All about John

John Kitzhaber is a medical man — once an emergency medicine physician — and yet a man who has devoted most of his working life to politics in the United States. Doctor changed to Governor when he won office in Oregon in 1995, after one term in the lower house and three successive terms as a state senator.

I have known John Kitzhaber for about 20 years, and hearing that he had decided to run for an unprecedented fourth term as Governor, I decided to visit Oregon before the election and sample opinion. I wondered whether training as a doctor had given him a magic touch that assured him automatic re-election.

As I went around the countryside, I met another John — son of a Danish immigrant. He did not think much of Governor Kitzhaber. In this John's view, living with a woman unmarried flew in the face of Bible teaching. I gently reminded him that the Governor and his partner were engaged to be married. He went on to say that Kitzhaber had been in office far too long; however, Wayne Morse was his hero. Morse epitomised that Oregon independence which had seen him elected successively as a Republican, Independent and Democrat United States senator over 24 years. Kitzhaber was so far only striving for 16 as Governor. I bit my tongue.

Oregonians have an idiosyncratic streak. On becoming the 33rd State of the Union in 1859, they rejected the blandishments of both the North and the South to join the Civil War.

As an aside, Kitzhaber was born in Colfax, Washington, named after Schuyler Colfax, the Republican Speaker of the House of Representatives who famously announced the passage of the constitutional amendment effectively abolishing slavery in the US and considered it the happiest day of his life. Ironically, the same belief in equality and equity that epitomised the Republican Colfax in 1865 resurfaced strongly in the character of the Democrat John Kitzhaber a century later.

Oregon is a multicultural community of 4 million people. The waiter at the Benson Hotel in Portland was proud of his Chinese heritage and the fact that his forebears were Chinese herbal doctors. Chinese immigrants were the backbone of Oregon's salmon cannery industry.

Oregon is also where the community stopped logging to preserve the northern spotted owl in the 1990s, and where, in the 1960s, the community stopped privatisation of their wide, sweeping beaches that the Native Americans and then the early settlers used as highways.

Kitzhaber entered politics in 1978. His major interest then was public education. He became nationally prominent with his development of the Oregon Health Plan in the 1990s. The Medicaid allowance provided to the state by the federal government had paid for all health care for the indigent but excluded the marginally poor from state health care support. Kitzhaber's plan had simple aims: he set out to make essential health care more widely available and more inclusive by rationing services, excluding those that were not cost-effective. The idea was bold and the planning and consultation broad, but like all health care legislation in the US, it ended up entangled in complexity.1 Kitzhaber admits that he should have paid as much attention to the political aspects of the health care system as to its funding.

In Portland, it was clear to me that I was in Kitzhaber territory, confirming what was obvious in 2010 when, for much of election night, he had been trailing his Republican opponent until the votes from Portland came in — like the Pacific Ocean crashing into the mouth of the Columbia River — ensuring his third term.

There was yet another John, who drove me around Portland, who had been an environmental activist in his youth but now exhibited a complete disenchantment with politics. Once he would have been part of the Kitzhaber constituency, but no longer. The problem with disappointed romantics is they make the worst cynics — and they stay at home on election day.

Kitzhaber as a political figure raises the question of the place of doctors in politics. Those who know of Earl Page in Australia and David Owen in Great Britain might well say they made valuable contributions — Page by his involvement in the first national health scheme with the passage of the National Health Act in 1953; Owen as British Foreign Secretary. What makes for such success, and how much does it depend on political longevity?

Two qualities that favour success in politics derive from being medically trained. The first is grace under pressure, which Kitzhaber has repeatedly demonstrated; and the second is a clear understanding of the importance of maintaining the currency of your knowledge and skills.

Whether or not he sees governing the state as a continuous ward round, he should recognise the sentiment expressed by a woman in the Oregon country town of John Day. Her father had been a child in an Okie family, who fled to Oregon from the Oklahoma dust bowl 80 years ago.2 She had lived in rural poverty. The people now were sick of politics, she said: “too much politics”. People wanted politicians to stop media posturing and get on with the job. She raised a sceptical eyebrow at the mention of the governor's challenger; it settled back when Kitzhaber was mentioned.

Whatever else he may be, Kitzhaber is a man for whom policy is the prime consideration.3 Political storms have to be handled by knowing first when to don raincoat and gumboots — admittedly over his trademark jeans, cowboy buckle and tan Western boots. And second, knowing when to empty the teacup once the storm has passed.

So what has happened since my visit?

Governor Kitzhaber was elected for his fourth term on 4 November 2014 with a greatly increased majority of 80 000. The Oregon electorate ran counter to what happened elsewhere in the United States. Democrat Jeff Merkley was re-elected to the US Senate in a landslide. The Democrats achieved an increased majority in both houses of the state legislature.

Given that majority, it will be interesting to see whether in 4 years Kitzhaber can fully implement Obamacare in Oregon, removing any bureaucratic glitches. Perhaps, despite so much asymmetry in the information available to date, he will be able to demonstrate to a country divided over this issue that universal health care is not only affordable, but cost-effective.