Social Media Contractor Needed

Job description—MVHCA Social Media Contractor

Mid-Valley Health Care Advocates ( is a Corvallis volunteer, non-partisan, 501 (c) (3) organization working for universal publicly funded health care in Oregon, and a coalition member of Health Care for All Oregon (

MVHCA seeks a freelance social media contractor to begin work in 2016. The person will work from home, under contract, from January 1 through September 30, 2016, under guidance of the MVHCA Board of Directors. Compensation is $550 for 35-40 hours per month. The incumbent will fulfill tasks as follows:

  • Assist in managing Facebook and Twitter accounts, create posts and events, grow followers, share posts from other organizations, publicize MVHCA events and blog posts. Post at least five times per week.

  • Assist in managing the MVHCA website, ensuring that blog posts, calendar, and events are up to date. Update the site at least once a week.

  • Create content appropriate to the mission and goals of MVHCA's grant.

  • Create and share content that informs the public about the implementation of the Affordable Care Act in Oregon, including information about the InterCommunity Health Network Coordinated Care Organization (IHN-CCO), the IHN-CCO Community Advisory Council, and its local Committees. Publish information on deadlines for signing up for insurance and where and when Benton County residents can get health care insurance enrollment assistance.

  • Communicate with the MVHCA Board and Committees, report in writing to the MVHCA Board on a regular basis, and remain informed of the needs of the organization by attending Communications Committee and Advocates meetings as the contractor’s schedule permits and reading and commenting on minutes and email exchanges as appropriate.

  • Track website and social media metrics, submit monthly reports to the MVHCA Board of Directors, and provide 3 quarterly grant reports.

  • Work within MVHCA’s adopted protocols for social media usage and if needed suggest modifications to those protocols to avoid conflict with IRS regulations pertaining to nonprofit lobbying.

  • Have at least one year of documented experience managing website content and social media.

This part-time position pays $550 per month for 35-40 hours of work. It requires a skilled and deadline-focused content manager who is able to track the progress of Oregon's health care transformation and provide useful information on the website, on Facebook, and on Twitter. The contractor must be a creative thinker and self-starter, able to work independently as well as in collaboration with others. If you are interested in this position and have the requisite skill set, please send a copy of your CV or resume with two professional references and cover letter describing your experience to The position is open until filled.

Protocols for MVHCA use of social media

Mid-Valley Health Care Advocates intends to employ internet social media, including its own website, to expand its effective outreach to the public regarding health care reform. In doing so, MVHCA intends to abide by the following protocols and develop others, as needed:
1) MVHCA will never, at any time, endorse any candidate for office;
2) “Endorsement” includes “liking” a candidate’s Face Book page;
3) MVHCA will abide by the limitations on “lobbying” required by any grant funds it receives;
4) While MVHCA supports health care reform, including the establishment of a single payer system, it will not advocate for the passage of specific legislation pertaining to the establishment of a health care system beyond the limits established for 501 (c )(3) organizations;
5) MVHCA will not publish direct links to an incumbent’s or candidate’s website or other social media such as Facebook and Twitter;
6) MVHCA may publish links to a nonpartisan voter’s guides created by other organizations as long as all candidates were provided an opportunity to participate in the guide;
7) MVHCA will not publish links to organizations which might support or oppose specific candidates;
8) MVHCA will not post any comment on a candidate’s social media site;
10) MVHCA may sponsor candidate forums and other electoral events, and advertise same on its social media, only if all candidates were given an equal opportunity to attend and participate;
11) MVHCA may report on the proceedings of candidate forums or debates on its social media, as long as postings are objective and no candidate is favored over the others;
12) MVHCA may also invite all candidates for a given office to submit guest postings as long as the following criteria are followed:
a) All legally qualified candidates are invited to participate
b) MVHCA will post a disclaimer that the views posted are those of the candidates and not necessarily those of the organization
c) All postings will be represented in a neutral manner, with questions and format favoring neither one candidate or another
d) The postings should represent a broad range of issues, not just a single issue.
13) Any postings MVHCA makes about candidates should be accompanied by the disclaimer that “MVHCA does not support or oppose specific candidates” and ask that others making posts also avoid specific endorsements or comments about candidates;
14) Any employee or contractor of MVHCA shall avoid engaging in political activity on their personal social media while simultaneously associating themselves with MVHCA;
15) MVHCA cannot be held accountable for any candidate publishing a link to its social media for any purpose.


