Photos from Mercy Killers LBCC Event

It was great to see so many people and so many new faces at the LBCC performance of Mercy Killers. Thank you to all who helped make the evening a success!

You can help MVHCA as we work for publicly funded universal health care like the rest of the developed world by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

July Events - Many Opportunities to Participate and Volunteer!

Below is a list of our big events coming up in July. Please let us know if you are interested in volunteering to help with any of these. You are also welcome to march with us in the 4th of July Parade and help with tabling at the Saturday Corvallis Farmer's Market. Volunteers are always needed, welcomed, and appreciated!

For the parade come to 8th Street between Jefferson and Monroe at 9:30 to line up wearing your red shirt if you have one. We will have signs for you to carry promoting Health Care for ALL, The parade begins at 10 and proceeds down Monroe Street and ends at the Riverfront.

What: Celebrate the 50th birthday of Medicare, “As American as Apple Pie!”
Hosts: Mid-Valley Health Care Advocates (

When: Saturday, July 18, 11:00 a.m. to 2 p.m.

Where: Riverfront Park in Corvallis, near the Saturday Farmers’ Market.

Why: Medicare, which faced widespread opposition in 1965 and was roundly opposed as “socialized medicine,” today allows 48 million Americans affordable access to health care.

Enjoy music, cupcakes, and short inspirational testimonies - more –


What: “Sick Around the World” documentary by T.R. Reid

When: Thursday, July 16, 7:00 p.m. to 9 p.m.

Where: Darkside Cinema, Corvallis $7

Why: Take another look at why and how most develop countries guarantee access to health care for their people. Discussion to be led by three local physicians.


What: T.R. Reid comes to Oregon, speaks in the Mid-Valley
U.S. Health Care, What to Do About It”

When: Saturday, July 25, 7:00 p.m. to 9 p.m.,

Where: LBCC, Takena Hall, Russell Tripp Theater. Free admission

Why: “Our Costly and Troubled Sick Care System

What: T.R. Reid comes to Oregon, speaks in Salem

When: Saturday, July 25, noon to 1:15 p.m.

Where: Salem Hospital Building D, Creekside Room Free admission, but please register.

Why: “Obamacare: Is It the Answer?”

Krugman: Government Does Health Insurance Better

The New York Times
April 10, 2015
Where Government Excels
By Paul Krugman

Like all advanced nations, America mainly relies on private markets and
private initiatives to provide its citizens with the things they want and
need, and hardly anyone in our political discourse would propose changing
that. The days when it sounded like a good idea to have the government
directly run large parts of the economy are long past.

Yet we also know that some things more or less must be done by government.
Every economics textbooks talks about “public goods” like national defense
and air traffic control that can’t be made available to anyone without
being made available to everyone, and which profit-seeking firms,
therefore, have no incentive to provide. But are public goods the only area
where the government outperforms the private sector? By no means.

One classic example of government doing it better is health insurance. Yes,
conservatives constantly agitate for more privatization — in particular,
they want to convert Medicare into nothing more than vouchers for the
purchase of private insurance — but all the evidence says this would move
us in precisely the wrong direction. Medicare and Medicaid are
substantially cheaper and more efficient than private insurance; they even
involve less bureaucracy. Internationally, the American health system is
unique in the extent to which it relies on the private sector, and it’s
also unique in its incredible inefficiency and high costs.

And there’s another major example of government superiority: providing retirement security... (more here).


Comment by Don McCanne of PNHP

Next week, when the Senate returns from its break, they will likely approve
House-passed H.R.2 - the “SGR fix” - a bill that is being used as a vehicle
to move Medicare closer to privatization by taking small incremental steps
in increasing Medicare premiums and deductibles - features that are more
characteristic of private individual plans than public social insurance

Paul Krugman reminds us that governments are better at providing health
insurance. So we should reject the current bipartisan efforts that are
moving us further in the direction of converting Medicare from a public
insurance program into a premium support model (defined contribution
vouchers) of a market of private health plans.

This week’s taxpayer boost given by the Obama administration to the private
Medicare Advantage plans - the fourth such devious boost in the past four
years - enhances the private plans to set them up as a model for privatized
Medicare. Is there no stopping this?

Help MVHCA as we work for Improved Medicare for All by donatinghosting a house party, signing up for the newsletter, and attending our monthly meetings. You can also Like us on Facebook, and Follow us on Twitter. Thank you.

