Portland’s Resistance Healthcare Platform

Health Justice

Health care is foundational to a just society. While the United States spends nearly 20% of its GDP on healthcare, life expectancy is down, and by many metrics, our country provides the worst care among the wealthiest nations while paying the most for it. Health and healthcare disparities mirror and contribute to other injustices in the United States. People of color and working class Americans disproportionately suffer from poor health, and have far worse access to convenient, affordable, health care services.

These disheartening health outcomes are not random acts of genetics and personal decisions, but instead represent a failure of public policy and an intentional disinvestment in the health of our community members.

Portland’s Resistance believes that a just society must include basic access to health services for all of its members throughout their lifetimes. Furthermore, Portland’s Resistance calls for healthcare that is culturally sensitive and individually responsive, while also recognizing a long history of health-based injustice.

Portland’s Resistance Health Policy Platform

Portland’s Resistance calls for a reimagining of our health care institutions to promote better health for everyone. Healthcare is a human right and our healthcare system must prioritize the health of all people over the profits of owners, administrators, and investors. We recognize that federal, state, county, and city governments all impact health care, in both separate and overlapping systems. Portland’s Resistance calls for healthcare improvements on every level. We will hold our elected officials accountable for maintaining forward momentum toward a system of integrated, accessible, affordable, justice-driven care.

We are calling for:

1. Universal, single payer healthcare available to all people living or working in Oregon

2. Reinvestment in public health

a. Preventive care and post-discharge care

b. Gun safety

c. Supervised consumption site

3. Correction of health inequities

a. Culturally/individually responsive healthcare

b. Healthcare facilities extend Oregon’s sanctuary values and protect the health of all people

4. Healthcare during incarceration

5. Workplace protections for patients using medicinal cannabis

6. Increased access to mental health resources

7. Expand healthcare for workers and the next generation of Oregonians

8. Reproductive health equity

9. Healthcare that supports all identities

10. Mandated price transparency

11. Ability to negotiate prescription medications and equipment in bulk

12. End skyrocketing executive compensation culture

13. Data collection and outcome transparency

1. Universal Healthcare

Portland’s Resistance supports immediate steps to enact a universal health care system that delivers high quality care to all persons regardless of race, gender, socioeconomic status, and immigration status. A single-payer system — leveraging the scales of state or federal market, eliminating the inefficiencies of the private health insurance system, and incentivizing preventive care — is the best way to affordably enable our community to lead healthy lives. All United Nations member countries have resolved to achieve universal health coverage by 2030 and Oregon can be a progressive model for the United States by designing, funding, and actualizing a statewide commitment to universal health care.

2. Public Health Emphasis for Individual Health Outcomes

Much of the national conversation around health care focuses on individual interactions between patients and providers, but no less important are the hundreds of ways that community members interact with each other and the environment every day. The options available to people to commute; access to clean water and vaccinations; convenience of sources for fresh, healthy food; and education about exercise and nutrition are all determining components of health outcomes. These factors can be designed to give people the education, habits, and resources they need to stay healthy proactively.

2a) Preventive and Post-Discharge Care

Preventive care is the least expensive and most effective way to keep the population healthy. Free and easy screenings for common diseases, regular check ups, and other forms of preventive health care keep people from getting sick and catch illnesses at the least invasive time to treat them, resulting in the best patient outcomes. When people do inevitably need to receive direct care, it can’t end when they walk out of the hospital, clinic, or doctor’s office. For many patients, the post-discharge period is a precarious one as they work to recover, develop a habit for new medications, and try not to relapse. A well-functioning healthcare system should use evidence-based, community-focused best practices to ensure that patients transition smoothly back into their lives and successfully integrate any physician-recommended changes into their routines.

2b) Lack of Gun Safety Measures is a Public Health Epidemic

Every year in the United States, over 33,000 lives are ended through gun violence. Two thirds (62%) of those deaths are suicides. Gun death in Oregon is higher than the national average; 12 deaths per 100,000 vs. a national average of 10 per 100,000. Suicides in Oregon accounted for 83% of all statewide gun deaths from 2010–2014, 21% higher than the national average. Oregon passed gun safety legislation in 2000 closing the gun show loophole — mandating background checks for all gun show vendors as well as federally licensed dealers. However, many gun purchases are currently conducted through online marketplaces which allow for direct gun purchases that can easily sidestep the need for background checks. Furthermore, the “Charleston Loophole,” — officially known as Delayed Denial — allows prospective buyers to purchase guns after three days even if the background check is not yet completed. This allowed for almost 3,000 unsanctioned gun purchases in 2015 alone, and a total of 58,779 total purchases since 1998.