Will Colorado Become the First State to Implement Single-Payer Health Care?

Tuesday, 20 October 2015
by Michael Corcoran, Truthout | Report

The fight for a statewide single-payer health-care system has shifted from the Green Mountains to the Rocky Mountains: Colorado citizens are about to put single-payer up for a statewide ballot referendum in the 2016 election. If voters approve, the state constitution will be amended to create a statewide, publicly financed, universal system for the first time in US history.

After a long struggle, Vermont's proposal for a similar plan died in January 2015, after a decision by the governor to abandon the plan. Green Mountain Care, as it was known, is the closest any state has come to implementing a public health-care system that covers everyone. So the failure was a major disappointment for advocates for social justice everywhere. But the setback didn't stop activists in states across the country from pursuing similar reforms. Many in these states watched events in Vermont closely - to see what worked and what didn't and to avoid the pitfalls that proved fatal.

Colorado has been especially active, and activists are set to turn in more than 150,000 signatures (about 99,000 are required) to put health reform on the 2016 ballot, said Lyn Gullette, campaign director for ColoradoCareYES. Organizers say they are optimistic that their strategy will succeed where Vermont's failed - and that when ballots are cast in 2016, public, universal health care may become a reality in Colorado.


You can help MVHCA as we work for publicly funded universal health care like the rest of the developed world by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

A Canadian physician responds to Gov. Pence’s Medicaid program

Yesterday’s Quote of the Day (“Government supports rotten teeth for patients in poverty”) discussed the Medicaid waivers obtained by Indiana Governor Mike Pence. Today’s post continues on that topic.

The Goal Was Simplicity; Instead, There’s a Many-Headed Medicaid

By Margot Sanger-Katz
The New York Times, January 28, 2015

Indiana has become the latest Republican-led state to expand its Medicaid program as part of the Affordable Care Act. As has become the pattern, it was done with a series of waivers from particular federal requirements.

When the state’s governor, Mike Pence, announced the news on Tuesday, the focus of his speech was less about his state’s decision to embrace this part of Obamacare than about the special concessions he’d been able to extract from the Obama administration.

Newly eligible Medicaid recipients will have to pay monthly premiums or be locked out of certain services, he announced, and higher-earning beneficiaries who fail to pay will be shut out of the program for six months. People who use the emergency room frequently will need to pay higher co-payments than the federal government has ever allowed.

The provisions, designed to encourage residents to take more responsibility for the costs of their health care, break new ground in what the Obama administration will allow in exchange for expansion.

NYT Readers’ Comments:

By Bob Solomon, MD
Edmonton, Canada

You live in "Cloud-Cuckoo Land" in the fantasy you have the best medical care system on earth. Baloney. Check it out.

Canada is right next door. Come see how a sane federal health plan works, covering all and ensuring that (1) we live longer, (2) we have fewer chronic ills, (3) we have lower cost drugs, (4) we have lower cost hospitals, (5) we have lower cost operations, (6) we have lower accounting costs for all parties, and (7) we have no medical bankruptcies and impoverishment anywhere, for any income, for the unemployed, for the elderly. Long waits for ER? I waited 4 minutes for an asthma attack to be dealt with, 2.4 hours for a minor ear problem -- wax. In Philly, I waited 2.4 for a back injury. Twice. So no difference.

We get free (tax-paid) care in Alberta. No out of pocket, no minimum, no exclusions, no co-pays, no nothin'.

Premiums exist in certain provinces: $35 a month per person or about that, and some people purchase extended coverage. I also pay approx. $1200 a year for added features: free or nearly free drugs, and a large subsidy for glasses, hearing aids, private rooms, canes, and things like that.

Americans live in a "exceptional" med world -- a medical services madhouse. It was not created by ACA, of course. And because of the med and drug and hospital corporations, I mean "people", and the know-little-or-nothing GOP, it was ensured to endure after ACA. Medical madness is still a disease you need to cure.