Why Vermont Failed to Enact Single Payer? (Part 1)

Guest Opinion by Dr. Samuel Metz on the Lund Report:

Its collapse was a legislative failure, according to this author, which Oregon legislators deserve support so the same problem doesn't befall us.

Drawing unwanted national attention to his tiny state, Governor Peter Shumlin pronounced Vermont’s quest for universal health care Dead On Arrival. This statement broke the hearts of activists who previously cheered passage by the 2011 Vermont legislature of Act 48, the first step toward America’s first statewide universal care plan.

But this collapse was no ordinary failure. It was not a failure of universal care, or of single payer, or even of Gov. Shumlin himself. This was a spectacular failure of a very different nature, and one with valuable lessons for Oregon. But we must learn the right lessons, not the wrong ones.

The Wall Street Journal called this a failure of universal care to reduce costs. Not true. Not only was the universal plan never implemented, all predictions in Vermont’s universal care study, prepared at the request of the legislature by Dr. William Hsiao, remain valid. Regardless of costs, universal care in Vermont would still provide better care to more people for less money. Dr. Hsiao’s conclusions are corroborated by more than two dozen other studies in 14 states that come to the same conclusion.

Megan McArdle of Bloomberg View called this a single payer failure. But this was not a single payer failure because Vermont did not enact single payer. Vermont made a valiant effort to provide universal health despite many federal laws, including Medicare, ERISA, and the Affordable Care Act, that make single payer impossible in any state. Instead, Vermont created a work-around in which Green Mountain Care, the proposed state health care program, would have included less than 60% of its population; Vermont’s proposal included multiple payers, not just the state single payer.

James Haslam, executive director of the Vermont Workers' Center and a respected leader in Vermont’s campaign for universal care, labeled this as Gov. Shumlin’s failure. But as tempting as it is to blame the messenger, this failure was not Gov. Shumlin’s. Governors do not enact legislation; legislatures enact legislation. Vermont’s 2011 legislature dared to establish a universal care plan, but it left enactment of the taxes to fund that care to the 2012 legislature. The 2012 legislature left the task to the 2013 legislature. The 2013 legislature left the task to the 2014 legislature. When the 2014 legislature left the task for the 2015 legislature, Gov. Shumlin did not need a Hebrew prophet to read the writing on that wall. He simply stated the obvious: No Vermont legislature in the foreseeable future would take that responsibility. He pronounced the death; he did not kill the patient.

The collapse of the Vermont plan was a legislative failure, clear and simple.

For the record, Gov. Shumlin and the majority of legislators were Democrats.

No matter how expensive health care becomes, private insurance costs more than single payer. In every population – the poor, the sick, the elderly, employees of large businesses who self-fund, our veterans – single payer costs less.

But Vermont legislators did not believe they could vote for replacing insurance premiums with single payer taxes and still get re-elected. Neither did Gov. Shumlin.

Gov. Shumlin attributed the death of Vermont’s universal care plan to runaway healthcare costs and the increased taxes needed to pay those costs. Both are true: Vermont’s healthcare costs are rising (like every other state) and higher taxes would be necessary to match them. But universal care does not generate higher healthcare costs. It converts what we currently pay privately (i.e., employer premiums, family premiums, deductibles, co-pays, out of network payments, and excluded medication costs) into taxes. Premiums, out of pocket payments, taxes – it’s all our money, just different labels.

And while the efficiency of single payer reduces total healthcare costs (not dramatically – most studies, including Dr. Hsiao’s, suggest a modest 5-10% reduction), the primary advantage of single payer is guaranteed access to healthcare that costs less, that removes fear of bankruptcy, and that does not depend upon employers.

What is Vermont’s lesson for Oregon?

Our legislators need our unequivocal support before they will make bold decisions: not just to enact universal healthcare (like Vermont), but to create the tax plan to fund it (unlike Vermont).

Legislators will not respond to our need for universal healthcare unless we tell them. Legislators will not vote for new taxes to fund universal healthcare unless they know they have our vote if they do. Enabling our legislators to avoid the debacle of Vermont requires us to take our message directly to their offices: We want universal care. We want them to make it happen. And we will vote for them if they do.

We must give our legislators courage (and our votes) to do the right thing. That’s Vermont’s lesson for Oregon.

Samuel Metz, MD, is a private practice anesthesiologist in Portland. He has collaborated with Oregon State Sen. Michael Dembrow on passing the HB 3260 study of financing options for universal health care in Oregon. Dr. Metz can be reached at More information about the HB 3260 can be found at

Jan 8 2015

Get involved today with the Oregon campaign for publicly funded universal health care.  Attend our the Rally on the Capitol Steps on February 11, and attend our monthly meetings.

