Kristen Bell (8:05)

Sure. And just to introduce ourselves, both Colin and I are engaged with an organization called Healthcare for All Oregon. And HCAO was kind of instrumental in helping to draft and build support for the Senate bill which established the joint task for um. That was a group of kind of individuals, people who either working in the healthcare system or who represented certain communities impacted by the healthcare system. And their charge was really to recommend a universal healthcare system that hit certain goals like equity, affordability, comprehensive care. Senate bill was passed in 2019 and the task force submitted their final report and recommendations in 2022. And that essentially was for a single payer system, that Oregon should establish a single payer universal care healthcare. And that has led into our more, more current work.

Dax Shepard (8:56)

And also they recommended forming a new organization or a new group of individuals to sort of get it over the finish line. Which is, they didn't have this name at the time in 2022, but that group that they recommended ended up being called the Universal Health Plan Governance Board, which was created by a Senate bill in the state of Oregon. And that is the group that is working over the next year and a half to finish this.

Derek Barris (9:19)

As I mentioned before we started recording, a lot of our audience is international. A number of people won't live in Oregon. Most of our listeners don't. Can you just explain what the implementation of a single payer system means as compared to what we have?

Dax Shepard (9:38)

Let's talk pie in the sky. It means joining the rest of the wealthy, smart nations who have decided to implement a universal health care system or a single payer system. It means following in the footsteps of Saskatchewan, which was the first Canadian province to transition to universal healthcare. So it means taking a lesson out of their book and trying to make something that works for Oregon. It's very different now than in the 1950s. I would not. Perhaps in the 1950s, some people in Canada thought their system was totally broken. I think a lot of people in Oregon and in the US think that our federal healthcare system is broken. Right. And so it's trying to take the lessons learned from functional universal systems around the world, applying it on just a single state in this very challenging system.

Kristen Bell (10:26)

A lot of health policymakers have identified this kind of state based route as the most viable path for the United States. Our national level, as we know, is going through its, you know, certain challenges in terms of having a cohesive vision for healthcare in the United States. And so a lot of health policymakers have said, yes, you know, let's look to a country like Canada, which started province by province. So Saskatchewan did it first. They proved the concept and then other provinces followed and adopted it. And then eventually that, that led to a national health insurance system. And so we are looking to, to do that just to here. Here in Oregon we can be the first ones.

Derek Barris (11:06)

And other provinces followed very quickly because they saw that it actually worked. I don't know if this is the perfect analogy, but it reminds me of when Colorado legalized marijuana and all of the other states saw that, oh wow, there's that much tax revenue available. Let's get this rolling. So perhaps we will, we will have that sort of effect here.

Kristen Bell (11:26)

Yeah, you know, in the United States it's, you know, that's what we kind of pride ourselves on. Sometimes it means slower though. You know, we have the states as, as labs. You know, we can, we can, we can test concepts in this case, it's a little frustrating because this is the most tested health policy in the entire world. You know, this is not a, a radical untested idea. Every wealthy nation in the world has shifted to universal health care. We are the, we are the, the radical weird ones clinging to our, our for profit system.

Derek Barris (11:56)

Yes, I mentioned Measure 111 specifically. This made affordable health care a fundamental right for all residents in our state constitution. Can you unpack what it took to pass this amendment and what it means in reality for Oregonians?

Dax Shepard (12:14)

Yeah, I can speak to that. I helped volunteer doing some outreach on social media during that campaign. The Portland Blue Bubble is a real thing. And so from my perspective, I really thought it would be a landslide because from my perspective, everyone in Oregon wants health care as a fundamental right. The reality of it is that it only passed with about 51% of the vote vote, but it did pass. As far as what it took to get it to the finish line. We were able to get an amendment to the constitution with hardly any budget. I don't remember exactly what that, what the budget was for that particular measure, but it was very small and it still passed even though it wasn't the landslide that I was expecting. In retrospect, looking at doesn't actually lay a groundwork for any action. It just says that access to healthcare, affordable healthcare, is a fundamental right. Those are the keywords, fundamental right for every Oregon resident. We're the only state that has that kind of language in our, in a state constitution. So that does give us a leg up in this journey towards universal healthcare. But I think perhaps some of the hesitation that maybe the 49% of Oregonians chose or, you know, considered when they cast their ballot in 2022 is that it doesn't do anything. It just changes the words of our state constitution, but it doesn't provide any steps to take to make that change.