By Don McCanne, MD of PNHP

Denying poor people dental care simply because they cannot pay the premium, as Pence's program does, defies logic. Does sentencing poor people to rotten teeth truly motivate them to find money that they don't have in order to provide them with the "dignity to pay for their own health insurance"?

Does Pence propose that we change the rhetoric from "skin in the game" to "rotten teeth in the mouth"?


Join the HCAO Rally for single payer on Feb. 11. Sign up Here.


Reshaping US Health Care From Competition and Confiscation to Cooperation and Mobilization

This article is by Donald M. Berwick, MD, published in JAMA (November 2014).


In this issue of JAMA, 3 Viewpoint s, by Powers et al, Fuchs, and Fisher and Corrigan, address problems, possibilities, and mechanisms for reshaping the US health care enterprise to better meet community needs at an affordable cost.

In their Viewpoint , Powers et al grapple with a question as old as democracy: How can productive collective action, which is required for a state to succeed, emerge from the factional divisions for which protection is required for democratic principles to succeed?

The founding fathers of the United States debated this vigorously. In the most famous Federalist Paper, Madison favored a large republic in the hands of a meritocracy to counterbalance the passions of a majority “faction” that might overwhelm legitimate minority interests. Others wanted to protect states’ powers, arguing that smaller political units could be more responsive to local groups.

Madison defined a faction as “a number of citizens, whether amounting to a minority or majority of the whole, who are united and actuated by some common impulse of passion, or of interest, adverse to the rights of other citizens, or to the permanent and aggregate interests of the community.”

Health care is ground zero for this problem, and the stakes are immense. Health care is a behemoth “faction” that controls one-sixth of the US economy and distorts the nation’s economic and political future. I recently ran as a candidate for governor of Massachusetts, and, in the course of an 18-month campaign, I saw vividly the effect of this dominating industry on the opportunities for the total well-being of a population of nearly 7 million people.

The Massachusetts state budget offers one example of the window on this problem. Between 2001 and 2014, government support for almost every category in that budget declined substantially in real terms. Public higher education: down 26%. Early childhood education and care: down 28%. Local aid: down 44%. Parks and recreation: down 43%. Meanwhile, state health care expenditures increased 63%. The patterns are similar on the private side. For businesses, the state’s medical costs, which are the highest in the nation, are one of the most substantial barriers to growth; and laborers’ take-home pay has at best stayed level, whereas their out-of-pocket medical costs and payroll deductions for health insurance have soared.

This amounts to nothing less than confiscation by health care of opportunities for growth and success in other sectors. The only plausible defense is that health is crucial and this level of funding is needed to ensure it. However, as Fuchs illustrates in his Viewpoint in this issue of JAMA, the evidence just is not there. No relationship exists between health care expenditures and health outcomes, either internationally among developed nations or nationally among the states with higher income levels. Health care in the United States is just taking the money, not because it needs it to advance the nation’s interests, but simply because it can take the money. It would be difficult to find a better modern example of a Madisonian faction.

Powers et al warn that distress over health care’s hegemony leads to simplistic “stories” to explain why it costs too much and delivers too little. Critics pick their favorite potential culprit and create, repeat, and believe their own claim that “if only…” insurers would behave, or patients would take more responsibility, or hospitals would be more communitarian, etc, all would be well. Those simplistic, unitary arguments, Powers et al claim, do damage to achieving deeper understanding and more productive action on health care as a complex system. The authors urge open, multistakeholder discussions that avoid reliance on simplistic causal stories and that aim for productive compromise.

Fisher and Corrigan agree, and in their Viewpoint they propose two supports for such compromise: a local or regional governance structure (a multistakeholder backbone organization to coordinate action) and a reliable funding stream for such coordinated action. They cite the Nobel prize–winning work of Ostrom, who studied how some local communities manage to avoid the “tragedy of the commons” with respect to stewardship of some limited, common-pool resource (like a fishery or forest).

As far as they go, these authors are correct. Simplistic stories do indeed dominate health care debates. However, many of the stories are true, as review of the first half of the View point by Powers et al makes clear. The problem is not that the stories are wrong; it is that each, taken separately, is severely incomplete. Yet tolerance is low in the sound-byte era for explorations of the complex causal interactions among finance, training, habits, physical structures, cultural norms, regulation, and organizational history and design. Moreover, the opacity of health care—the persistent lack of good information about cost, quality, and outcomes—continues to confound conversation. It would be such a relief, but quite wrong, to blame and try to defeat one single, key culprit.

