Sam Metz, MD, retired anesthesiologist from Portland, Oregon, gives his "3 Questions, 9 Answers" talk about how to meet the listener at her/his level of understanding about our health care system. He then adds the evidence in a step-wise fashion to move the listener toward the conclusion that universal improved Medicare for All or another form of single payer health care is the best solution to our dysfunctional health care system.
Below is an outline of Dr. Metz's 3 Q 9 A
Three Questions, Nine Answers about Health Care
by Sam Metz MD July 2014, MCH 2/15 MCH 3.17
1. Why do we need health care reform?
a. Our health care costs are twice the average of industrialized countries. We are the most expensive nation on the planet.
b. In almost every category of public health, the US is at or near the bottom of industrialized countries.
c. Health care costs are destroying American families with bankruptcies and devastated credit.
2. What do we want health care reform to achieve? Forget about selling insurance policies or reducing the national debt. We want:
a. Health care access for us and our families no matter how poor, sick, old, or unemployed we may become.
b. Reduced health care costs. Not just for government, insurance companies, employers, or employees... for everyone.
c. Better health. We want improved medical outcomes but not sustain a health care industry and administrators more then needed to reach those outcomes.
3. How do successful systems succeed? Other countries provide better care to more people for less money than we do. What do they have in common that we don’t?
a. They include everyone, without discrimination against the sick. In the US, we punish the sick by charging them more, reducing their benefits, or excluding them altogether. Successful systems do not do that.
b. They encourage patients to seek care. They do not discourage people from seeking care with “customer-driven care,” “skin in the game,” high deductibles, high co-pays, etc. Instead of patients deciding if they need care before they see a physician, the physician determines if the patient need care after she sees the patient.
c. Financing is provided by publicly accountable, transparent, not-for-profit agencies. In most countries you can make a profit providing health care; we are the only country that encourages you to make a profit financing health care. (Financiers are simply brokers: they collect from money patients and deliver it to providers.)
If you have a system that includes everyone, encourages care, and funnels all health care money through only one publicly accountable, transparent, not-for-profit agency for financing, we can call that “single payer” (as in Canada and Taiwan) or “multi-payer through one public agency” (as in many European countries).
The ACA deserves praise for at least temporarily helping many Americans, some of whom have gained insurance and access to healthcare for the first time in their lives. But the ACA is deeply flawed.
Neither the ACA or its Republican replacement will improve the health of our population because both preserve financial incentives to avoid those who need care the most: the sick and the poor. Competitive markets cannot promote healthcare for the population. Here's the reason. To effectively compete, a health insurance company must observe the 70% rule of avoiding risk. It makes good business sense and it is the fiduciary responsibility of companies’ CEOs and Boards of Directors to do so. This leads to garden metaphors (lemon dropping and cherry picking) and the exclusion of the people who need care the most. The result is ever-increasing suffering, and delays or avoidance of treatment.
Neither the ACA nor CCOs effectively neutralize this incentive. Trillium, for example, which administers the CCO for Medicaid patients in Lane County, tripled its profits in 2013 and its parent company, Agate Resources, is being purchased by Centene, a Fortune 500 company of St. Louis, Missouri. Meanwhile in 2014 - 2015 safety net services such as Occupy Medical saw their main clientele change from homeless and uninsured patients to “insured” patients. Most of these were on the Oregon Health Plan and in the Trillium CCO but not able to access to care through Trillium. Trillium points to lack of primary care providers, but nurse practitioners and other qualified primary care providers were turned down as hires by Trillium. Private companies are taking an ever-increasing role in administering and profiting from public programs such as Medicaid and Medicare, usually without adequate public awareness or oversight and with resulting diversion of public health care money away from health care into other uses.
Our health care system creates financial hardship for families, businesses and governments, deters people from gaining timely medical attention, and confiscates money from underpinnings of health such as adequate housing, education, infrastructure, and social services.