Kristen Bell (13:35)

And I, you know, add to that, I think that that was, yeah, a big impression that a lot of people had. They weren't sure what the, the import of it was, but in fact, a lot of countries have used a constitutional amendment as the first step on their path to universal healthcare. So Brazil did that, for example, by adding it to the constitution it then creates. In this case, it was a mandate on the Oregon state legislature that they have to fulfill. Now they're obligated to come up with some way that health care is guaranteed to every Oregonian. And they could have gone any number of routes. They could have just expanded Oregon Health Plan, which is our state's version of Medicaid hcao. We had allies in the legislature who we were working with, and we knew they wanted to establish a universal healthcare system. We worked. You asked what helped lead to it. We worked in a broad coalition, Oregon Nurses association, unions. There was a variety of organizations who all came together and tried to amass support for this. That was the first step that led to future bills that created the governance board that Colin mentioned. And another way that the measure is important is that if an eventual plan that's passed is challenged constitutionally, like that's something that the opposition might try to do. We have this in our constitution now to say, actually this universal health care is constitutional, so it also protects, it protects any future plan in that way.

Derek Barris (15:01)

One of the main criticisms we've gotten over five years of this podcast now is that because we criticize wellness influencers and contrarian doctors that we don't care about health care, which could be nothing further from the truth. My belief is that watching all of these people monetize things like supplements instead of advocating for socialized medicine, it helps their bottom line, but it's not going to make anyone but the more affluent people who can afford the accoutrements of the wellness industry already, and they're probably already a leg up in terms of health. I was looking at who was for and who was against this ballot measure in 2022, and it seemed pretty universal that all of the people who work in healthcare, doctors, nurses, researchers, were all on board with this measure passing. Was that the case?

Kristen Bell (15:54)

Mostly, yes. You know, interestingly, sometimes I'm a professor of public health. And so I was, I remember I was teaching a class at that time and one student raised her hand and she said her dad, who was a lawyer for a physician's group, and I can't, I don't know which one it was. She shared that that physician's group was, was against the bill. And we, it opened up a good conversation because, you know, a lot of people trust their doctors to tell them, you know, well, what is universal health care? Should we be for this or not? And a lot of doctors are so fed up with the system right now, they're so fed up with trying to prescribe the best care for their patients and having insurance company representatives, you know, delay or deny the procedure or the treatment that a lot of physicians are now on board for universal health care. But historically, like the AMA was against universal health care because it can mean a reduction in salaries for some of the highest paid doctors. So you have to kind of look for those nuances is when you see who's on board or who's supporting. But right now, you know, our organization, we partner a lot with, for example, Physicians for a National Health Plan. You mentioned nurses. So Oregon Nurses Association. These are huge, deep pockets of support for this work.

Derek Barris (17:09)

The amendment states that the right to access health care, it has to be balanced with other public services in terms of the budget and how it's going to be funded.

Dax Shepard (17:24)

I would say yes. And I would also say that that was not the intention of Measure 111. It's like I said, sort of that broader mandate to have healthcare as a fundamental right. It is very fortunate, a little bit of kismet, that this universal Health Plan Governance board does fulfill that wording within the Constitution.

Kristen Bell (17:43)

Yeah, you know that. I mean, it is a part of a promise like, okay, we have to fulfill this, that everyone has healthcare as a right. But they added that language in that we can't kind of take money from other, you know, we can't defund education in order to pay for this or something. So that is an area that hasn't been decided on by the governance board. But the governance board has a finance and revenue committee. So they are looking at specific revenue streams that, yes, do not affect the rest of the state's budget.

Derek Barris (18:12)

Now, I went to my first volunteer meeting a few weeks ago. I met where I met you, Colin. And when I was listening to all of the steps that need to happen in the next year, it really opened my own eyes. Even though on this podcast and in before, even before this, I've been advocating for universal healthcare. It's like, oh, yeah, it is a bureaucracy right now. America basically has four different healthcare models all trying to compete at the same time. And so trying to cut through that is going to be difficult. Can you just sort of unpack what the next year is going to entail to ensure that the legislation comes before the Senate?

Dax Shepard (18:52)