Handling the Tough Questions about Single Payer

In preparation for the February 11 rally in Salem and to otherwise help the cause, you are invited to practice your persuasive skills. We will get together from 1-5 PM on January 10 at the First Presbyterian Church, 114 Southwest 8th Street, Corvallis, OR 97333. Discussion leaders will include Mike Huntington; Tim Roach, retired  Presbyterian minister; Sandi Bean PhD, Public Health; and Charlie Swanson, chair of the ballot measure committee for Health Care for All Oregon.  RSVP Mike Huntington or Tim Roach

You can also view the event on Facebook and invite your friends here.

Why Did Swiss Voters Reject Single-Payer Health Care?

Supporters of a single-payer, Medicare-for-all health care system in the U.S. were puzzled September 27 when Swiss voters rejected a reform proposal by 62 percent.

The new law would have replaced the current system, where about 60 insurance companies offer mandatory health coverage, with a single insurer, the government. It would have offered all medically necessary care, paid for by taxes adjusted to each person’s ability to pay.

To Americans who’ve worked for such a system here, nationally and state by state, it was a blow. What’s not to like about single payer?

Swiss and American media, academia, and business sectors rushed to interpret the results. Virtually all crowed that the Swiss people had rejected government-run national health insurance because they preferred private insurers.

But these convenient interpretations rely on false assumptions to justify a model of health insurance that is unraveling—less conspicuously in Switzerland, but dramatically in the U.S.

Let’s look at what’s wrong with these pro-business interpretations, and see what lessons the Swiss referendum has for single-payer advocates here.

Mainstream Answers

Washington Post “policy wonk” Jason Millman wrote that the Swiss rejection shows that single-payer has little chance of gaining popular support in the U.S.

He notes that in 1996, the Swiss voted for an individual mandate that compels everyone to buy a basic package of health services. That law eliminated discrimination for pre-existing conditions, meaning companies have to sell equal plans at equal prices to all customers. The government subsidizes low-income people. In Millman’s view, the resulting Swiss system is very much like Obamacare.

Another policy reporter, Avi Roy from Forbes, asserted that Obamacare (and Romneycare before it) was modeled on the Swiss system: people shopping among competing private plans with little government interference.

Roy says the referendum demonstrates the “political popularity” of universal coverage via private insurance. He concludes that because the Swiss have rejected single payer, there’s good reason to believe Americans will reject it, too.

What’s Wrong with the ‘Official View’?

These interpretations are based more on ideology than on facts. Why?

First, Swiss health care is not a version of Obamacare. The differences are critical to understanding the implications of the Swiss referendum for health care reform here.

Second, Swiss health care, though far superior to ours in terms of access, quality, and equity, has critical problems that threaten the system. Those problems illustrate why, four years after Obama signed the Affordable Care Act into law, health care access, quality, and equity are increasingly threatened here too. The Swiss is a model to reject, not to embrace.

Third, the referendum does not prove that the Swiss don’t want government involvement in health care, nor that they like private insurance companies. Quite the opposite.

Indeed, an analysis of a series of referendums over several years shows that, like the U.S. population, the Swiss are increasingly unhappy with treating health care as a business, rather than a social good.

1) Obamacare is not a version of the Swiss system.

The current National Health Care Law, known as LaMal, requires that everybody living and working in Switzerland carry health insurance—we call this an “individual mandate.” So the Swiss are required to purchase insurance for a uniform, comprehensive package of medical services.

But the national government operates at every level to make everything run smoothly. To more than 50 percent of the population, the government offers full or partial subsidies to purchase insurance. So more than 99 percent of the population is covered.

The government also compels insurers to sell policies to everybody at the same price, irrespective of health status, medical history, gender, age, or location (within each canton, the administrative equivalent of a U.S. state). A 25-year-old and an 80-year-old pay exactly the same premium for the same plan. The only exception: those under 25 pay substantially less.

If your income changes, or job changes, or marital status changes, your doctor need not change.

The government also enforces a “basic” package that is very comprehensive—in the U.S., some call it “Cadillac,” as if only spoilt Americans would dare demand it! Thus basic insurance, Swiss-style, includes outpatient care—essentially whatever a doctor prescribes—hospital care, mental health, all pharmaceuticals on the government’s list, some rehabilitation services, some dental care, some herbal medicine, and acupuncture.

Importantly, the government forbids insurers to make a profit from the sale of the mandatory package, and it compels them to contract with every single health care provider in Switzerland.

