Last night I listened to a couple of Oregon physicians nail what this country needs to do to solve our health care problems. In short: a single payer system, Medicare for all.
They convinced me that in many ways the health care reform bills being considered by Congress are going to move us in the wrong direction. I'd already had misgivings about this legislation; now I'm as worried that it will pass as that it will fail.
It was made by Dr. Paul Hochfeld, a Corvallis E.R. doctor. He spoke after the film, along with Dr. Michael Huntington, one of the Mad As Hell Doctors who recently made a cross-country trip to push for real health care reform.
I worked in health planning and health policy research for over a dozen years. It's disturbing that the same problems being grappled with back in the 70's and 80's are still with us -- and are even bigger now.
Hochfeld and Huntington said that the current health care reform legislation is better than nothing. But not a whole lot better, because it basically brings tens of millions of more people into a crappy, inefficient, over-priced health insurance system.
Make that non-system.
Right off the bat they asked the audience if our health care system needed to be fixed. Just about everybody raised a hand. Then they said: "Wrong answer. We don't have a health care system. It isn't a system at all."
It's a mess. Fareed Zakaria echoed Hochfeld and Huntington in a recent Newsweek column:
There are two great health-care crises in America -- one involving coverage and the other cost. The Obama plan appears likely to tackle the first but not the second. This is bad economics but also bad politics: the crisis of cost affects 85 percent of Amercians, while the crisis of coverage affects about 15 percent.
Obama's message to the country appears to be "We have a dysfunctional health-care system with out-of-control costs, and let's add 45 million people to it."
A single-payer system clearly is the way to go. And it's just as clear that neither Congress nor Obama wants to head that way, unfortunately.
I wanted to ask Hochfeld and Huntington some questions, but didn't get to.
One issue I wondered about got answered pretty well in the Q & A session after the movie: given that there are so many problems facing U.S. health care, why do you seem to feel that changing the payment system to single-payer is the most important thing to do?
They said that when health care providers know they'll be seeing a patient for a long time, maybe for the rest of his or her life, there are going to be big incentives to focus on preventive care and health promotion. People won't be drifting out of the system (oops, non-system) when insurance coverage is lost.
A nationwide electronic records system would be much easier to implement with a single-payer system. Research on what treatments work best would be greatly facilitated, leading to better health outcomes at lower cost.
Malpractice lawsuits would be reduced under a single-payer system. Patients wouldn't worry about going bankrupt if a medical care glitch resulted in them needing more treatment. And they would feel warmer and fuzzier toward their health care providers once those nasty money-grubbing insurance companies don't stand between people and their doctors.
It looks like if a single payer system ever is going to be available to Oregonians in the semi-near future, it will be the state of Oregon that makes it possible.
Hochfeld and Huntington appeared fairly optimistic that this could happen. If John Kitzhaber, a reform-minded physician, becomes governor again the chances would be considerably higher, since Kitzhaber isn't wild about the direction health care reform is taking now.