There have been eight mass shootings in Oregon since 1980, claiming a total of 28 lives. In almost every case, the killer obtained weapons legally, or through the legal purchases of family and friends. Of the guns used in the 93 mass shootings in the US since 1982, 73% were purchased legally. The impetus to address legal firearm purchases is clear.

While PR recognizes a long history of gun control legislation being written and enforced in racist ways we support justice-centered approaches to strengthen gun regulation at local, state, and national levels. This is especially important in cases of military-style weapons and high capacity magazines, and in cases where the purchaser presents a threat to themselves, their family, or the public. PR also supports efforts to enhance gun safety laws to make sure that gun owners store their guns and ammunition safely and securely. While PR recognizes that no gun safety law can address every issue leading to gun violence (especially in cases involving mental illness, domestic violence, and suicide), sensible regulations like these nonetheless save lives and contribute to a safer, more accountable society.

2c) Establish a Supervised Consumption/Injection Facility

Portland’s Resistance supports a Harm Reduction model in addressing drug consumption. We recognize that drug use occurs, that drug users have inalienable rights, and that we can save lives and reduce drug dependence through safe, supportive community health infrastructure. One harm reduction strategy that is gaining traction worldwide, though it is only just gaining a foothold in North America, is the Supervised Injection Facility (SIF).

Studies estimate that 6.6 million people in the US use injection drugs in their lifetime. These users experience increased risk for HIV/AIDS, hepatitis C, and other blood-borne illnesses. Harm reduction measures around the world such as supervised facilities and needle exchanges programs have proven to significantly reduce the spread of these diseases. Programs that encompass multiple vectors of use, and include wraparound services, are promising. Including addiction medicine in a continuum of services is crucial.

The first SIF in the US will open in Seattle, WA following a 58% spike in heroin-related deaths in that city. In Portland, the rate of deaths from heroin overdose has increased four-fold since 2000. Statewide, 202 deaths related to methamphetamine use occurred in 2015, a 15-year high. Use and prevalence of both of these drugs is projected to rise.

Portland’s Resistance supports current local volunteer efforts to disseminate safe consumption and anti-overdose tools. We would like to see these efforts continued, expanded, and supported, through the establishment of a Portland-based supervised consumption facility.

In keeping with the harm reduction philosophy and public health perspective, Portland’s Resistance supports decriminalizing drugs, providing rehabilitative and restorative services and treating addiction primarily as a disease, not a crime.

3. Reverse the Trend of Race-Based Health Disparity

Locally, as well as nationally, we see that people of color are often more adversely affected by health conditions than white people. This is in part an effect of other aspects of systemic racism, such as higher levels of poverty and unemployment, and lack of access to healthy foods and safe housing. But it is also the direct result of the stresses of racism itself. According to the Coalition of Communities of Color in Multnomah County, “the stressors of living with racism influence blood pressure, birth weights, heart disease and mental health. Some researchers are beginning to frame it as ‘premature ageing.” In Multnomah county, “babies born to minority mothers in Multnomah County are more likely to die before birth, to be born prematurely, and to be born on time but underweight,”

in large part due to the daily stresses of racism on mothers that local researchers refer to as “toxic stress.”

Portland’s Resistance believes that justice is attained not when an injustice is put to rest, but when the legacy of that injustice is identified and directly addressed. As such, even universal health care is incomplete unless it maintains special provisions for addressing the specific health need of different communities. Health care must be inclusive and accessible for all, culturally sensitive, and responsive to the individual needs of each person. Portland’s Resistance is committed to promoting good health for all communities; locally, statewide, and nationally.

3a) Culturally/individually responsive healthcare

“One size fits all” tends toward the size that best fits dominant culture. Different segments of society suffer from different health afflictions and even patients with the same health ailments may have them for vastly different reasons. For instance, cancer is diagnosed later in black people and kills proportionately more African Americans and Native populations than white people. Geographically uneven access to care and research inequity also contribute to health disparity. Primary solutions to these disparities include policy commitment, increased use of community health workers, community outreach, cultural competency training, language/translation services, wellness promotion, and evidence-based approaches to managing chronic conditions. If funding models or incentives are outcome-based, then those outcome metric must be culturally reflective as well to avoid punishing entities that are doing successful work within specific populations.

3b) Healthcare facilities extend Oregon’s sanctuary values and protect the health of all people

In order to effectively maintain sanctuary from the xenophobic and racist policies of our federal administration, safeguards must be extended into all realms of our society, especially health centers. Our neighbors and community members should be able to access health services without fear of law enforcement being contacted to profile, harass, and arrest them. Government health contracts and subsidies should require the adoption of Oregon’s sanctuary policies. Injustices in our immigration system should not force immigrants to jeopardize their own health or the health of people with whom they come into contact.

