By John Costa / The Bulletin  /  July 25. 2010

At some point, every organization faces a moment when it can either honestly confront the trouble it faces, or decide it will ignore or deny the difficulties so evidently on the way.
So it is with the state of Oregon and, as odd as this association may sound, St. Charles Health System.
Both confront enormous problems, yet the leaders of one have their heads in the sand and the leaders of the other seem to be trying to take control of the future.
The state, in budget terms, is upside-down.
It simply can't afford itself.

Estimates of how much vary from one estimator to another, but outgoing Gov. Ted Kulongoski thinks it's in the billions of dollars.
As the late Sen. Everett Dirksen of Illinois was rumored to have said: “A billion here, a billion there, and pretty soon you're talking real money.”
That remark is probably apocryphal, but the message couldn't be more timely.
This is an election year, and Oregonians will be deciding, among other things, the makeup of the state Legislature and the occupant of the governor's office.
Given the desperate state of Oregon, you would think that clear and bold thinking would be the order of the day.
Sad to say, that's not so.
In fact, if hand-wringing and denial were political philosophy, Oregon would be a beacon of wisdom.
The reality is that the state is going to have to do one of two things: either downsize the government or raise taxes and fees.
Unfortunately, reality does not square with the electoral calculus.

Raising taxes is death with most voters, and reducing the government is equally fatal with the government work force, which is a massive voting bloc.
As a result, the serious though painful solutions are avoided like the plague.
How anyone is expected to choose wisely between politicians running on anything but the truth on the most important issues is beyond me
Avoiding the obvious but painful decisions is how the state got into this mess. The notion that doing the same might get it out of the mess would be comical if it were not so tragic.

What a different approach at St. Charles.
There is not an element of American medicine that does not face huge challenges, and with a familiar ring as to the problems of the state.
The public has expectations of service that the medical system will not be able to afford for very much longer.
The number of people expecting care, which is continuing to increase in price, is growing at the same time that the principle public provider of health revenue faces a future it simply can't afford.
And to complicate matters, Congress has passed, and President Barack Obama has signed, a major health care reform law whose long-term impacts are hard to decipher.

It would be understandable, if not acceptable, to simply get down low and wait until the policy and financial clouds clear.
But the board and the administration of St. Charles and the Physician Hospital Alignment — a group of doctors who have pledged cooperation with the hospital — have embarked on a very comprehensive reorganization of medical services.
At the risk of oversimplification, the folks are trying to bring to St. Charles a system less dependent on independent providers and built on a full coordination and integration of medical services and specialties.
The hope is that this approach will save money and effort by eliminating duplicated services and enhance care through more medical coordination.
How it will all be implemented is still being worked out.
Needless to say, it has its critics and it has its supporters.
Fair enough, but regardless of the outcome, it is reassuring to see a group of men and women look to the problems of the future and decide that something can be — in fact has to be — done.

Good for them.

John Costa is editor-in-chief of The Bulletin.