By Samuel Metz, M.D.
Portland (Ore.) Tribune, Feb. 1, 2018
Measure 101 barely saved Oregon’s Medicaid funding for two years, but our health care (like that in the 49 other states) is still the world’s most expensive.
For what Oregonians pay in health care taxes, insurance premiums, deductibles and co-pays, citizens in other countries receive 100 percent coverage for all treatable diseases. We Oregonians consider ourselves lucky if we dodge bankruptcy when our family needs care.
Why is health care in Oregon so expensive?
It’s not the usual suspects: Waste, fraud and abuse. It’s the unusual suspects: people who handle our insurance money.
Insurance administrators are not evil. They are, rather, a product of our uniquely dysfunctional health care system. Every billable health care event requires an insurance officer to determine:
• Was the patient insured?
• Did benefits cover the condition? Did benefits cover treatment?
• Did physicians follow preauthorization procedures?
• Was the physician in network?
• Did diagnosis and procedure codes match?
That’s a lot of time. Then they repeat 30 percent of this work because three of 10 first insurance claims are denied.
This process diverts 20 percent of insurance premiums away from health care and into administration. This loss does not include physician time lost to complete the claim in the first place. It does not include deductibles, co-pays or out-of-network expenses. It’s simply the cost of billing. Our billing costs are two to 10 times that of other countries.
Enter Bernie Sanders.
U.S. Sen. Sanders did not invent single-payer health care. He was not the first to introduce a single-payer bill. In fact, single-payer health care was invented before he was born, here in the Pacific Northwest.
An American industrialist, Henry J. Kaiser, guessed that keeping his employees and their families healthy without intervening private insurance companies would be good for his business (actually, the idea came from his company physician Dr. Sidney Garfield). Both were right.
The Sanders’ 2017 “Medicare for All” single-payer bill reflects Kaiser’s 1930s plan: include everyone, treat treatable conditions and pay physicians with administrative simplicity. These concepts are emulated by most large American businesses (using “self-funded” health care — private single-payer plans) and every other developed nation. The United States missed this message.
Most proposals save money by excluding sick people, withholding benefits, or underpaying providers. Single payer, in contrast, converts administrative overhead into health care.
Single-payer efficiency is validated daily by corporate single-payer plans in the United States and national single-payer plans in Australia, Taiwan, Denmark, Israel and a few dozen other countries.
All these single-payer plans provide better care to more people for less money.
Sen. Sanders may be the most dramatic American advocate, but he’s not alone. Four members of Oregon’s congressional delegation already endorse the single-payer system: Sen. Jeff Merkley and Reps. Earl Blumenauer, Suzanne Bonamici and Peter DeFazio.
The holdouts — Sen. Ron Wyden and Reps. Kurt Schrader and Greg Walden — need to hear from us. Oregonians want better care for more people for less money. Our congressional delegation should make it happen.
Oregon hasn’t solved its health care crisis by rounding up the usual suspects, nor by passing Measure 101. America’s biggest corporations and our international neighbors teach us the answer: single-payer health care. Call Sen. Wyden, Rep. Walden, and Rep. Schrader and give them the message. Oregon families will be grateful.
Dr. Samuel Metz is a private practice anesthesiologist who lives and works in Portland.