As Fisher and Corrigan emphasize, it is difficult to imagine systemic remedies without a platform for systemic leadership and coordination, which would, of course, require resources. Pure market advocates would likely prefer to set the invisible hand to work, but markets are no more likely on their own to sort out the health care mess than they are to clean the air or produce a literate citizenry. Some combination of public and private action is required.

As sound as they are diagnostically, the Viewpoints by Powers et al and by Fisher and Corrigan go nowhere near far enough as frameworks for real solution. Both strongly encourage cooperation, but, to paraphrase Frost, “something there is” in the US health care world that does not embrace cooperation. Time and again, the nation has witnessed not the growth of cooperative solutions to health, but their stalling and, too often, their demise. Promising collaborative projects have come and gone, but none has produced yet the durable, extensive improvements in cost and health that the United States needs. Current examples offer continuing hope, such as the Washington Health Alliance, the Common Table Health Alliance in Greater Memphis, Tennessee, and 14 other communities also engaged in the Aligning Forces for Quality program of the Robert Wood Johnson Foundation. However, to be frank, and keeping in mind the enormous gaps in performance that Fuchs reiterates, not a single community in the nation has yet come close to the scale of improvement in health, health care, and per-capita cost that ought, in theory, to be achievable.

So, what to do next? Probably, as the Viewpoints by Powers et al and by Fisher and Corrigan imply, this is a time for local and regional action, rather than national. The political atmosphere in Washington, DC, is too unfavorable for the needed bold goals, systemic dialogue, and cooperative problem solving. Recently, Martin et al have tried to make a case for health care leaders’ moving consciously from strategies of leverage (maximizing influence) to strategies of cooperation. That requires establishing shared goals for the system as a whole, building trust among stakeholders, developing new business models, and combining competition and cooperation, rather than relying on one or the other, solely.

But even that is not enough. The conditions for success fully managing the commons that Ostrom discovered are very difficult to achieve among health care leaders with decades of investment in preserving institutional self-interest. The sheer scale of the health care enterprise, even at the level of a single region or city, makes the barriers high.

The antidotes to health care’s confiscation must include something bigger, more forceful. This is the time for mobilization—not just the intellectual mobilization of clever community projects but also the political mobilization that ended the Vietnam war, began to deliver on civil rights, birthed modern feminism, and started down the long road toward equal rights for the LGBT community.

Who can mobilize? It will not be the health care behemoth; it is not evil, but it is too big to change itself. Instead, change will require the collective political will of those   who are losing ground every day to health care’s unbridled confiscation of the future: laborers who want to protect their families, business leaders who want to survive in a competitive economy, a better-informed citizenry who want health, not procedures, and health care professionals who want not the hassles of complexity but work that adds meaning to their lives. Quite frankly, it will require leaders with the courage to take on the factional control that Madison rightly feared.


Glimpses of the CCO Summit- Achieving Health Systems Transformation?

December 4, 2014

Report by Lee Mercer, President Health Care for All-Oregon
December 4, 2014

Speaking to 1300 plus attendees at the Coordinated Care Organization Summit in Portland, Susan Johnson, Regional Director, US Department of Health and Human Services (Region 10) said Oregon is “leading the nation like a North Star” towards creating a sustainable model of health care for the future. Nichole Maher, President of the North West Health Foundation sees the key to health in our communities and health outcomes being now defined by zip code, race, income and other social determinants. She thanked Governor Kitzhaber for a budget reflecting dedication to health equity.

Kitzhaber outlined some of the successes of Oregon’s recent initiatives— 95% of Oregonians have health insurance and a million have enrolled in a new health care model. As the CCO’s start covering public employees we are moving towards savings that culminate in a structural budget surplus in 2123.

Building on this theme, keynote speaker Don Berwick, MD, former administrator, Centers for Medicare and Medicaid Services, and Founding CEO, Institute for Healthcare Improvement, praised Oregon and the attendees of the conference. “Bravo! You’re doing something amazing—there is a bright light here.”

