By Samuel Metz, M.D.
Portland (Ore.) Tribune, Nov. 4, 2014
What are the saddest parts of the Cover Oregon debacle?
The first is that our state government spent $250 million for software development that, in the end, left us with … nothing.
Not only nothing, but with a hostile and very wealthy software development company intent on compelling Oregon to pay even more for … nothing.
Actually, that big loss is neither unexpected nor unprecedented. The majority of software development projects, both government and private, ultimately fail to produce the expected product. Oregon’s government is not immune to these catastrophes: In the 1990s, Oregon spent more than $100 million on Department of Motor Vehicles software that ultimately produced … nothing. So Cover Oregon did not break new ground in failed projects, not even for failed government projects.
The saddest part of Cover Oregon, however, is that a universal health plan in Oregon would have rendered Cover Oregon, plus its software, its website and indeed its entire mission, totally unnecessary. Matching four million Oregonians with a specific insurance policy is expensive. But universal health care is not.
Why was Cover Oregon so expensive? The Affordable Care Act compels Oregon, like the rest of the country, to spend millions of dollars assigning us into one of hundreds of insurance pools, based on employer, age, number of coworkers, military status, residence, family size and a host of other factors.
Our assigned insurance pool then determines which insurance plans we might qualify for and which physicians we can see. These insurance plans are further subdivided into hundreds of benefit plans, which could be unaffordable, inadequate or both.
We then recalculate everything with every change in employer, age, etc. That’s why we need Cover Oregon (or a federal website) to keep track of this massive paperwork.
It doesn’t have to be this way. And it isn’t this way for health care systems that successfully provide better care to more people for less money than we do in Oregon.
These successful health care systems (around the world and in our own country) possess one common characteristic — they assign everyone to just one insurance pool (human beings), with just one set of benefits (treatable conditions are treated), and with just one network (all licensed physicians).
No successful system spends money on websites like Cover Oregon in order to sort sick from healthy, poor from wealthy and employed from jobless. They spend money on health care.
Cover Oregon is necessary only if we want to restrict care and limit benefits. If we instead commit to comprehensive care for everyone, Oregon saves money. How much? The money we now spend on software development, website design, insurance administration, marketing, lobbying and provider overhead that deals with all this would be more than enough to provide every Oregonian with access to comprehensive care.
We know this because every health care system that provides universal comprehensive care also spends less money with better results than we do now.
What does the Cover Oregon debacle teach us? Restricted care costs more than universal care.
Oregon doesn’t need to spend more to provide better care to more people. We just need to spend our money on health care, not Cover Oregon.
Successful systems tell us how to achieve that: Universal care.
Samuel Metz is a Portland anesthesiologist and a member of Physicians for a National Health Program and Mad As Hell Doctors, organizations that advocate for universal health care in Oregon and nationally.