Toward A Health System that Works for Everyone

 Liz Baxter is Executive Director of the Archimedes Movement, which seeks to create a new space for civic engagement outside of our traditional legislative and governance structures to deal with the crisis of the U.S. health care system.

How did the Archimedes Movement get its start?

Gov. John Kitzhaber launched the Archimedes Movement in 2006 in an attempt to build a bridge between complex health policy questions and grass roots action, and to make these issues make sense to the ordinary Oregonian or Washingtonian. For the public to become engaged, they need to understand what role they play, and how they can influence the decisions being made.

After the Archimedes Movement was launched, the first thing we did was to listen to people and hear what they wanted in a new health care system, then to design a framework for solutions based on what we were hearing.

In 2006, we travelled throughout the state and held 12 community meetings. We kept hearing the same things over and over again. People wanted health care they could afford. They wanted it to be local. They wanted to have everybody be part of whatever system was created. At the end of the day, they wanted the system to focus on making people healthier.

Archimedes was a Greek mathematician who was quoted as saying, Give me a lever long enough and a place to stand and I can move the earth." Gov. Kitzhaber believed that’s Oregon is place where we can make a difference and the public voice is really the leverage point. Oregon, because of its size, is still a place where people come together to speak about things that are important to their communities. If we could channel that, Oregon could again become a leader in health reform, and that we can influence not only what happens inside the State Capitols but in Washington DC as well.

The Archimedes Movement has three objectives: influence policy being discussed at the state level; influence what’s being discussed at the national level; and build a movement that will shift the debate about health reform from a question of “How do we find the money to pay for health care as it becomes more and more expensive?" to “What must we do to improve the health of all Americans?" We can't just focus on how we pay for insurance. We must also talk about what we are purhcasing and how we organize and deliver care.

What is the mission and vision of the movement?

The Archimedes Movement wants to accelerate real change at the local, state and national levels to create systems and structures that enable all Americans to live healthy lives, while clearly stating that is in the public’s interest to have high quality, accessible care for all at a cost we can afford. We do that through education, collaboration and taking action.

Our leadership structure adopted the “triple-aim” approach developed by Don Berwick that calls for three objectives to designing the ideal health care system. One is to improve the health of a defined population. Second, to reduce cost, and third, to improve the patient’s experience. If we have those three things as our objective, that should help us figure out what steps we should take along the way.

We have an 18-member leadership team and followers across Oregon, Washington and close to 30 other states. My job is to try and keep us focused on our message and strategies and keep us from being distracted by other crazy things that are going on in the health reform debate. It is very easy to focus on one solution to the health care crisis, and lose your focus on transforming the health care debate in the country. It’s so important to reach across different communities and identify leadership who can talk about what health reform solutions work for their communities. The only thing that will make a real different in this debate is if people will step up and talk about what’s important to them.

People have a tendency to vote for a candidate, and wait until the next election cycle to figure out if they want to vote for that person again. We’re helping people involved in the Archimedes Movement understand that they’re in a partnership with people they’ve elected. We don’t want our elected officials doing a job by themselves – we want them to do the job with us.

What was your career path leading up to your current post?

My undergraduate degree is in social work and I graduated in 1977. What I wanted to do at the time was to be a probation officer. I was living in California during a time of economic downturn. I became the director of a Big Brother Big Sister program in Southern California and was amazed to see how much influence a volunteer can have on someone’s life. I worked there for a couple of years then I moved to Oregon.

I moved to Oregon in 1980. I got a job with the State of Oregon working with what was known then as the Indo-Chinese Refugee Program. I was working with families who had just been located to the Portland area, coming from Laos, Cambodia, Thailand, and Vietnam. I learned so much about their culture and family connections. I learned about what people are willing to do to get to a place where they can take care of themselves and their family. It was a profound learning experience for me.

I then worked with agencies in both Clackamas and Multnomah counties that focused on keeping frail seniors in their homes through Oregon Project Independence. The program tries to keep older adults from becoming too impoverished that they needed Medicaid, and so frail that they needed to move out of their homes. I decided to pursue graduate studies in gerontology at the University of Southern California. When I came back to Portland, I did some consulting work then got a job at Good Samaritan Hospital, where I worked for about 13 years. I worked on three large federally-funded research projects, all of which were focused on connecting high-risk patients with resources in the community. Although I worked for a large health system, I spent 13 years working on projects aimed at keeping people out of the hospital; again I learned a lot about the strengths and resources of families and the communities they live in.

In 2000, I was asked to help lead a state planning grant that was looking at private-public partnerships that would help reduce the number of the uninsured in Oregon. After five years, I left the Office of Oregon Health Policy and Research in 2006, and later that year began working with Governor Kitzhaber.

How does your previous work in research tie in with your current focus on public advocacy?

Tying together research and public advocacy has allowed me to see the influence of my work from many different perspectives. Learning about what people need, and understanding how the systems work – my role has been to influence the system, to make it work to ensure that people get what they need. I can only do that though, because I understand what the system looks like to people on the outside.

Barbara Stewart and Pat Archbold, two nurse researchers based here in Portland, refer to it as local knowledge and colonial knowledge. For example, as a social worker, you may have the knowledge about how systems work. And when you go into someone’s home, the people you work with know their value systems, spiritual beliefs and who they can depend on in their family. They know what they need. Somehow, as a social worker, you have to create a match between their needs, their existing resources and what the system has to offer.