The government also imposes a system of risk equalization. It compensates companies that enroll individuals with more expensive medical needs, taking the money from companies that enroll healthier users.

The government also compels mechanisms to deal with prices. Within each canton, prices must be negotiated between associations of providers and insurers, and everybody must abide by them. So providers within a canton are paid equal amounts for equal services, regardless of which plan the patient has.

Finally, the state also enforces limited deductibles (about $300 U.S.) in all plans, and a maximum out-of-pocket cost of about $700.

Users can choose to purchase cheaper policies as a trade-off for higher deductibles (up to 2,500 Swiss francs, or about $2,500 U.S., for adults, and 600 francs, or about $600 U.S., for children). They can also choose policies with restricted provider networks, though few do.

As you can see, this looks nothing like “no government interference.”

Obamacare: A Reality Check

Nor does it look like a version of Obamacare. A few comparative points:

  • Obamacare does not cover 100 percent of the population. In fact, more than 30 million people living in the U.S., the majority of them citizens or legal residents, will remain uninsured by 2024, according to the Congressional Budget Office.
  • Obamacare does not guarantee a homogeneous, generous basic package of services.
  • It does not guarantee equal prices for equal services—hence all these calls for greater transparency of prices so “consumers” can shop more productively! Prices vary according to age—older people pay up to three times as much—geographical location (over 18 different ones only in California!), even gender composition of the workforce insured.
  • Providers under Obamacare are paid differently depending on the patient’s plan—which is unheard of, and would be scandalous, in Switzerland.
  • Obamacare does not guarantee access to every provider in your state—only to providers in your plan, and only as long as your plan does not change.
  • As to maximum out-of-pocket, we’re not even close to the Swiss.
  • As to the celebrated choice of plans, it hardly applies to the 160 million Americans with employer-sponsored coverage (now 60 percent of the non-elderly population; it was close to 70 percent back in 2000), who are stuck with whatever “choices” their employers offer (assuming they offer any).
  • Last and not least, insurers in the U.S. can and do make a profit for selling you insurance for medically necessary care. Which is the only reason they are in the business of selling insurance!

So the belief that Swiss health care and U.S. health care after the ACA are “more or less the same” is quite misguided.

At the center of the ACA is a well-oiled money-making machinery for the medical-industrial complex: insurance companies, Big Pharma, and for-profit (and many non-profit) medical establishments.

2) Over the last decade corporate interests have hijacked the Swiss system, despite the strong government oversight.

This has led to increasing overall and out-of-pocket costs, making the Swiss system the third most expensive in the world.

To control costs, the Swiss government has promoted managed-care options and encouraged users to comparison-shop. So in addition to the classic comprehensive plans, insurers are offering narrower provider networks and higher deductibles and co-pays, and users are prompted to choose plans annually.

However, the Swiss appear not to like all these “new choices” after all, because in a 2012 referendum more than 70 percent voted against a dramatic expansion of managed care, proposed as a key mechanism to “control costs and improve the system.” And only a very small minority chooses to change plans every year.

Last, a growing number find health care unaffordable and are failing to pay their premiums.

Simply put, all the problems the Swiss are grappling with are rooted in the for-profit nature of the companies that participate in the system. As these companies become more financially successful, and hence more powerful, they get harder to tame—and their influence on the politicians who decide health policies grows stronger and stronger.

Clearly, even in the best-case scenario—the highly regulated environment of Swiss private insurers—entrusting them with the provision of health care is assigning a fox to guard the henhouse. The attempt to achieve justice in health care via competing private insurers is a pipe dream.

3) The defeat of the single-payer referendum does not mean the Swiss people reject a government-run system and support private insurance.

The Swiss have rejected almost all referendums since 1891—only 20 out of 191 have succeeded, even when issues were popular.

Critically, one successful referendum was LaMal, the 1996 health insurance law that banned profit from the sale of medically necessary care. It also allowed the government to pass on money from companies spending less on patient care, to those spending more—certainly not an indicator that the Swiss shun “government interference” on behalf of ordinary people, nor that they trust private insurance to do well by them without supervision.

Also worth noting: in 2007 single payer was rejected by 71 percent, but the figure fell to 62 percent in 2014. Maybe the Swiss are beginning to cut through the anti-single-payer propaganda?

Further Reading

For a detailed comparison of the U.S. and Swiss systems, see my article “Is the Swiss Health Care System a Model for the United States?”

For a thorough, albeit ideological (i.e. supportive of “market forces”) review of the current state of the Swiss system, see the 2011 OECD report.

