coordinated care organizations. Then in 2012, in the shortened session, SB 1580 gave legislative approval to the Oregon Health Authority’s proposals for CCOs. What’s surprising is that SB 1580 passed with overwhelming support from House Republicans with 23 out of 30 of them voting for it, many of whom call themselves conservative.

All of this is an accelerated version of Obamacare. Under Obamacare, CCOs are known as “ACOs” — Accountable Care Organizations.

A CCO is responsible for providing fully integrated physical health services to provide coordinated care between all aspects of healthcare. Another, simpler way to think of it is ACORN running your healthcare. That, or its Obamacare arriving early in Oregon.

A CCO is a complete overhaul of how healthcare will be administered and institutes numerous new layers of bureaucracy between a patient and their doctor.

No longer will you just see your doctor. Instead, there will be multiple layers of non-medical personnel all making decisions about your healthcare. For example, there will be a Peer Wellness Specialist to assess your needs, a Personal Health Navigator to “enable” you to make decisions, even a Home Care Commission. Somehow all of this new bureaucracy is going to save money and provide better care, even though funds that could be spent on doctors is being spent on bureaucrats.

The stated goal of all of this upheaval is to save money and to put control of administering Medicaid on the local level. To pay for all this, the governor negotiated a $1.9 billion deal paid out over five years, with an initial down payment of $620 million for fiscal year 2013—on the condition that Oregon saves 2% on its Medicaid costs. Funny thing, that. Over those five years, Oregon is likely to spend about $22–$25 billion and 2% would come to $454–$500 million. So we’re spending $1.9 billion to save $500 million? Does no one in the governor’s office have a calculator?

In part, it will “save money” by instituting a hard cap on Medicaid spending. Each CCO will be given a global budget (made up of funding from various sources) but once the money runs out, that’s it.

Recently, Marion County became the first in the state to sign an operating agreement with a CCO when two out of three Republican commissioners voted to do so. Commissioner Patti Milne was the lone holdout.

Let’s get back to some of those questions. The proponents of this adamantly say, “It’s not Obamacare.” And that’s true—sort of. Aside from the obvious-to-everyone-but- the-proponents similarities between CCOs and Obamacare, there have been numerous articles and comments by public officials, including the governor himself, that show a clear connection. Health and Human Services Secretary Sebelius said of the CCOs, “We are proud to support… these efforts to coordinate care, which mirror our efforts at the national level, thanks to the Affordable Care Act.”

If it walks like Obamacare, quacks like Obamacare, looks like Obamacare…

But let’s look at some of the other statements by proponents of the CCO, such as, “It’s only going to affect Medicaid,” meaning it won’t affect the rest of us.

This is a curious thing to say, because on the very first page of the Agreement Marion County just signed, Paragraph B says, “CCOs will initially provide health services to Medicaid beneficiaries” (emphasis mine). Not only that but “H.B. 3650 also directs OHA to develop plans for CCOs to provide healthcare services to employees of the Public Employees’ Benefit Board and the Oregon Educators Benefit Board by contract.” Did they not read their own bill? (Again?) That, and there are plenty of publicized statements by Kitzhaber and others who all say this is designed to eventually capture all of us.

“We have to do it.” Isn’t it funny how a bill designed to give local control about healthcare doesn’t give counties an option? Aside from that, according to Sam Brentano, Marion County Commissioner, if the operating agreement doesn’t work out, “We’ll just opt out.” If that’s the case, then that invalidates his and others’ argument that counties have to do it in the first place.

“Medicaid already has a cap, so this is no big deal.” Except that’s not quite true either, because Medicaid only has a soft cap, which is how states end up with a hole in their budget when they over spend it. A true cap would prevent you from overspending that account. CCOs, however, do have a hard cap.

No less than the far-left Robert Woods Johnson Foundation says, “The total budget for each CCO would be capped at a set amount each year, a feature no other state currently offers… The idea of capping Medicaid spending is innovative and has never been approved by the federal government.”

And no one knows what happens once that money runs out. Does your grandmother simply do without?

What about liability for the counties? While Commissioner Brentano assured me signing the agreement doesn’t have any liability for the county (how does signing any agreement not incur liability?), according to the agreement, the county is a board member with “the authority to manage and conduct the [CCO]’s operations.” Not only that, the agreement puts the county in the position of a super majority. Both of those sure sound like potential liability nightmares if something goes haywire.

There are still plenty of unanswered questions beyond these. Like, what happens if the promised $1.9 billion doesn’t materialize? What’s the impact of allowing non-profit organizations the ability to participate in forprofit CCO? What will be the effect of having a taxing authority on the board of directors? Will they be forced to institute a health tax to fill the gap? Why is there a clause that seems to allow the CCO the ability to create its own insurance company? Or what happens if Obamacare is struck down?

Actually, we know the answer to that one. Oregon’s CCOs were specifically designed to continue whether or not Obamacare survives its court challenge. We are the test case.

I guess if you’re going to fall and break a hip, you better do it in the first half of the year.

© June 2012 by Mark Anderson. All Rights Reserved. Please use proper citations.