Oregon needs to get a better attitude

By Samuel Metz, M.D.
Portland (Ore.) Tribune, July 7, 2015

The Federal Aviation Agency reports that not all airline accidents are caused by bad weather. Some pilots, in a crisis, succumb to “hazardous attitudes,” making a bad situation worse. By teaching pilots to overcome these attitudes, flying becomes safer.

And so it is with health care. Oregonian voters have our own “hazardous attitudes” that worsen the impending health care crisis. Overcoming these attitudes means health care becomes less expensive, more accessible, and, like aviation, safer. But before correcting these attitudes, we must identify them.

The FAA’s hazardous attitudes are simple: Antiauthority, impulsivity, invulnerability, “machoness,” and resignation. Voter attitudes toward health care are far more complex.

First hazardous attitude: “Other people should only get the health care they can pay for.” This is certainly true today. And without action, it will be true indefinitely. Other industrialized nations, all of which provide better care to more people for less money, adopt a different attitude: Everyone needs health care, so let’s find the best method to achieve it.

Second attitude: “Restricting access to health care reduces costs.” Gov. Nathan Deal of Georgia advocates closing emergency rooms to people who can’t pay, thus saving money for taxpayers. This radical proposition certainly benefits wealthy taxpayers without emergent needs. But for the rest of us, helping wealthy taxpayers by denying emergency care to our families could mean dying on the doorsteps of an emergency room.

Third: “Taxes are bad.” Who would disagree? Lower taxes liberate money for other things. Unfortunately, lower taxes sometimes increase the costs of other things, and dramatically so with health care. The amount currently paid by Oregonians for insurance policies and out-of-pocket medical expenses exceeds the additional taxes needed to fund a universal care plan. If Oregonian implements universal care, higher taxes reduce costs.

Fourth: “Smart consumers make good choices.” When buying a used car, a flat screen television, or a new house, informed consumers make better choices. Unhappily, this is not true in health care. Most private buyers on insurance exchanges fail to pick the best policy. Almost all seniors picking Medicare drug plans select a bad one. These people are not stupid — health care is simply much more complex than retail shopping.

Last attitude: “We should tend to our own families and let others fend for themselves.” That may have been appropriate for the frontiers of 19th-century Oregon. But in 21st-century Oregon, community efforts generate extraordinary results unobtainable by families working alone. Successful health care systems around the world all depend upon entire nations working in unison, not upon rugged individuals stalking affordable health care alone in the wilderness.

One final point: Costs do not stand between Oregon and a better health care system. Every other industrialized country spends less than we do, yet they provide better care to more people. What enables these countries to succeed where we fail is abandoning the attitudes that currently paralyze us.

A pilot’s hazardous attitudes can produce catastrophic results. Our own hazardous attitudes can prevent us from getting the health care reform we need.

Samuel Metz is an anesthesiologist who lives and works in Portland. He has written about health care reform and community health issues for the Tribune and other publications. Contact him at