For a full “reality check” of the Affordable Care Act, see “Why do Americans still need single-payer health care after major health reform?”

To understand the single-payer movement’s recent setback in Vermont, and what comes next, read “Vermont Governor Backs Away from Health Care for All.”

Lessons Learned

Why, then, was single payer defeated? What can we learn?

In this article from Labor Notes, Claudia Chaufan  discusses the recent rejection of a single payer referendum in Switzerland and how it relates to the ACA and the campaign for universal coverage in the United States..

First, we need to grant that the state of Swiss health care may be of concern for the Swiss (they seem to have lower tolerance than we do!), but it is still not as bad as in the U.S. People who experience the greatest barriers to care in Switzerland are the most politically disenfranchised—the young, poor, women, immigrants, much like here—so the problem has yet to affect the so-called middle class enough to pass a referendum.

Second, we can see the extraordinary power of corporate propaganda. The scare tactics deployed by corporate interests in Switzerland were quite extraordinary, both in 2007 and this year. Likewise, their interpretation of the results was designed to discourage supporters of public health care—to make us think we’re more alone than we really are.

The Swiss referendum teaches us that:

  • We need to sharpen our understanding of what the ACA is really about, who our enemies are, and what our alternatives could be.
  • We must increase our outreach to the disenfranchised, to those who don’t think their voices make a difference.
  • And we must work on improving our political education of those we wish to reach—rather than watering it down to sound bites that fit within the boundaries of the “politically feasible.”

Claudia Chaufan, MD, PhD, is an associate professor at the University of California San Francisco and a member of Single Payer Now and of Physicians for a National Health Program.

- See more at:

Glimpses of the CCO Summit- Achieving Health Systems Transformation?

December 4, 2014

Report by Lee Mercer, President Health Care for All-Oregon
December 4, 2014

Speaking to 1300 plus attendees at the Coordinated Care Organization Summit in Portland, Susan Johnson, Regional Director, US Department of Health and Human Services (Region 10) said Oregon is “leading the nation like a North Star” towards creating a sustainable model of health care for the future. Nichole Maher, President of the North West Health Foundation sees the key to health in our communities and health outcomes being now defined by zip code, race, income and other social determinants. She thanked Governor Kitzhaber for a budget reflecting dedication to health equity.

Kitzhaber outlined some of the successes of Oregon’s recent initiatives— 95% of Oregonians have health insurance and a million have enrolled in a new health care model. As the CCO’s start covering public employees we are moving towards savings that culminate in a structural budget surplus in 2123.

Building on this theme, keynote speaker Don Berwick, MD, former administrator, Centers for Medicare and Medicaid Services, and Founding CEO, Institute for Healthcare Improvement, praised Oregon and the attendees of the conference. “Bravo! You’re doing something amazing—there is a bright light here.”

But, he noted, there is “a burden of leadership for Oregonians as pioneers.” Pioneers are bound to experience uncertainties. He said Oregon should sense the importance of what we are doing and maintain cooperation—unprecedented levels of cooperation. Everyone must be willing to give up something as we stay focused on the triple aim of better care, better health and lower cost. The cost of health care is inhibiting us from being what we want to be as a nation.

His thesis, illustrated by graphs showing escalating costs, is that health care is “confiscating” opportunity in terms of eating up public finance. As premiums rise faster or through taxes), it is all, sooner or later, coming out of the pockets of the workers. And it means that health care is stealing from all the other programs that government might be providing.

He sees the health care system metaphorically like the Choluteca Bridge, in Honduras. Built well by US engineers, it has weathered every storm for generation, but, over the years, the river has moved and the bridge is no longer relevant.

To make health care relevant and effective, Berwick noted, we must begin treating it as a human right and build a system which is cost effective and sustainable. He sees a need for developing a cooperation index in our work. A focus on transformation and not the finances. He concluded by congratulating Oregon again on its successes, adding “the country needs you!”

Numerous Health Care for All Oregon advocates, proudly wearing their red t-shirts proclaiming health care as a human right, were disappointed that Berwick, an outspoken supporter of single payer as a candidate for Governor in Massachusetts, didn’t mention this needed systemic reform. He probably didn’t want to steal the thunder of the progress in reducing health care costs by Oregon’s CCO system.

Then a series of speakers outlined how they have organized their CCO’s in communities throughout Oregon. Much emphasis was on building the Community Advisory Councils that guide CCO’s. A number of moving personal stories illustrated the partnering of behavioral, physical and dental health specialties throughout the state. Also, stories emphasized partnership with early childhood education.