Making those important linkages has been a constant part of my job. Working with the Archimedes Movement, I try to harness those same strengths, but now outside of the structure of a large organization – trying to hear what communities need and translate that into ways to transform a system.

What achievements are you most proud of?

Thanks to many lawmakers, the Archimedes Movement introduced a bill in 2007. The bill itself didn’t go anywhere: we had a hard time getting it out of committee. But the values of the bill stayed on. There were 15 principles that were shaped by about 3,000 people. Those principles became embedded in a piece of legislation that did pass, Senate Bill 329, which created the Oregon Health Fund Board.

Having those 15 principles included in the law is amazing. We started out with a draft that we put on a website. Many people made suggestions online, and we took the draft to 12 community meetings. It’s amazing to me that someone in LaGrande can look at the piece of legislation, and say: “I put that word in.”

Transparency is really important to us. It’s the notion that Oregonians have a right to know how decisions are made and the information used to make those decisions. Public input is valuable – but not everyone writes to his or her Legislator. Getting as many people to be engaged in the public input process is critical. Your legislature works for you, and you have the right to voice your concerns. If more people became involved in that process, they (we) would have the ability to outweigh the influence of paid lobbyists who swarm the capital.

Inclusion is one of our first principles, but that notion is not always politically popular. As we went around the State in 2006, people were trying really hard to wrap their heads around what “everybody” meant. They expressed concerns about whether “illegal immigrants” would be included, and whether people who don’t take good care of themselves would receive care. Through dialogue – taking these issues head on in an honest way – we watched communities come to understand and express how they wanted their future communities to be – a place where no one is left out or left behind. That was very powerful. It made better sense to them to have everyone with an equal opportunity to be healthy.

As a country, we spend more than enough money on health care. Last year alone, we spent $2.3 trillion and more than half of that is public money. If we allowed the public to determine the best “return on investment” on such a huge amount, we would probably do something very different. Making a change might cost us more money in the short run, require an investment to build the system. As long as we know what we’re trying to build we can do it. Whether it’s money for electronic health records, or designing a primary care system where people can go to a provider who speaks their language and understands cultural influences on the decisions they make, we can find ways to spend our money smarter.

How does your cultural background affect the way that you lead?

Oregon is a very open and inclusive state but few of our elected leaders are people of color. One of the things that I find most interesting is the struggle about whether we want to acknowledge the cultural richness of our state, or whether we want to be color-blind when it comes to talking about policy. There is still such discomfort in talking about race, as if by not talking about race we can assume, and act as if, we are the same.

I am mixed race, so it is fascinating to me the number of people who won’t ask me about my ethnicity, but assume they know. After speaking at a conference recently, one of my own volunteers came up and said: “I had no idea you were a person of color.”

Both of my parents are from the US Virgin Islands. My mother, who passed away just one year ago, was mixed race; her father was the first Black bandmaster in the United States Navy, while her mother was mixed race of both black and Panama heritage. My father is white, from the French Islands, and his descendants were builders, mechanics, farmers and manual laborers. The US Virgin Islands were owned by Denmark until the 1920s, which believed in strong public education, even for their slaves. , It is a place where racial roles were completely the opposite of what they are in the mainland United States and interracial marriage was and remains very common. As an example, almost all elected officials in the USVI are people of color.

There’s something very different about an island culture where everyone pretty much knows everyone. There’s a lot more interaction not only among the races, but also among different socioeconomic classes. My parents instilled in me this belief that you can’t really know a person until you ask them to talk about themselves, and learn what’s important to them. I’m a good listener, and that desire to learn about other people has been a significant part of my work life as well.

The year before I was born, my parents moved to New York City. Looking for an apartment in New York City, they had to tell potential landlords that my Mom was from Puerto Rico. If she told them she was from the Virgin Islands, she would be considered Black, and no one would rent to them. Remembering that story reminds me in New York in the 1950’s, forty miles of the Caribbean Sea distinguished who could rent an apartment or not. So many decisions are based on perception rather than fact, but parents were both so startled by it, and yet thrived despite of it.

I grew up in a family where we were always questioning the logic of the assumptions that people make about us. I have three boys –my oldest is married to a young woman from Pusan, South Korea. My two youngest boys, who are both adopted from the foster care system, are also of mixed race. If I were to show you a photo of my extended family, you’d see children of the deepest, richest black, to kids who look like blonde, blue-eyed surfers and every shade in-between. I cherish our diversity as a family, but cherishing means being willing to talk about it and learn from our experiences. And now, I have a grandson who is half Korean and half everything else! I love the diversity and the richness.

So, to answer the question, how does my cultural background affect the way that I lead, it affects everything. My co-workers and colleagues know that no assumptions are allowed in our decision-making. I push those I work with to always ask and learn, don’t assume. Whether because of time constraints or limited budgets, we all are tempted to take short cuts and say that “we know” what this person or that person would think. My goal is that everyone has a chance to speak for themselves, to use their own voice be heard and become part of the landscape of this nation. I know that we can do better.

Fall 2009 Colors of Influence

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"The Archimedes Movement has three objectives: influence policy being discussed at the state level; influence what’s being discussed at the national level; and build a movement that will shift the debate about health reform from a question of “How do we find the money to pay for health care as it becomes more and more expensive?" to “What must we do to improve the health of all Americans?”

"Learning about what people need, and understanding how the systems work – my role has been to influence the system, to make it work to ensure that people get what they need."




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