What the U.S. really needs is a single-payer health system
By Samuel Metz, M.D.
The Oregonian, March 17, 2014
Imagine all your medical information imprinted on one wallet-sized card. Then you lose it. Is this an inconvenience, or a catastrophe?
In France, Taiwan and other countries providing universal health care at lower cost, it’s an inconvenience. Get a replacement, and all is well. No harm, no foul.
But not here. In Oregon, and anywhere in the U.S., your medical records determine the kind of care you get, and maybe if you get any care at all.
It’s a life or death issue.
We are the only country in the world that uses our medical records, along with residence, age, military status, number of co-workers, our employer’s choice of insurance companies, part-time status, income and size of family to determine how much care we will receive and which providers we can see. We then repeat this every time we change residence, age, military status, etc.
No wonder it takes a massively expensive computer system to figure all this out. No wonder it cost Oregon millions of dollars to design this Cover Oregon computer system, repair it, maintain it and change it. And given that thousands of Oregon families need this computer system to work before they can get health care, it’s no wonder we are incensed when this computer system doesn’t work.
None of these millions spent on computer design, repair, maintenance or change goes toward medical care.
All other industrialized countries provide better care to more people for less money than we do. How do they do it? Everyone, sick or healthy, is in one risk pool – human beings. Everyone, rich or poor, receives one set of benefits – treatable conditions are treated. Americans are unhappily unique in insisting health care be dependent upon our age, employer, medical records and all these other factors, but not upon our need.
It is unrealistic to expect our Cover Oregon website to function perfectly for each of the millions of Oregonians simultaneously and desperately attempting to use it. Yet, here we are. We created a website-based health care system in which software separates patients from health care, and now we live with the consequences.
It doesn’t have to be this way. If we want to provide better care to more people for less money, we should learn from countries already achieving it.
Scrap the website and software. Treat every Oregonian the same – you get the care you need when you need it, no matter who you are. Divert the money we pay in premiums and out-of-pocket expenses into a common fund that pays for us all.
This is not a fantasy. Every country in the world that uses such a single payer system provides better care for less money than any of our computer-driven websites could possibly achieve.
Imagine an Oregon in which everyone gets cost-effective care, regardless of medical condition. In this better world, we still risk accidental release of our medical records. But in this better world, the lapse is an embarrassment, not a death sentence.
Samuel Metz, of Portland, is a member of three groups that advocate for publicly funded, universal health care: Health Care for All Oregon, Physicians for a National Health Program, and Mad as Hell Doctors.