Sure. Yeah. It's going to be complicated. And that's. That's okay. Things are complicated. So the four different subcommittees of the board. So again, the name of the organization that was appointed and selected and created with the senate bill is called the Universal Health Plan Governance Board. It's just nine humans that have a lot of experience in the healthcare industry in Oregon and were approved by the legislature and our governor. Those nine humans are the people that actually will make the final decision and make the final plan. And they have four, currently four, eventually five subcommittees of different groups that include both members of the board and other Oregonians that have expertise in different areas that they need to focus on. And so those four subcommittees are the Finance and Revenue Committee, the Plan Design and Expenditure Committee, the Operations Committee, and the Community Engagement and Communications Committee. I was selected for the Community Engagement Communications Committee. I'm really excited for it because it aligns with my personal interests and my work with healthcare for all Oregon. The Plan Design and Expenditure Committee and the Finance and Revenue Committee need to work in conjunction over the next several months. And they said, and I hope that they can still do this with a few changes in their staffing, but they need to deliver the sort of official first draft of the plan. Again, there was a 2022 blueprint, let's say not even, not even like a real draft, but 2022. There's something to work from this summer. 2025, they have said that they want to deliver a first iteration of the plan, including some of the specifics of the financing mechanisms, which are certainly going to be interesting. Myself, I'm interested to see and I think that some other Oregonians will be very passionate about whatever they they decide this summer. They need to deliver a first draft of the plan in October of this year. The schedule is that the Community Engagement and Communications Committee will be delivering some specific documentation like one pagers, PowerPoints, simple ways to convey this message to Oregonians between January and March of 2026. The bill says that there is a minimum of 10 in person or virtual events, 10 outreach events that the Community Engagement Committee and the Governance board needs to do to convey that information to Oregonians. I believe in March is when they want to close March of 2026, they want to close that sort of open forum for. Or that's not quite right. Anyway, that particular open forum will close in March, but then there'll still be a few months where the public can weigh in. And then the final version of the plan, which is the thing that could be voted on either by our state legislature or us as Oregonians. The final version is due September 15, 2026.

Derek Barris (21:33)

As of now, the legislation is scheduled to be implemented in 2027. I want to be realistic about this. There was a lot of discussion about that at the meeting. What barriers exist that could stop that from happening?

Dax Shepard (21:46)

That's a great question. I would not say 2027 is a guarantee. I have heard that it is 2027 or 2028, and I'm curious what you're going to respond, Rebecca, but I think that it is impossible to even predict the challenges and barriers that could come.

Kristen Bell (22:06)

Yeah, and the, you know, a couple nuances. So ideally, if the plan is presented to the legislature in 2026, that gives them a few months to look at it, tweak it, make edits as they'd like, and then they would be voting on it during the live session in 2027. It wouldn't be implemented in 2027. It would probably take, you know, until 2028, till we started seeing some changes. The governance board is actually going to be putting together another subcommittee for the implementation, like, transition plan. That might take a few years also. So we don't know. Maybe they say, hey, let's do this all in one year, make it quick. Or maybe we take four years to fully transition into this. And there are, you know, HCAO is looking at what might happen because the legislature can vote on it in 2027, and we hope they would. We're power mapping the legislature. We're talking to our representatives, getting advocates and allies on. However, we also think it's likely or very possible that they might punt it to the voters. They might say, this is too big for us to decide. Let's let Oregonians decide. We love democracy. We love Oregonians having a voice. But given that 51% margin for the constitutional amendment, this is why we are preparing right now. We need to get out into every corner of the state having conversations, educating people about what this is. Because it's one thing for people to say healthcare is a fundamental right. It's a different thing to say, okay, let's overhaul our entire system and shift to single payer when most people and most Oregonians don't know what that means. You know, as a professor of public health, I study health systems, so I know what it means. I also know it's very doable. Every wealthy country has done this. This isn't a frightening kind of unknown, like I said. But HCAO and our coalition organizations, we have a lot of work to do in terms of getting out there and educating the public so that they know what, what, what may come on their ballot measure in 2028.

Derek Barris (24:04)

Let's think about that realistically, because, Colin, you are doing communications here. Besides my work in journalism, I've done a lot of marketing writing in my career. I still work on the side for a tech company doing marketing writing. One thing you learn is it's. It's essential to present very simple messages. When you say universal healthcare, you're right, Rebecca. That sounds wonderful. What does that mean for the Oregonians? Like what? What would you tell them why they should support this bill, what will it mean to their actual life?

Kristen Bell (24:37)

Things like when you're, when your child is sick, you don't have to worry about whether you can afford it. When you get a cancer diagnosis, you can focus on healing and being with loved ones and not having to worry whether your insurance company is going to pay for that treatment that you need. The stories we hear, quite literally that's that the last one is a real story. At our, at our an annual. Last year we had a volunteer who came up. He was in his twenties, he had gotten a cancer diagnosis in college. And he talked about having to be in the middle of treatments and having to spend hours and hours on the phone with his insurance company not knowing if that treatment he had scheduled in a month was going to be paid for. So those are the stories. In fact, we're about to launch a new story collection project to try to get those out there. But you're right, when we get into universal healthcare, publicly funded, single pay payer, these terms, people get caught up on them. But what it means is that money should no longer be a barrier determining whether you and your family can be healthy and, and have security in that realm, not have to worry about going bankrupt and not just you, but your neighbors as well.