4. Healthcare during incarceration

Incarcerated individuals face many barriers to receiving adequate healthcare, despite being one of the most observed and monitored segments of society. From the very beginning of their interactions with the criminal justice system, arrestees have difficulty accessing prescription medications, people suffering from addiction are often unable to get detox and withdrawal treatments, and in many cases basic mental health protocols are not observed. These systemic failings at best represent undertraining or carelessness from corrections employees and at worst indicate a callous disregard for human life. Regardless of the causes, an unacceptable number of people die each year during incarceration in Oregon from completely preventable circumstances, and Portland’s Resistance calls for an end to these unnecessary deaths.

Defying national best practices, pregnant women who are incarcerated do not receive comprehensive prenatal care and are allowed insufficient time with their newborns. In some Oregon prisons, new mothers are allotted only two extra, two-hour long visits a week in addition to normal visiting hours, during which they can breastfeed their babies. Portland’s Resistance believes that we all have a responsibility to parents and the next generation of Oregonians and supports comprehensive prenatal care, the availability of family planning information, access to an abortion, programs that allow parent and child to bond, and post pregnancy counseling and health services.

We call for an end to the use of solitary confinement and other forms of social isolation used inhumanely and counterproductively as punishment within our correctional facilities. These measures serve no rehabilitative purpose, and in many cases exacerbate underlying mental health issues and result in more harm and trauma. Human beings are social animals, and if time in incarceration is to serve any redemptive and rehabilitative purpose, the focus must be on giving inmates the skills and experiences they will need to reintegrate into society, not barbarically torturing and traumatizing them.

With a lack of investment in mental health and social safety net resources, and public intolerance for mental-illness related behavior, mental illness has become increasingly criminalized with 40%-80% of incarcerated individuals having mental health issues. Undertrained and underresourced jail and prison staff rely on solitary confiinement, punitive use of restaint and solitary confinement, and routinzed force to address inmates’ mental health concerns. Restrcting access to contact with others, fresh air and natural light, freedom of movement and out-of-cell time, and social servces becaue of, not in spite of mental illness, is counterproductive and against widely agreed upon evidence-based recommenaations. Lack of acess to resources and services results in both missed opportunities for individals and increased difficulty in managing jails and prisons

Transgender individuals face unique health challenges when housed in correctional institutions. In many cases they are placed with the population matching their assigned sex at birth. Transgender inmates are frequently the target of abuse, violence, and harassment. We believe that transgender individuals should be able to choose which population to be housed with based on their assessment of where they will be most safe.

Health care is a human right, not just an American one. Everything in this section is meant to refer not just to American citizens incarcerated in jails and prisons, but also to immigrants, visitors, and others who end up detained in any of our correctional facilities (including ICE detention centers). From the point of arrest forward, individuals are under the bodily control (and are the legal responsibility) of the state and our policies must prioritize maintaining their physical well being.

5. Workplace protections for patients

Patients who are prescribed medical treatments that can be reasonably accommodated into their workplace should not fear the loss of their job due to a health condition. If an employee is able to perform the required duties of their position then their medical circumstances should not be used as a pretext to terminate their employment. One area of concern for Portland’s Resistance is around the medicinal use of cannabis. The people of Oregon have spoken and since 1998 cannabis has been a recognized and legal treatment for medical conditions within our state. However, employment law has not kept pace and employers today can still fire an employee for using cannabis even if it is prescribed and the employee is not using, possessing or under the influence at work. Workers who are prescribed medicinal cannabis and use it in a manner that doesn’t affect their workplace should not be open to targeting by their employer.

6. Increased Access to Mental Health Resources (Especially for Houseless Community Members)

Oregon ranks fourth-to-last in a measure combining higher prevalence of mental illness and access to mental health care among all states. Oregon has the highest prevalence of mental illness for both young people and adults. While facilities and programs exist to support people living with mental illness — notably, supportive housing initiatives and assertive community treatment teams — Portland’s Resistance encourages civic and state leaders to devote resources to our most vulnerable community members, particularly when joined with supportive and safe housing. PR applauds the opening of the Unity Center in 2016, particularly as it represents a collaboration between community health leaders to address a shared issue.

Portland’s Resistance intends to hold the City of Portland and Multnomah County accountable for the stated goal of providing 2,000 new supportive housing units — complete with physical health, mental health, employment and drug treatment services — for the houseless in the next decade. Portland’s Resistance encourages the Oregon Health Authority to maintain and expand access to mental health treatment for people served by the Oregon Health Plan and people currently without health insurance.

