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Opinion: Lessons From Oregon's Universal Health Care Task Force

Oregon doctor-advocate says universal care recommendations are crucial, but will take work — and won't solve all problems.
October 20, 2022

On September 29th, my work and those of my colleagues on the SB 770 Universal Health Care task force concluded with our report to the legislature. In 2019, Oregon’s legislature charged our task force with design of a statewide health care plan to provide Oregonians with better care to more people for less money.

We succeeded.

CBIZ Optumas, our task force actuaries, predicted that our plan would provide health care to all Oregonians (including behavioral care, vision care, hearing care, and dental care) and allow patients to see any provider, while saving Oregonians nearly $1 billion annually.

My two year-long task force experience taught me key lessons about Oregon’s health care challenges. I share them here.

Single payer is the only solution. Despite attempts by policy experts in fifty states to create sustainable and efficient health care using our current chaotic and unstructured system, small tweaks offer no relief. A single payer model is the only format with real world experience that can provide Oregon with better care to more people for less money. And so the task force used a single payer model, creating the biggest change to Oregon’s health care ever proposed. Small changes failed. Big change is the only option.

Oregon must uncouple health care from employment. No other nation expects employers to choose employees insurance, benefits, and providers. This unique and nonsensical arrangement impedes access, cripples business growth, and generates a constant and highly expensive turnover (“churn”) in insurance coverage. By decoupling health care from employment, the task force plan provides stability, improves efficiency, and promotes the economy.

Early access to primary reduces costs and improves outcomes. Early access to primary care (especially behavioral care) reduces later consumption of complex and more expensive care. By eliminating cost-sharing at time of need such as deductibles, co-pays, and coinsurance, the task force plan will improve the medical, social, and economic well-being of all Oregonians. The experience of every other industrialized nation and over 40 studies of single payer in the US (including a 2017 Oregon study by the RAND Corporation) confirm improved efficiency with early access.

Single payer permits providers to spend less time billing and more time caring. Single payer plans offer more care at lower cost by dramatically reducing billing complexity. By using one risk pool (everyone), one benefit schedule (treatable conditions receive treatment), and one network (any patient may see any provide), less money goes to billing and more money goes to health care. The task force plan could allow providers to practice without cashiers. Instead, providers dedicate their time and energy to patients.

Oregon needs new federal legislation to permit state-based universal health care. Federal laws prohibit states from pooling federal and private health care spending into a single payer fund. Current waivers are insufficient. Oregon’s legislature must make a bipartisan appeal to our Congressional delegation to sponsor new federal enabling legislation, also called a “superwaiver.” A better statewide health care system starts with removing federal impediments.

Single payer requires new taxes to replace current private spending. The task force plan replaces what Oregonians pay in premiums, deductibles, co-pays, and out of pocket spending with new taxes. CBIZ Optumas estimates these new taxes are $1 billion less than what Oregonians would otherwise spend annually under our status quo. To fund the task force plan, the legislature must create new taxes with sufficient revenue to replace private spending.

Lastly, the task force plan corrects many health care problems, but not all of them. Our plan provides better care to more people for less money. But this is only a start. Even after implementing our plan, Oregon still faces challenges in equity, housing, food, transportation, long term care, disability care, and many social determinants of health. The task force plan should not be the end but the beginning of creating better and healthier communities in Oregon.

Samuel Metz, MD, is vice president of Physicians for a National Health Program – Oregon and a founding member of Mad As Hell Doctors. He was a member of Oregon’s 2018 Universal Access to Health Care legislative work group, the Oregon Medical Association’s 2018 Universal Healthcare Task Force, and Oregon’s 2019-2022 SB 770 Universal Health Care Task Force. His opinions are his own.