Thoughts inspired by the magnificent testimony at the hearing, supporting SB 631

by Samuel Metz. M.D.

What does “insurance” mean?
Outside the US, “insurance” refers to that particular nation’s format for universal care. Within the US, “insurance” is an industry that restricts health care only to paid policy holders and limits the care of policy holders only to what the contract obligates. Those obligations are proprietary information that the company will not reveal to consumers who might purchase a policy, nor to policy holders before they seek care, nor frequently even to physicians providing the care until after the care is provided.

Clearly, no one in the US needs more “insurance.”

Even though civilized countries with universal care talk about “insurance,” we should not. We should talk about universal care.

Should we advocate for more private health insurance policies?
Every country manages to provide health care to the healthy and wealthy. The US does so through private health insurance. Providing care to the sick and poor is another challenge which every industrialized nation has met, except us. American private health insurance was not designed to provide care to the sick and poor. No American insurance company can stay solvent selling comprehensive policies at affordable prices to sick people.

This is true regardless of whether the insurance company is for-profit or not-for-profit, or whether it is a CO-OP or not, or whether it is privately owned or corporate.

European private insurance companies provide better care to more people for less money than American companies because they are compelled to follow rules that American companies would find intolerable (I can spell those rules if interested). Our insurance industry will fight those rules as strongly as they will fight single payer financing.

What to do about Americans who “fall in the cracks” of the Affordable Care Act?
The cracks in the ACA are larger than the sidewalk. Although more Americans own insurance policies, they still lose their life savings, and homes, and, occasionally, their lives attempting to pay for health care with insurance. No one in the US is on solid sidewalk. Everyone in the US,

insured or not, is at risk for bankruptcy if they get the wrong disease at the wrong time.

Charity care” in the US.
The US is the only industrialized nation that offers “charity care” because it is the only industrialized nation that needs it. In other nations, poor people with no resources get the same care as their wealthier neighbors.

When Hurricane Katrina left New Orleans with almost no functioning hospitals and no physicians available to provide care, Cuba offered at its own expense to send medics and medical supplies to aid the victims. Even though the US had no method of providing free medical care to these Americans, our government declined the offer.

What are “risk pools” and why did Paul Hochfeld think them important enough to discuss?
“Risk pools” are an exclusively American concept, like “medical bankruptcy” and “charity care.” In every other country, access to health care is determined almost exclusively by species: if you are human, you get access to the same health care as all other humans.

In the US, our entry to health care is determined by our age, employer, number of our co-workers, part-time status, immigration status, marital status, size of our family, military experience, and a host of other factors. The particular combination of these factors determines our “risk pool” which in turn determines how much we pay for health care, what health care we receive, how much our providers are paid, and which providers we can see. We spend hundreds of billions of dollars figuring out which risk pool each of us might belong to (e.g., the added expense of creating and maintaining exchange websites). We then spend billions more re-calculating that assignment when one of these factors changes.

If Oregon stopped spending money on determining risk pools, we would recover more than enough administrative money to pay for all the extra care we would receive.

How does the ACA affect businesses and health care?
The ACA created an enormous game in which employers desperately try to spend as little as possible on the health of their employees without regard for the health care consequences for their employees or their communities. If an employer fails to play the game properly, they will be driven out of business by their competitors who play better.

Exception: employers that self-fund are able to provide better care to all of their employees and their families for less money than with private insurance. Employer “self-funding” programs are private single payer programs; hence their efficiency.

The ACA added additional administrative costs to employers who need more personnel to manage benefits. Employers and employees alike pay additional administrative costs to subsidize private insurance policies for other people, and the costs of exchanges.

The ACA makes healthier Americans more dependent than ever on private insurance as their portal to access to health care.

The array of live testimony and submitted documents is a giant step toward getting Oregon to understand, accept, and embrace universal care. Thank you, everyone, who participated and attended.


Samuel Metz is a private practice anesthesiologist, HCAO representative from the Portland chapter of Physicians for a National Health Program, and founding member of Mad As Hell Doctors.