But, he noted, there is “a burden of leadership for Oregonians as pioneers.” Pioneers are bound to experience uncertainties. He said Oregon should sense the importance of what we are doing and maintain cooperation—unprecedented levels of cooperation. Everyone must be willing to give up something as we stay focused on the triple aim of better care, better health and lower cost. The cost of health care is inhibiting us from being what we want to be as a nation.

His thesis, illustrated by graphs showing escalating costs, is that health care is “confiscating” opportunity in terms of eating up public finance. As premiums rise faster or through taxes), it is all, sooner or later, coming out of the pockets of the workers. And it means that health care is stealing from all the other programs that government might be providing.

He sees the health care system metaphorically like the Choluteca Bridge, in Honduras. Built well by US engineers, it has weathered every storm for generation, but, over the years, the river has moved and the bridge is no longer relevant.

To make health care relevant and effective, Berwick noted, we must begin treating it as a human right and build a system which is cost effective and sustainable. He sees a need for developing a cooperation index in our work. A focus on transformation and not the finances. He concluded by congratulating Oregon again on its successes, adding “the country needs you!”

Numerous Health Care for All Oregon advocates, proudly wearing their red t-shirts proclaiming health care as a human right, were disappointed that Berwick, an outspoken supporter of single payer as a candidate for Governor in Massachusetts, didn’t mention this needed systemic reform. He probably didn’t want to steal the thunder of the progress in reducing health care costs by Oregon’s CCO system.

Then a series of speakers outlined how they have organized their CCO’s in communities throughout Oregon. Much emphasis was on building the Community Advisory Councils that guide CCO’s. A number of moving personal stories illustrated the partnering of behavioral, physical and dental health specialties throughout the state. Also, stories emphasized partnership with early childhood education.

Kevin Campbell, a former business man and now CEO of Greater Oregon Behavioral Health, Inc. noted that, in Eastern Oregon, it was less about talking health care transformation and more emphasizing community strengths and local control. A big piece was doing Community Health Improvement Plans. In their vast region, 12 counties developed 12 independent plans and then found a unifying consensus. Not only did they serve Medicaid/OHP users, but philanthropic support was forthcoming which meant many of the facilities and services are available for all in the communities. One grant was given for each county, and the OHSU Center for Evidence Based Policy helped assess the grant projects.

CCO 101

Judy Mohr Peterson, Director of Division of Medical Assistance Programs (Medicaid) at OHA, spoke in a break out group providing an overview of the Coordinated Care Organization system. She started by outlining the reasons for the need for transformation:

  • Health care costs are unsustainable

  • Health outcomes are not what they should be

  • Lack of coordination between physical, behavior and dental health

Previously, during a budget crisis, there were three ways to deal with a shortfall of Medicaid dollars. One was to cut people, and thus began the lottery for OHP participation. Another was to cut benefits- this often meant cutting mental health, dental health or prescription drugs, all of which are optional under Medicaid. Finally, they could cut provider rates.

Under Kitzhaber’s vision of the triple aim, the goal was better health, better care and lower costs. Not just one or two, but all three. So Oregon set out to reduce waste, improve health and take steps to build a more sustainable model.

There are now 16 CCO’s, and 95% of 1,000,000 folks on Medicaid are enrolled. Mental, physical and dental health are all in one budget. Incentives are in place for quality and achieving growth limited to 3.4% (a cut of 2%).

Mimi Haley (Columbia Pacific CCO) and Coco Yackley, Operations Manager, Columbia Gorge Health Council, outlined more of the nuts and bolts of putting CCO’s together. In the Gorge the CCO was embedded in an existing organization (Pacific Source). The Community Advisory Council was formed, giving Pacific Source one vote, with 50% consumers and 50% “at risk” (financially) organizations. The Clinical Advisory Panel (optional) was also formed.

The Columbia Pacific CCO was formed in the coastal counties of Clatsop, Columbia, Tillamook and Douglas. It operates under a global budget as a wholly owned LLC of Care Oregon in partnership with Greater Oregon Behavioral Health. There are 15-20 directors. One seat each is held by Care Oregon and GOBH. There are 4 Community Advisory Councils, one for each county. They have grown from 7,000 to 25,000 members. Some of the health strategies include Health Home Assessments (discovered a woman who used oxygen has carbon monoxide leaking from her furnace—after repairing, she no longer required oxygen) and Health Resiliency (trauma informed support to “high utilization” patients).

