Panel on Health Reform Focuses on Ditching the Insurance Industry

Prominent healthcare critics speaking in Portland staunchly support and defend a single payer system

April 27, 2012—Three prominent critics of the country’s current healthcare system and ardent reform advocates appeared in Portland today to discuss their views on health reform, President Obama’s Patient Protection and Affordable Care Act, and what ought to be done to ensure that everyone has access to quality healthcare.

Cathy Schoen, senior vice president of the Commonwealth Fund, spoke, as well as Drs. Arnold Relman and Marcia Angell, former editors of the New England Journal of Medicine. Dr. Bruce Goldberg, director of the Oregon Health Authority, also participated. The event was sponsored by the advocacy group, Mad As Hell Doctors and Physicians for a National Health Program.

Schoen put the United State’s healthcare system in the context of other Western, developed countries. “We are the most expensive country in the world in what we spend per person, and in our share of the economy,” she said. “And we don’t get the outcomes that you expect.”

The United States, she said, spends 18 percent of its gross domestic product (GDP) on healthcare.

“A very complicated system,” she said, and that complication requires time and resources to deal with certain parts, particularly the insurance system.

The insurance system was what Relman pointed his finger directly at as the sole reason for why the country’s healthcare system has become a “fragmented” “shambles.”

“We run our healthcare system as if it’s a business in the free market…and not like the social service it ought to be,” he said. “In no other country do they make that terrible mistake.”

He also said that “we believe in the myth that the private market—private capitalism—can work as well in healthcare as it is reputed to work in other areas [of the economy].”

His impassioned lecture, which one of the moderators joked had as much “fire and brimstone” as a Sunday sermon, asked what good does a private insurance do?

“Nothing,” he said. “They pass money from one pocket to another and keep part of it for themselves. They are simply middle men who have intruded as parasites onto the healthcare system.”

Relman is an advocate of a non-profit single payer system were everyone would pay a “fair, graduated” tax, and the government would heavily regulate the system, including setting monthly premiums and determining the benefit package, which would be the same for everyone. Such a system, he said, would not create any “inappropriate economic incentives.”

The idea of a implementing a single payer system in Oregon has persisted for years, but it hasn’t gone anywhere. A bill introduced in the 2011 session died in committee.

John DiLorenzo, an attorney and lobbyist, advocated for legislation during the 2011 session that would have created a sales tax, using the revenue to pay for a state-sponsored healthcare system. That bill also died in committee.

Since then, an advocacy coalition has been organized to spread awareness about a single payer system in Oregon. And Rep. Michael Dembrow (D-Portland) has publically stated that he intends to reintroduce legislation during the 2013 session to create a single payer system.

Dr. Marcia Angell, Relman’s wife, gave an overview of President Obama’s Patient Protection and Affordable Care Act, which she argued is a “step in the wrong direction,” because it’s financially unsustainable.

Dr. Bruce Goldberg, the director of the Oregon Health Authority, who spoke last, agreed with the previous speakers, and didn’t discuss healthcare financing, but focused on how Oregon’s Medicaid system is about to change with the creation of coordinated care organizations.

He told four stories—the first about an elderly woman with congestive heart failure, who lived in a hot apartment and had to go to the hospital after she had a heart attack. All that she needed to be healthy, Goldberg said, was an air conditioner. “Our healthcare system doesn’t recognize that as medicine,” he said. “There’s no billing code for an air conditioner.”

The second story was about a rural hospital that began to lose money because people were visiting the emergency room less often after three doctors decided to provide care between 7 a.m. and 11 p.m. “The incentives were wrong,” he said.

The third story recounted how a 10-year old with asthma, who had visited the emergency room multiple times, improved after a community health worker visited his home and worked with his family to remove some toxic household cleaners and other factors that exacerbated his asthma. “That should the vision of our healthcare system in a lot of ways,” he said.

The fourth story told how an elderly man with congestive heart failure was able to live a healthy and independent life at home after he began participating in a pilot program that provided coordinated care through patient teams.

The first two stories, Goldberg said, represented problems that he expects coordinated care organizations to solve. Coordinated care organizations, or CCOs, are expected to begin serving the state’s 650,000 Oregon Health Plan patients this August, and integrate their physical, mental and dental health.

“If this works with Medicaid, and our most vulnerable citizens, that’s going to be a model for all the rest of us,” Goldberg said. “All of us want an easier healthcare system.”

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I am a physician and from my perspective, which I realize has its limitations, agree. New technology is no doubt contributing to the unsustainable costs, but is probably secondary to ordering/prescribing the "latest and greatest." If the latest technology/meds weren't prescribed, their costs would not be incurred. The public perceives lower/older cost options as inferior and prefers the more expensive option assuming that cost has something to do with quality. So how do we get physicians as a group to educate the public that "more" isn't necessarily better?