Alan Bates and Ben Westlund stopped in Medford over the weekend to talk to whoever would listen about rebuilding Oregon's health-care system.

The two state senators found a crowd of more than 100 people waiting for them Saturday in Medford's Central Library. There were doctors and doctors' wives, a hospital administrator or two, people with debilitating health problems, and dozens of ordinary folks who wanted to know more about proposals in the Legislature that would fundamentally change the way Oregonians get health care — and pay for it.

Bates and Westlund came to town to talk up SB 329, the bill that would create an Oregon Health Trust to manage all aspects of health care in Oregon. They had their routine down after more than a dozen similar meetings from Bend to Beaverton over the past few weeks, including one marathon day that took them from Coos Bay to Ashland with a stop in Grants Pass.

Westlund, the Bend Democrat, shared stories about his bout with lung cancer a few years back. Dr. Bates, the Ashland Democrat, told tales from his medical practice about the arcane billing practices and administrative costs that drive up the cost of health care.

Both returned time and again to the same key points: health care costs need to come down; quality must improve; and every Oregonian needs to have health insurance. They repeatedly stressed that there's already enough money being spent on health care ($10.6 billion in Oregon in 2004, according to studies), to pay for universal health care if we spend more efficiently.

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Bates said his medical office, for example, has to bill about 30 different health insurance providers, all of whom have their own forms and procedures.

"We've got to simplify and standardize the flow of paperwork," he said, to bring health care costs down.

Westlund said his cancer fight taught him the value of health insurance on an emotional level. Just knowing that he had health insurance helped him through his treatments because he knew that even if he died, his family would not face catastrophic medical bills.

Having health insurance "literally helped me heal," he said.

The system envisioned in SB 329 would establish a basic benefit package for all Oregonians. Pre-existing conditions would be covered, Bates and Westlund observed, "because everybody's in."

Everybody who has lived in Oregon for at least a year, that is. The bill includes a one-year residency requirement to prevent people from moving to Oregon just to take advantage of the medical benefits.

"We'd be killed if everybody with pre-existing conditions came to Oregon," Bates said.

The first step toward creating the new system would be passing legislation this session to create the health trust, which would then create the benefit package that would be available to all Oregonians.

Private employers could offer their own insurance independently, but they would be encouraged to join the program to increase the size of the insurance pool, and the benefit package would be rich enough to entice employers to enroll their workers.

People could still see the doctors they know and trust, Bates said.

"Choice is absolutely necessary," he said.

Both senators offered plenty of real-life examples to illustrate the need for change. Westlund observed that the Bend area now has nine expensive, high-tech MRI machines — far more than medical need alone would justify.

"You guys (in Jackson County) are pikers," he said, tongue firmly in cheek. "You only have six."

"Who pays for that stuff?" he said. "We all do."

Bates noted that two hospitals in the Eugene-Springfield area are both planning to build new facilities that could cost as much as $500 million by the time they're completed.

"We simply can't afford that anymore," he said, noting that one key aspect of the new Oregon Health Trust would require hospitals and other care providers to justify the need for new facilities.

Another aspect of the SB 329 would require everyone who enrolls in the insurance program to complete a form that gives physicians specific instructions on end-of-life care. A central registry of those "advance directives" would be maintained so that hospitals and physicians would know whether critically ill patients want to be resuscitated or allowed to die naturally.

Presently there is no central registry for advance directives. Bates said hospitals and physicians often perform heroic and expensive interventions on patients who may not want such treatment because they lack specific instructions to do otherwise. The registry would help reduce costly end-of-life care, Bates said, noting that intensive care costs can exceed $10,000 per day.

Westlund said every Oregonian has to accept some responsibility for creating the existing system and helping to create a new one.

"Everyone wants to cast aspersions, to blame somebody else," he said. "In a sense they're right. We're all to blame. We all have a certain level of culpability. The enemy is us and we all have to change."

Bates and Westlund answered questions for half an hour, then drove across the Cascades to Klamath Falls for their next meeting.

Reach reporter Bill Kettler at 776-4492 or e-mail:bkettler@mailtribune.com