Letter to the editor: Oregon’s universal health journey is headed in the right direction

Single-payer advocates Tom Sincic and Valdez Bravo say that things are mostly going according to plan at the Universal Health Plan Governance Board, though the group should be hewing closer to its statutory mission

by Tom Sincic and Valdez Bravo | December 23, 2025 | The Lund Report

The article in The Lund Report “Board edges towards goal of a universal health plan for Oregon” (Nov. 19, 2025), offers a valuable update on Oregon’s progress. Yet, there’s a broader way to frame this story - one that more accurately reflects what’s being built, where we’re headed, and how we get there.

Background: Oregonians’ constitutional right to health care

Since voters passed Measure 111 in 2022, Oregonians have recognized “cost-effective, clinically appropriate, and affordable health care” as a fundamental right. The path was next defined by the state law that charged the Universal Health Plan Governance Board (UHPGB) to design a system that improves the “health status of individuals, families, and communities.”

The work of the UHPGB is to build a true universal health care system that meets Oregon’s constitutional obligation, including a complete financing and implementation plan. This is transformative work, not a technocratic tweak to a failing insurance model.

Financing and affordability: the money is there

Critics claim the plan lacks financial detail, but this implies that the board should have had a complete financing plan in its draft report, which is inaccurate. The fragmentation and lack of transparency that characterizes our current system makes the work to capture and redirect that financing a highly complex process. Those recommendations are not due to be complete until September 2026. Oregon’s data collection and analysis is ongoing, as is entirely appropriate.

What we know is that the status quo is unsustainable. Medical debt remains the leading cause of bankruptcy; approximately 40% of adults delay care because of costs; families juggle between rent and prescriptions. As UHPGB Chair Dr. Helen Bellanca noted, “The system will be simpler, more affordable and more sustainable.”

Importantly, Bellanca is also correct that the “revenue to fund the plan is already in the system.” The goal is to redistribute existing health care spending — not raise overall costs.

Dr. Sam Metz’s assertion that the UHPGB has no stated goal of cost control misses the point. The statutory mandate is to achieve universality and affordability simultaneously, not to perpetuate austerity assumptions. A universal system has significant levers to control costs through simplified administration, price-setting, global hospital budgets, expanded primary care investment and bulk purchasing.

Structural transformation, not “upheaval”

When (former UHPGB member) Warren George observed, “We’ve got to realize how much trouble we’re really in here,” he hit the mark. Oregon spends roughly twice what peer nations do for health outcomes that lag behind. We can’t afford incrementalism.

The article describes the elimination of PEBB and OEBB as a “hurdle.” It’s not. It’s actually a benefit — for workers and taxpayers alike — reducing duplication, contract negotiations, and overhead. Nor should aligning with federal programs be viewed as an “upending” of Medicare or Medicaid. It’s a transformation toward efficiency and universality, and multiple legal analyses - including from New York’s similar efforts — indicate states can proceed without violating ERISA.

Aligning Language with Law

While the article notes a goal to “minimize cost-sharing at the point of care,” Oregon law is clear: we must remove cost as a barrier. Even minimal cost-sharing often delays care and adds administrative complexity. That distinction matters because it gets to the heart of equitable access.

Likewise, the draft report’s ongoing debate about who qualifies as a “resident” highlights another definitional gap. Statements such as “permanently live in Oregon and spend more than 200 days in the state” raise unnecessary confusion. Residency has yet to be defined but we believe it should remain simple — just as it is for voting, which would require only self-attestation.

Similarly, reminding readers that “it does not matter whether you are housed or unhoused” restates the obvious. Residency, not housing status, is the relevant standard.

Clarifying language and assertions

The article references “value-based care” as a potential reimbursement approach. We must note that this model is both controversial and misaligned with the directive of the state law that set up the board. “Value-based” systems often add administrative burdens and fail to measure genuine health outcomes, instead rewarding box-checking. Oregon should not fall back into the same traps that fractured our current system.

Similarly, the mention of using a “hybrid” fund involving private banking is inconsistent with statute. The statute setting up the board explicitly defined plan funding as a public trust. T he inclusion of private banking undermines that fundamental principle.

The article notes the UHPGB’s draft recommendation that called for offering public option plans to individuals not covered by their employer.. This was accurate, but the recommendation does not reflect the statutory mission of the UHPGB. Oregon already studied the “public option” path extensively in 2019 and demonstrated its failure to achieve either cost savings or administrative simplicity. Single payer - not multiple competing payers - is what meets the constitutional mandate.

Public administration and transparency

The UHPGB’s draft correctly notes that the plan must be administered by a public corporation, accountable under Oregon’s ethics, meetings, and records laws. This design ensures the system’s transparency and flexibility while protecting it from privatization. The accompanying public trust fund, separate from Oregon’s general fund, is a statutory requirement - not an option.

The path forward

The article sometimes employs words like “agreed upon” or “would,” which risks implying finality. In fact, all current proposals remain preliminary until the legislature finalizes them. The UHPGB’s charge is to craft proposals consistent with ORS 751 - not to enact them.

Oregon is not guessing its way through reform - it’s following a clear legal directive. Our constitution and state law already define the destination: a publicly financed, equitably accessible, truly universal system. The work underway by the UHPGB and its committees represents progress toward that vision.

As the Board prepares its September 2026 report for the 2027 Legislature, we urge Oregonians to stay engaged. Submit testimony. Ask hard questions. This is about more than fixing a broken system — it’s about fulfilling a promise we’ve already made to ourselves.

Tom Sincic, MSN, FNP-Retired, is president of Nurses & Friends for Single Payer. Valdez G. Bravo, FACHE, is president of Health Care for All Oregon.