Among challenges cited by the CCO’s include billing issues, different payment models and provider shortages. They couldn’t give metrics on provider shortages, but noted that most dentists in the area do not take Medicaid. Coco Yackley quipped that she could “see why single payer would help” due to the complexity of the various payment systems. Well child visits paid for by Medicaid, may, in a private insurance plan, be on a different annual calculation, so those patients may have to pay out of pocket.

Appreciating the opportunity to learn about the cost savings and system improvements being pioneered in Oregon’s Community CCO transformation, a nagging question remains. If this system is indeed more patient centered, why are all the metrics cited for its success, cost saving outcomes, not health outcomes?

In the Executive Summary of the 2013 Performance Report large improvements cited are:

Decreased emergency department visits. Emergency department visits by people served by CCOs have decreased 17% since 2011 baseline data. The corresponding cost of providing services in emergency departments decreased by 19% over the same time period.

Decreased hospitalization for chronic conditions. Hospital admissions for congestive heart failure have been reduced by 27%, chronic pulmonary disease by 32% and adult asthma by 18%.

Developmental screening during the first 36 months of life. The percentage of children who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21% to 33% in 2013, an increase of 58%.

Increased primary are. Outpatient primary care visits for CCO members increased by 11% and spending for primary care and preventive services are up over 20%. Enrollment in patient centered primary care homes has also increased by 52% since 2012, the baseline year for that program.

So cost savings are great and more screenings and primary and preventative services are wonderful.

But where are the patient health outcomes? How is the health of the folks not doing emergency room visits? Are they managing their congestive heart failure, chronic pulmonary disease and adult asthma? And how is the health of the kids being screened and patients getting primary care services?

At some point beyond cost savings and increased services, health outcomes need to be the final measure of a sustainable health system. When we have metrics which say that, in Oregon, we have achieved the lower infant mortality and higher life expectancy rates, the lowered rate of disease and the other health outcomes achieved by all industrialized countries which have in common universal, publicly funded health systems, we can say we are fully succeeding in transforming our health system.

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Study: Strict Malpractice Laws Do Not Reduce Health Care Costs

Laws that make it harder to sue physicians for malpractice do not reduce hospital emergency department care costs, according a RAND Corporation study published Wednesday in the New England Journal of Medicine, Reuters reports.

The study found that:

  • Tougher limits generally did not reduce the cost or volume of ED care;
  • Legal risk does not motivate physicians as much as some previously thought ("Wonkblog," Washington Post, 10/15); and
  • While there was a 3.6% drop in Georgia ED charges, researchers noted that the strict malpractice laws provided "little (if any) change" in ED physicians' practice intensity.

"[The latest results] certainly [run] counter to most people's expectation[s]," said chief study author Daniel Waxman of the RAND Corporation.

Click here for the full article.

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CCO Celebration Video

On August 12, 2014, MVHCA hosted a celebration of 2 years of coordinated health care provided by InterCommunity Health Network Coordinated Care Organization (IHN-CCO). Thank you Maegan Prentice for recording, editing, and uploading the video of this successful event. For more MVHCA events see our Calendar and Upcoming Events pages. Photos here.

What does it mean to have coordinated care? Watch and find out.

Join Us at the Philomath Frolic Grand Parade This Saturday, July 12!

Come march with MVHCA this Saturday in the Frolic Grand Parade. It promises
to be a lot of fun! We will hand out flyers announcing our Healthcare Movie
night at their Library on July 24th. This is an important opportunity to
get our message out to Philomath residents!

Meet at 9:30 at Philomath Middle School.  Dagmar Johnson will get there early to get
our line-up designation, so look for our group when you get there.

Parking is available in the east High School parking lot and Clemens
Primary School. Please enter Clemens Primary lot off of 19th St: you will
not be able to park on Applegate in front of the High School. Remember to
drive slowly and watch for children.

We will have a variety of "injury-related" props to wear to illustrate our
theme of "Our health care system is injured - help us fix it!" We will have
our banner, signs,  and a large puppet to carry. So come one and all!

Hope to see you there.