Dax Shepard (25:47)

We've also been talking about internally and in some conversations with the governance board about the language of freedom right now. I think a lot of, of people who like their American freedom do not feel like they have a lot of say in what happens in their health care. You know, if your employer decides to change another step back somehow in America, employers are responsible, responsible for determining your health insurance. You know, there's a long history there, but that's not standard. And why is it the on the onus of your employer to make these determinations? So your employer is not free to put their hands off of this thing. You're not free to have a say in what kind of insurance your employer decides to go with. Once you have that insurance, you're not free currently to go see the provider of your choice. You're not free to choose a less expensive prescription medication. You have to go with whatever is approved by your insurance. There's a severe lack of freedom that we don't actually talk about readily, but we are ready to begin the conversation. Having the freedom to choose any provider in the state of Oregon, having the freedom to leave a job that you don't like and still have the same quality healthcare that you had before. I mean, those are powerful messages.

Derek Barris (27:01)

I've wanted to go to, ohsu since moving here. But I have to go to Providence, and I very much like my practitioners there, to be clear. But Providence as a system has many issues that I would rather not support. So that is one. One vote for freedom for me, for sure. Rebecca, you've studied public health systems. So one criticism I've often heard, often from the right politically in America, is that universal healthcare would take away freedom because then people would no longer be able to choose. Yet every other country that offers socialized medicine also has private options on top of that. Now, I know we don't want to speculate too much about what's coming, but could you imagine that for people who are concerned that they would no longer have their private insurance options, that they'll probably likely still exist in America?

Kristen Bell (27:50)

Yes, but with some nuance there too. So, you know, getting into the wonky language, there are single payer systems and multi payer systems. Those, those, both of those can be universal healthcare systems. So in multi payer systems like Japan, private health insurance still exists alongside the government programs, but they are regulated beyond recognition here. So, so the private health insurance companies do not operate in, in any way, shape or form approaching how they operate in the US they have to charge the same amount, they have to cover the same things. It's basically a mirror image of the government program. It's just administered through a different body. Now what the task force recommended was a single payer system. The governance board is kind of working on that model now within kind of a health systems analysis. Single payer systems are the most efficient. So there are a lot of advantages there. And that's where the health plan, the insurance plan that everyone is on is the same and it's run by the government. Private health insurance does exist, but not competing directly with that government plan. Private insurance exists for supplementary care. So you as an individual will have mental. Sorry, yeah, mental health care, dental, vision, comprehensive physical care through the regular government plan. But if you want additional care, supplementary things, you are absolutely free to go buy supplemental insurance offered by a private health insurance company.

Derek Barris (29:21)

Thank you for breaking that down. Last question. I've talked about healthcare for all Oregon in the intro. The link is in the show notes so people can find you and donate if they feel compelled. What can Oregonians do right now to help support this effort? And maybe also talk about any initiatives you have coming up with Healthcare for All Oregon?

Dax Shepard (29:43)

Yeah, I think Oregonians need to put this in front of their friends and their family for the next year and a half. Just having conversations about what you think about it obviously, I think it's a great idea. Right. But if everybody in Oregon agreed with me, we'd be. This conversation would be done by now. You know, that's not a reality. But having a year and a half worth of dialogue in preparation for this vote I think is really important. And as far as ways to get involved with our organization, we always are looking for new volunteers. Just in the last six months, we've had different chapters. Chapters are sort of like our geographic way of organizing all the two. 20,000 members that we have in our organization. 20,000 plus. Getting involved with your local chapter or starting a conversation with a HCAO leader about getting a chapter going in your county would be awesome. This May, actually, it's May. We're doing our May membership drive, so we're trying to recap, raise several thousand dollars by the end of the month. And I think we will succeed.

Kristen Bell (30:45)

Yeah, I would add to that. You know, I think the first thing that people need to do is let themselves believe that this could happen. This is not a pie in the sky, abstract idea. I think a lot of Americans have been kind of backed into a corner just imagining we can never do this, but this is real. The ball is in play, the game is in motion. We are within a couple years of being able to potentially vote on this and be the full first state in the country, which then sets this domino effect off. So I think once people get that, like, feel that in their bones that we can actually do this. Yeah. The next question is, how can I help? And that's what is amazing for all Oregonians, I always say. I think the only thing that is going to stand in the way of us actually pulling this off is if enough Oregonians get educated and involved and be part of the push to make this happen. We are, you know, we encourage everybody to follow us on social media. Colin is just a social media master. You will see him all over our Instagram and TikTok and Facebook. We're educating people on what's going on there. We're in the middle of revamping our website right now. So if you have questions about what this plan is or what it means, you will be able to go onto the website and get clearer on. On how this will help people and be able to ask, you know, frequently asked questions or, you know, there are a lot of myths and misinformation that goes around about universal healthcare. And so we'll be addressing all of that. You know, as Colin mentioned, getting invol our local chapters, we. We just need people out here, you know, helping us spread the word and making sure that we're kind of inoculating people against the misinformation and disinformation that we probably can't expect from opposition once they once they catch wind of.

Colin Stackhouse (32:41)

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