7. Health Care for Workers

Taking care of oneself and one’s family should not conflict with continued access to gainful employment and income. Portland’s Resistance believes all workers are entitled to paid parental leave, paid sick leave, and paid family support leave. According to Fair Shot Oregon, “Currently, only 14 percent of workers across the nation have access to paid family and medical leave at work, and only 40 percent have access to a short-term disability policy on the job.”

Portland’s Resistance supports city, state, and federal legislation that keeps workers secure in times of crisis and family necessity.

8. Reproductive Health Equity

Portland’s Resistance is committed to promoting body autonomy and guaranteeing reproductive equity across all genders. We are pleased that the organizations, leaders in the Oregon Legislature, and Governor Kate Brown made the Reproductive Health Equity Act (HB 3391) a reality in the 2017 session. The Reproductive Health Equity Act mandates that insurers cover a comprehensive set of reproductive and sexual health services, including guaranteed abortion access at no additional out-of-pocket cost to the patient. The law is trans-inclusive, and allocates funding for all persons regardless of citizenship status. Because HB 3391 is written to explicitly address the needs of historically underserved and currently at-risk communities, it is a model for the type of legislation we will advocate for in all areas of health policy. HB 3391 enters into effect Jan 1, 2019, and PR is committed to ensuring the community is informed of all the services available to them beginning in 2019.

9. Healthcare that supports all identities

We support people living their true identities and we believe our healthcare system should support and enhance that goal. For our transgender friends and community members it may (or may not) include medication or specialized procedures to live as their true selves and our laws, policies, and medical training should ensure that they are not discriminated against. Trans youth deserve body autonomy and best practices advise the availability of counseling services, and, if desired, hormone therapy or surgery. Ultimately each person is the authority on their identity, not their teachers, parents, friends, religious or community leader, or social group. Thanks to the tireless work of advocates and activists, insurance plans in Oregon, including the Oregon Health Plan, cover most gender-related medical needs, Portland’s Resistance is committed to protecting these services and working to expand them, where needed, to make sure all of our community members can access the care they need to live as the person they are.

10. Mandated price transparency

Regardless of who is paying the bills for healthcare it is impossible for patient, provider, or insurer to make educated choices when the most basic fact of what things will cost is not readily available. Portland’s Resistance supports the requirement of itemized and standardized cost sheets easily available before receiving care and itemized receipts available afterwards. This type of transparency creates informed consumers and also applies pressure to reduce administrative waste within the healthcare system.

11. Ability to negotiate prescription medications in bulk

We advocate ending the prohibition against the Department of Health and Human Services negotiating prescription drug prices using the full scale of Medicare recipients. The majority of Americans support the federal government using the volume of care recipients to get the best deal for patients.

12. End skyrocketing executive compensation culture

At its core, our healthcare system must prioritize first and foremost what is best for a patient’s health. As healthcare has become such a large and lucrative industry, executive compensation packages have ballooned. This raises questions: who personally profits from tax deductions and other forms of public support? Who benefits when costs are lowered, and why are savings not passed on to patients? Portland’s Resistance calls for reduced inequality in healthcare employee compensation, and ending executive compensation packages that catapult publicly-subsidized executives into the ultra wealthy.

13. Data collection and outcome transparency

Portland’s Resistance believes that the public (as well as individual patients/prospective patients) has a right to know the likelihood of a procedure’s success, how often specific medications are prescribed, satisfaction of previous patients, price data, and other information related to healthcare. We advocate for transparency and accountability for government regulators, healthcare providers, pharmaceutical companies, and other entities in the health sector regarding costs to patients and the public. Coordinated care organizations, who reap billions of dollars of public funding in Oregon should be subjected to public meeting and open records laws and should be required to implement other transparency best practices so the public can be assured that our significant public investment is being managed wisely. Lastly, while transparency is often inherently good, and contributes to unforeseen downstream effects, transparency in healthcare has been shown to lower costs and improve outcomes.

Conclusion

Portland’s Resistance is not a healthcare advocacy group. However, our policies speak to the values that we hold. We intend to support and complement other dedicated organizations that advocate a progressive healthcare future, from across the nation to within our neighborhood.

We reject the version of America where adequate healthcare is only available to the wealthy, the employed, and the lucky — where huge swaths of our community live within one medical emergency from bankruptcy. Our region can follow in the footsteps of most other industrialized countries in the world and recognize that good individual health is necessary for pursuing a fulfilling life as well as for overall societal health. Now is an opportunity to change directions, resist the undermining of public health coming from Washington DC, and build the vibrant community we all deserve.

Portland's Resistance

Written by

Portland’s Resistance was born on 11/08/2016. We organize direct action and policy demands to bring about the just and equitable future that we all deserve.

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