Oregon Doctors Rise Up Against Individual Mandate

Physicians hope to remove roadblock to universal coverage and lower overall healthcare costs

February 28, 2012 -- Three Oregon physicians are among a group of 50 doctors who filed an amicus brief with the Supreme Court arguing that the individual mandate in the Affordable Care Act should be struck down.

The doctors’ friend-of-court brief creates strange bedfellows by essentially arguing that the individual mandate to purchase insurance coverage violates interstate commerce law.

In doing so, the physicians who signed the document, calling themselves progressive single-payer advocates, aligned with conservative groups who are trying to abolish the legislation by using the same argument.

These physicians made it very clear that they support the moral and fiscal arguments for single-payer and universal healthcare in America, however, and believe that the only solution to the U.S. healthcare crisis to control costs and achieve comprehensive coverage for everyone “is to adopt a national publicly-financed single payer health insurance system, in which one public entity handles billing and other administrative transactions on behalf of all participants,” according to the brief filed February 13.

Dr. Paul Hochfeld, who’s worked at Good Samaritan Regional Medical Center in Corvallis as an emergency room physician for 32 years, says he’s not really against Obamacare, but “against pretending” that the mandate is a good fix for healthcare.

“We don’t really want the whole thing thrown out,” he said. “We just want to make sure that everyone is in the same risk pool, so that the insurance companies can’t profit off of the low-risk pools while we still have to pay for the high-risk people, so in essence we’re subsidizing the insurance companies’ profits.”

Dr. Samuel Metz, of Portland, who travels all over the Willamette Valley as a private-practice anesthesiologist, also signed onto the brief because he believes the individual mandate will increase healthcare costs.

It costs society more to deal with an amputee who lacked insurance than to provide ongoing diabetes care or prevent illness, said Metz who also cited examples of his own relatives who’ve been bankrupted by medical emergencies “for getting the wrong disease at the wrong time” even while having health insurance.

“The mandate is a way for Congress to avoid its responsibility to create a progressive tax that would divert the currently wasteful funding going to private insurance companies,” Metz said.

The idea that the government would force individuals to buy a commercial product is also appalling to doctors.

“Even if they’re willing to subsidize this, what are they going to make us buy next?” asked Hochfeld. “If they think that healthcare is a human right and is so important that they need to make sure that everyone gets it, then they need to create a system with the same set of rules for everyone. And if it’s not cost-effective, then the government’s not going to pay for it, and that’s the only way to ensure that we get value our the money.”

The third Oregon signee, Dr. Mike Huntington, a radiation oncologist in Corvallis who retired about five years ago, admitted that he was part of “extravagant use of specialized technologies” at the Samaritan Regional Cancer Center, where the cost of an eight-week course of radiation treatment for people with prostate center rose from $24,000 to $66,000 between 1996 and 2006.

“I saw the tremendous waste of administrative service in the private insurance companies,” Huntington said. “I also saw people coming in with advanced cancers because they weren’t able to afford health insurance.”

Huntington chairs the education committee for the Oregon Single Payer Campaign, which may change its name to “Health Care for All,” and is among the many doctors who are getting tired of the single-minded single-payer movement.

“One of my frustrations with the single-payer movement is the fixation with single payer, because it’s a means to an end,” Hochfeld said.

Nationwide movement

The doctors joined national nonprofit groups Single Payer Action and It’s Our Economy in challenging the government’s claim that the individual mandate is necessary to reach Congress’ goal of universal coverage.

“We want single payer, so we’re trying to get rid of the individual mandate so that the legislation will pass,” said Russell Mokhiber, editor of Common Dreams and founder of Single Payer Action.

“Every year 40,000 to 50,000 people die for lack of health insurance (“Health Insurance and Mortality in US Adults,” American Journal of Public Health, December 2009), and if there were 120 people crashing into buildings every day, Congress would get this thing done,” Mokhiber added. “We believe the individual mandate should get struck down because it’s unconstitutional, and we don’t want to be forced to pay jacked-up insurance. My insurance company is not going to pay a penny until there’s $15,000 out of my pocket.”

A series of presentations and panels arranged by Mad As Hell Doctors and the Oregon chapter of Physicians for a National Health Program kicks off April 26 at Oregon Health & Science University. Dr. Marcia Angell, senior lecturer in the Department of Social Medicine at Harvard Medical School, will discuss physician conflicts of interest and the pharmaceutical industry, and Dr. Arnold Relman, a Harvard professor and former editor of the New England Journal of Medicine, will focus on healthcare reform for physicians.