Kevin Campbell, a former business man and now CEO of Greater Oregon Behavioral Health, Inc. noted that, in Eastern Oregon, it was less about talking health care transformation and more emphasizing community strengths and local control. A big piece was doing Community Health Improvement Plans. In their vast region, 12 counties developed 12 independent plans and then found a unifying consensus. Not only did they serve Medicaid/OHP users, but philanthropic support was forthcoming which meant many of the facilities and services are available for all in the communities. One grant was given for each county, and the OHSU Center for Evidence Based Policy helped assess the grant projects.

CCO 101

Judy Mohr Peterson, Director of Division of Medical Assistance Programs (Medicaid) at OHA, spoke in a break out group providing an overview of the Coordinated Care Organization system. She started by outlining the reasons for the need for transformation:

  • Health care costs are unsustainable

  • Health outcomes are not what they should be

  • Lack of coordination between physical, behavior and dental health

Previously, during a budget crisis, there were three ways to deal with a shortfall of Medicaid dollars. One was to cut people, and thus began the lottery for OHP participation. Another was to cut benefits- this often meant cutting mental health, dental health or prescription drugs, all of which are optional under Medicaid. Finally, they could cut provider rates.

Under Kitzhaber’s vision of the triple aim, the goal was better health, better care and lower costs. Not just one or two, but all three. So Oregon set out to reduce waste, improve health and take steps to build a more sustainable model.

There are now 16 CCO’s, and 95% of 1,000,000 folks on Medicaid are enrolled. Mental, physical and dental health are all in one budget. Incentives are in place for quality and achieving growth limited to 3.4% (a cut of 2%).

Mimi Haley (Columbia Pacific CCO) and Coco Yackley, Operations Manager, Columbia Gorge Health Council, outlined more of the nuts and bolts of putting CCO’s together. In the Gorge the CCO was embedded in an existing organization (Pacific Source). The Community Advisory Council was formed, giving Pacific Source one vote, with 50% consumers and 50% “at risk” (financially) organizations. The Clinical Advisory Panel (optional) was also formed.

The Columbia Pacific CCO was formed in the coastal counties of Clatsop, Columbia, Tillamook and Douglas. It operates under a global budget as a wholly owned LLC of Care Oregon in partnership with Greater Oregon Behavioral Health. There are 15-20 directors. One seat each is held by Care Oregon and GOBH. There are 4 Community Advisory Councils, one for each county. They have grown from 7,000 to 25,000 members. Some of the health strategies include Health Home Assessments (discovered a woman who used oxygen has carbon monoxide leaking from her furnace—after repairing, she no longer required oxygen) and Health Resiliency (trauma informed support to “high utilization” patients).

Among challenges cited by the CCO’s include billing issues, different payment models and provider shortages. They couldn’t give metrics on provider shortages, but noted that most dentists in the area do not take Medicaid. Coco Yackley quipped that she could “see why single payer would help” due to the complexity of the various payment systems. Well child visits paid for by Medicaid, may, in a private insurance plan, be on a different annual calculation, so those patients may have to pay out of pocket.

Appreciating the opportunity to learn about the cost savings and system improvements being pioneered in Oregon’s Community CCO transformation, a nagging question remains. If this system is indeed more patient centered, why are all the metrics cited for its success, cost saving outcomes, not health outcomes?

In the Executive Summary of the 2013 Performance Report large improvements cited are:

Decreased emergency department visits. Emergency department visits by people served by CCOs have decreased 17% since 2011 baseline data. The corresponding cost of providing services in emergency departments decreased by 19% over the same time period.

Decreased hospitalization for chronic conditions. Hospital admissions for congestive heart failure have been reduced by 27%, chronic pulmonary disease by 32% and adult asthma by 18%.

Developmental screening during the first 36 months of life. The percentage of children who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21% to 33% in 2013, an increase of 58%.

Increased primary are. Outpatient primary care visits for CCO members increased by 11% and spending for primary care and preventive services are up over 20%. Enrollment in patient centered primary care homes has also increased by 52% since 2012, the baseline year for that program.

So cost savings are great and more screenings and primary and preventative services are wonderful.

But where are the patient health outcomes? How is the health of the folks not doing emergency room visits? Are they managing their congestive heart failure, chronic pulmonary disease and adult asthma? And how is the health of the kids being screened and patients getting primary care services?

