By Peter Mahr
The Oregonian
February 26, 2010

The Oregonian’s recent editorial on the president’s health care proposal is off base. The editorial board states that Barack Obama’s plan “includes essential elements of reform.” But there is no discussion of what elements are indeed essential when analyzing health care reform.

T.R. Reid, a one-time correspondent for The Washington Post and chief of its London and Tokyo bureaus, explored health care systems around the world in his book “The Healing of America.” He found that health care systems vary greatly but all wealthy industrialized countries build their systems on three essential elements. First, there is one system for everyone, regardless of age, wealth, employment, race or health status. This results in administrative efficiency, cost control and fundamental fairness. Second, all other developed nations have health care financing that is not-for-profit. Their health insurance systems are not allowed to profit in the provision of necessary health services. This eliminates the fundamental conflict of interest that insurance companies face in our system: In order to profit, they deny access to care, bar sick members or refuse payment of services. Finally, the third basic principle is that all other developed nations with health care systems provide true universal access to health care services. Nobody is uninsured. Nobody is denied access if unable to pay.

Obama’s health care proposal does not include any of the basic principles for true reform. Our inefficient, expensive patchwork system of health insurance would be maintained. For-profit financing would continue in the private insurance market while individuals and employers would be forced to buy it. Finally, there is no guarantee of universal coverage. Millions would be left without insurance and millions more would face financial hardship in payment of their premiums, deductibles and out-of-pocket payments.

The Oregonian has a responsibility to its readers to provide factual and analytical information. Since all other industrialized countries provide true universal access to necessary health services at roughly half the cost than we do, it is common sense to tease out common principles that make their systems work. T.R. Reid has done this for us and clearly exposes great problems with Obama’s proposal. It is The Oregonian’s responsibility to inform it’s readers of these weaknesses and suggest alternatives.

One alternative that includes all three elements of reform is single-payer national health insurance — Medicare for all. By scrapping our patchwork system and improving and expanding Medicare to all, administrative costs would plummet due to increased efficiency of the payment system, the conflict of interest between paying for medical services and making a profit would be eliminated and everyone, all Americans, would have access to all necessary medical services regardless of ability to pay. The Oregonian has a responsibility to make this known to its readers. In blindly supporting a reform that lacks any of the basic components required for a functioning health care system while ignoring a reform that includes all of these elements, The Oregonian has failed to truly inform the public.

Peter Mahr is a Portland physician and a member of Physicians for a National Health Program.

http://www.oregonlive.com/opinion/index.ssf/2010/02/a_doctors_view_getting_to_real.html

By PETER MAHR
Guest Column, The Oregonian
December 30, 2009

As a family physician I must write to convey my frustration and indignation with the Senate health care bill.

It is an immense bill offering minor advances in the access to health care for Americans via private insurance, the expansion of Medicaid and the increase in money for community clinics. But in cementing the role of private insurance as the vehicle for Americans to access necessary health services, the bill wastes billions of dollars a year due to the inefficiency and profit motive inherent in this system.

Furthermore, the bill will still leave millions without any insurance and even more people underinsured. Those who have insurance with affordable premiums will find the cost-sharing (deductibles, co-pays and out-of-pocket expenses) onerous. Those with insurance offering adequate access to health services will pay premiums that are unaffordable.

Finally, by taxing Americans four years in advance of the initiation of subsidies for the purchase of insurance, this bill underestimates the true cost to our country. In the end the bill will mandate that all of us buy into and subsidize the inefficient and expensive private health insurance financing system we have today.

My frustration doubles when I realize that there is a viable, efficient and affordable alternative to health care financing that could be enacted tomorrow. With a system of national health insurance, we could cover 100 percent of Americans at a dramatically reduced cost for families, businesses and our country. Under a national health insurance plan everyone pays into the insurance pool via progressive income or payroll taxes.

Let’s call this our premiums. Then, when we are sick and go to the doctor or have a surgery, the doctor or hospital gets paid from the money in the pool. It is not socialized medicine: Doctors and hospitals continue treating patients as before. They remain private and autonomous.

Since a national health insurance system eliminates the profit motive, as well as the advertising and executive pay associated with private insurance and slashes burdensome and expensive administration on the doctor and hospital level, it would finance access to health care for all while reducing costs dramatically.

Finally, my frustration will pale in comparison to the American people’s anger when they find out what the Senate bill means for them. In the Senate bill, the Congressional Budget Office estimates that a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, or $9,000, on health care costs. On the other hand, a family of four making the median income of $56,000 would pay just $2,900 under a national health insurance plan.

If the American people knew that we could organize our health care financing in an efficient, fair and affordable manner, and reduce their family’s health care costs by a third, they would jump at the chance. If they find out after the fact, when they are paying taxes to subsidize a private insurance system that does not meet their health care needs and puts their personal finances at risk, they will surely be looking for someone to blame.

Are you paying attention, senators?

Peter Mahr of Southeast Portland is a family physician with Physicians for a National Health Program.

http://www.oregonlive.com/opinion/index.ssf/2009/12/a_doctors_voice_a_national_hea.html

The Oregonian
Letter to the editor
October 19, 2009

In your Sept. 15 report, “Wyden sees costly flaws in health bill,” some concerns were raised about increasing families’ expenses for health care.

Currently, the average family of four covered under an employee health plan spends a total of $4,225 on health care annually. That’s $2,713 on premiums and another $1,522 on medical services, drugs and supplies (Employer Health Benefits 2006 Annual Survey, Kaiser Family Foundation and Health Research and Educational Trust; U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.)

In House Resolution 676, a single payer plan, there is a simple payroll-based health insurance premium for both employer and employee of 4.75 percent.

This payroll-based premium will pay for all needed medical services and will replace all current premium payments, deductibles, co pays, and out of pocket expenses. The average family with an income of $56,200 per year will pay $2,700 per year: simple, affordable and comprehensive.

I urge everyone to multiply their current income by 4.75 percent and compare that with their current total health care spending of premiums, deductibles and out of pocket costs for drugs and services. They will find that in 95 percent of all cases they will pay less for health care.

That is why it is extremely imperative that all current health reform legislation be compared to single payer legislation. In all cases we will find that the single payer system provides 100 percent access to care with reduced costs for the vast majority of Americans.

DR. PETER MAHR
Southeast Portland

http://blog.oregonlive.com/myoregon/2009/10/single-payer_would_boost_bucks.html