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They speak to arguments for single payer, but nothing is said about the legal arguments of why the individual mandate violates the commerce clause of the constitution. They failed to prove their argument.

Where were these doctors with these suggestions during the ObamaCare debates or last year when the GOPs in the House held those laughable hearings for ObamaCare replacements that amounted to: 1. criminalize malpractice lawyers 2. allow for purchase of health insurance across state lines(resulting in all health insurance companies moving to Texas, home of a 25% uninsured population, or whatever the most anti-consumer state is. 3. pray I'm a liberal DEM, and I gladly support all proposals. Which proposal do I support most? Generally, I support the comprehensive proposal I hear last the most. That's how open I am. The latest conservative proposal seems to be in favor of simply expanding the current ObamaCare high-risk pools to make low & medium risk pools. Sounds good to me. I currently have the ObamCare high-risk plan for Michigan. Of course, for conservatives to support this proposal would mean admitting that ObamaCare wasn't the worst tyrannical act ever perpetrated by a government against its people in human history, giving Obama & the DEMs credit for their initial legislation, and admittedly flip-flopping on this most bitter battle of our generation, and facing up to that every election to follow for a long time. I'm not sure they are there yet.

The Mad As Hell Doctors of which Hochfeld, Metz and Huntington are members were on the road from Portland, Oregon to Washington, D.C. in September and October 2009 holding public town hall meetings about single payer health care reform in over 40 cities telling the story of how it had been excluded from the debate by Senator Baucus in May 2009 and kept f'off the table' by the insurance lobby through various means. See for yourself at the following link: http://prezi.com/vnkigmljhgy5/single-payer-health-care-reform/

We need universal healthcare. Not this piecemeal expensive complicated mess that we have now...Allhealth Insurance is still out of range for most people That includes the high risk federal plan...600.00 low end for a single person give me a break... Cobra plans.. Retirement plans.. Insurance is to expensive inany way shapeor form...Insurance companies are profiting and most folks remain uninsured.. Iagreewithhe progressive Doctors.

Ha ha, and with a private market, most in Oregon non-profit companies with less than 3% profits and in competition for their very existance, just how is a single governmental agency going to bring the cost down, with no competition for its existance? Folks, until we're willing to allow people to have less care and suffer the consequences, until we as a society, are willing to impliment incentives and sanctions to bring people to become more responsible for their own health maintanence, and until we demand the health care industry become transperant so we can be more responsible consumers, we will fail to even bend the cost curve. You are far short-sighted to even think a single payor system has ANY incentive to lower cost, other than to ration care and dictate what procedures will be provided, and being decided through government, will be a politically driven system.

I want to commend Ray Rendleman and the Lund Report for yesterday's very thoughtful article "Oregon Doctors Rise Up Against Individual Mandate'". I noticed 2 interesting 'Anonymous" comments. I then read the amicus brief that Lund provided to fact check Ray's article, the amicus brief as well as the assertion that they failed to prove their argument. I am not a lawyer but I have spent more than a few years in health systems and public health. Frankly I was quite impressed with the amicus brief, especially the overall argument that the Congress did not consider alternatives to the individual mandate that make this individual mandate unnecessary. I suggest that the Anonymous commentators and those of us who regularly read articles from Lund read the amicus brief carefully. Let's shed more light and less heat on how we can both improve health outcomes and make health care more affordable for all of us. I plan to have my health and social policy students critique this brief to more deeply understand what their generation can be doing to improve quality and affordability. Finally, instead of continuing to encourage partisan perspectives on health that divide us, let's review and discuss documentaries like the new TR Reid 'US HealthCare - The Good News". Mike Leahy

Thank you Mike Leahy for an excellent response - I still have hope that rational thinking and an honorable agenda will eventually lead to a real improvement of our healthcare system from all perspectives - equity, cost effectiveness, and quality. Petra S. Berger Ph.D. RN CPHRM, Salem, OR

If the amicus brief achieves its purpose in having the mandate declared unconstitutional is there even the slightest chance that single payer wouldn't face the same fate? Democrats paid a major price at the polls for enacting health care reform. If it is struck down, do these physicians really think politicians will respond by enacting a much more radical reform?

This is to clarify that the Oregon Single Payer Campaign--Health Care for All Oregon has taken no stance on P-PACA or the mandate for all to buy health insurance. The three Oregon physicians who signed the Amicus Brief did so independently from their affiliations with any organization. Mike Huntington MD