At some point beyond cost savings and increased services, health outcomes need to be the final measure of a sustainable health system. When we have metrics which say that, in Oregon, we have achieved the lower infant mortality and higher life expectancy rates, the lowered rate of disease and the other health outcomes achieved by all industrialized countries which have in common universal, publicly funded health systems, we can say we are fully succeeding in transforming our health system.

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Implementing a Universal Healthcare System Costs Less, Provides Better Care

The U,S. spends more money on administrative costs than anywhere in the world, according to a recent article in Health Affairs. (note: comment and response by Dr. Metz added Nov. 22.)

Guest Opinion by Dr. Samuel Metz on the Lund Report.

Dr. Samuel Metz speaking at the  MVHCA Annual Picnic , August, 2014.

Dr. Samuel Metz speaking at the MVHCA Annual Picnic, August, 2014.

OPINION -- Honoring a rather unpleasant tradition, the September issue of Health Affairs published yet another peer-reviewed study confirming that administrative costs in the U.S. healthcare system are the highest in the world. These administrative costs do not improve patient care. They pay for more administrators.

Each American physician requires 10 administrators to stay in business. Why does American healthcare require twice as many administrators as any other healthcare system?

Because these additional administrators perform a function totally unnecessary in other countries: They restrict access to healthcare and limit benefits of patients who do gain access.

If restricting access and limiting benefits produced a healthier population at lower cost, then Americans could be proud of our massive number of administrators. But the U.S. does not have a healthier population and our healthcare is not inexpensive. In fact, our public health is the worst in the developed world, and our healthcare system is the most expensive of any nation on the planet.

Some blame government bureaucracies for these excessive administrative costs. But let’s not be hasty. Per patient, private insurance overhead exceeds that of Medicare, Medicaid, and the VA – combined. We may have doubts about our government to spend money in other areas, but when it comes to reducing the administrative costs of health care, government programs are ten times as efficient as private insurance.

Restricting access and limiting care is an expensive process, consuming more money than we would spend simply providing unrestricted access and treating all treatable diseases. How do we know? Because every healthcare system in the world that implements universal care without limiting benefits ultimately provides better care to more people for less money.

Where does our private insurance model lead us astray? The primary goal of insurance companies, like all other businesses, is to make more money than they spend. But an insurance company cannot stay solvent selling comprehensive policies at affordable prices to people who will get sick. So insurance companies spend a lot of money to avoid populations that include sick people, to shift costs to patients, to limit benefits, and to exclude physicians who care for patients with expensive diseases (e.g., AIDS, cancer). After all, who will buy a policy that lets you go broke before you get better?

How much money do insurance companies consume in their (so far successful) efforts to avoid selling policies to sick people and limiting their care? A conservative estimate is $400 billion annually (that’s $5 billion annually in Oregon).

How much would the US spend if we simply provided comprehensive care to everyone? About $300 billion ($3.3 billion in Oregon).

The math produces an inescapable conclusion. If Oregon diverted all the money we currently spend to restrict access and limit benefits and instead invested directly in healthcare, we could provide comprehensive care to everyone and save ourselves $1.7 billion dollars.

There is no mystery. A statewide healthcare program that diverted all the money we currently spend on insurance premiums and out-of-pocket payments into a single agency that paid for comprehensive healthcare for everyone would cost less than we spend now. Not only that, but all Oregonians would enjoy healthcare when they need it, no matter what their employment status might be. We just need to stop paying money to restrict access and limit care.

It’s obvious that the barriers to healthcare cost more than providing healthcare. If we commit to universal healthcare in Oregon, we can not only save money but get better care.

Samuel Metz is a private practice anesthesiologist who lives and works in Portland.  He is a member of Physicians for a National Health Program and a founding member of Mad As Hell Doctors, both of which are organizations that advocate for universal health care in Oregon and nationally. He is collaborating with State Sen. Michael Dembrow on finding private funding for the HB 3260 study of financing universal health care in Oregon. He can be reached at

Comments posted on the Lund Report


Submitted by danneils on Thu, 11/13/2014 - 16:32   I'm sorry to attack this commentators premise, but the vast majority of Oregonians are already on a government run program. We just gave 300,000 more Oregonians free medical and dental coverage through the Oregon Health Plan's Managed-Care program. Are you honestly going to tell me these 300,000 people in the 'government run' system are getting that happy freedom you seek? Instead of having that freedom of choice, they are have a limited doctor selection, care management, many top specialists not participating, and those administrators are alive and well to make decisions about expensive procedures. On the other side, for those smaller amount of folks in the private-pay system, they are being offered over 100 different plans from 10 companies with no waiting periods for pre-existing conditions. The Marketplace is making it affordable for many, and many are offered a huge doctor networks where they can self-refer to the provider of their choice (Providence alone has around 12,000 providers statewide. Are we really to believe that if the smart people can assemble a single-payor system in Oregon we'd suddenly get the best of both worlds? Trying to point at administrative costs alone as the problem is short sighted.

