Intelligent national health care reform and a single payer system would powerfully reduce these problems for Oregon and many other states. 

The problem with messing with health care payments and hospitals--however necessary from the state's side--is that healthy non-profits have to maintain certain asset/debt ratios to make good bond ratings. Otherwise their costs go up. They need their cash assets (call it "profit" to do this). They are constantly tinkering with pricing, layoffs, selling off services, jerking around to get into federal revenue streams, meeting the fast-changing requirements of law, and so on. All of this jerking around gets expensive. And then there are the unforeseens of the latest jerking arounds--like making multimillionaires out of clever investors. It's hard to get states and the feds and insurance companies and pharmaceuticals and taxpayers and everyone else into a relationship that is effective and efficient. Right now, the waste is unbelievable.