Submitted by samuelmetz on Sat, 11/15/2014 - 06:17

Danneils makes important points. In reply, here are statistics from the Oregon Insurance Division annual report. About 42% of Oregonians get health care through a government program (primarily Medicare and Medicaid). Because not all physicians accept patients in these government programs, physician choice for these patients is limited. These patients are not free to “self-refer.” About 47% of Oregonians get health care through their employer. Because their employer picks their insurance company and their insurance company picks their physicians, physician choice for these patients is limited. These patients are not free to “self-refer.” About 6% of Oregonians get health care through individual policies. Because only a limited number of companies offer individual policies and the insurance company selects physicians, physician choice for these patients is limited. These patients are not free to “self-refer.” (1) About 200,000 Oregonians have no insurance and no means to pay. Because they lack both insurance and money, they have no choice of physician. These patients are not free to “self-refer.” We should remember that emergency care is not free. While patients with urgent needs cannot be turned away, patients are billed for emergency services and risk bankruptcy if they cannot pay. Other people (like Danneils and me) ultimately pay for their emergency care through higher taxes and higher premium prices. “Affordable” insurance refers only to the price of the premium. Families with “affordable” insurance with high-deductibles may find they cannot afford deductibles, co-pays, excluded conditions, or services from out-of-network physicians. Thus many Oregonians with private insurance policies risk bankruptcy or death if they get the wrong disease at the wrong time. This is called “under-insurance”. Many patients with high-deductible insurance still have a “waiting period” because they must wait until they accumulate enough to pay the deductible. About 500 Oregonians die each year because they never accumulate enough money. In summary, I agree with Danniels that our current system fails to provide us with guaranteed access to health care, or with affordable health care, or with patient choice of physician, or with protection from medical bankruptcy. This applies to both private and public health care programs. Most Oregonians, insured or not, are just one hospitalization away from financial catastrophe. Danneils ultimately asks, “Are we really to believe that if the smart people can assemble a single-payer system in Oregon we'd suddenly get the best of both worlds?” The answer is Yes. A single payer agency, be it private or public, that collected all money currently paid in premiums, out of pocket expenses, and taxes which then paid for all treatable conditions for all Oregonians and included all physicians, would provide us with the care we need with maximal physician choice and at lower cost.

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Despite ObamaCare, US Health System Still a Complete Mess

In this recent article in the Daily Beast by Molly Worthen, the author writes about how difficult it is to find out what medical procedures will cost and how much insurance will pay. She makes the point that single payer health care would be a much simpler system.

“How can we tell how much we’ll have to pay in total, assuming it’s a routine birth?” my husband asked.

“Oh, I couldn’t tell you that,” Tami said. Despite churning through droves of pregnant patients each year—many of whom are, like me, insured by the Blue Cross Blue Shield state employee plan—she had no information on what anything would ultimately cost. “Call your insurance company,” Tami said.

This is the evil genius of the American insurance system. No one has any information, and no one is responsible. I was reminded of the opening scene in Franz Kafka’s The Trial, when the officials who rouse Josef K. from bed to arrest him on an unexplained charge tell him they have no idea why he is under arrest: “We’re lowly employees who can barely make our way through such documents,” one says. 

All are part of the growing economy of people—all very nice people, I’m sure—who have college degrees in medical billing and coding, who make their living feeding the bureaucratic beast that cost consumers $200 billion in excess administrative fees in 2009. Much of that waste would vanish if the United States adopted a public single-payer system of the kind that most developed countries favor.

A truly free market requires all parties to have access to the same information—and the time and expertise to interpret that information. Healthcare, by contrast, is an economy of specialized goods that most lay people don’t fully understand, in which insurance companies and many healthcare providers have a vested interest in concealing prices from consumers. And I’m always surprised by how few doctors seem to know the cost of treatments they prescribe. The Affordable Care Act may be better than no reform at all, but the law subsidizes this broken private insurance system. It also adds over 10,000 pages of regulations to the already byzantine bureaucracy that makes American healthcare one of the least cost-efficient in the world—behind even Venezuela and Iran.

For more information about single payer health care, check out our FAQ page.