Why Study Health Care Options After ObamaCare?

Metz-12-09-01-85-125x125President Barack Obama received a lot of flak for creating the Affordable Care Act. But he is no more the creator of “ObamaCare” than publisher Bill Gaines was the creator of “Mad Magazine” (instead we thank illustrator and writer Harvey Kurtzman). When charged by the president with designing a health care plan, Congress took the Massachusetts model (subsequently known as “RomneyCare”), injected it with earmarks, expanded it nationally, and rebadged it as the Affordable Care Act (ACA). This resemblance is not superficial; according to Jonathan Gruber, the MIT economist who helped design both pieces of legislation, “they’re the same [expletive deleted] bill.”

Genealogy aside, does the Affordable Care Act (ACA) or the Massachusetts experience remove further need for Oregon to study health care alternatives?

If Oregon wants increased access, reduced costs, or improved health, sadly not.

Increased access? In a national study, the Congressional Budget Office (CBO) estimated the ACA will leave 60 million Americans either under-insured or un-insured. We do not yet have a state study in Oregon, but these national figures suggest 700,000 Oregonians will risk medical bankruptcy or death from a treatable disease… if the ACA works perfectly.

Reduced costs? The CBO estimates an increase in overall health care spending of $100 billion annually despite reduced government spending. We do not yet have a study in Oregon, but we can expect an annual increase of $1 billion in Oregon’s health care costs …if the ACA works perfectly.

Better public health? Since RomneyCare began, measures of public health in Massachusetts are static. Medical bankruptcies increased 30%. Health care costs are rising faster than any region in the country.

We do not yet have a state study in Oregon, but the Massachusetts experience and our best research predict Oregon’s health care will remain dangerously inaccessible, costs and bankruptcies will increase, and our public health will stay unimproved…if the ACA works perfectly.

Note the phrase: “We do not yet have a study in Oregon.” We have no idea what the ACA will inflict on Oregon, nor what we might do instead. This is where HB 3260 steps in.

HB 3260, which enjoyed bi-partisan legislative support, authorizes the Oregon Health Authority (OHA) to study at least four health care financing alternatives: (1) the ACA as implemented now; (2) the ACA with a public option and Basic Health (an unimplemented provision of the ACA); (3) publicly funded, privately provided universal care (sometimes called “single payer”); and (4) public funding to purchase private insurance policies for all Oregonians. The OHA may also study other options.

Funding comes from grants and other private sources. The OHA will select a third party to conduct the study. The OHA will then present results to the 2015 Oregon legislature with its choice of the best option.

HB 3260 enjoys widespread community support, including from OHSU, the Oregon Medical Society, the Main Street Alliance (formerly the Oregon Small Business Council), Oregon Rural Action, and the Oregon Public Health Association. Bruce Goldberg, OHA director, sent a personal endorsement. The Northwest Health Foundation graciously agreed to act as fiscal agent for donated funds.

The value of the study is obvious. Oregon must prepare for a worst case scenario – the ACA working perfectly. Our legislature will be grateful for a study funded by Oregonians, supervised by Oregonians, and perhaps even conducted by Oregonians that offers credible information about our state health care options.

Sir John Harvey-Jones said, “The nicest thing about not planning is that failure comes as a complete surprise and is not preceded by a period of worry and depression.”

Let’s not be completely surprised in Oregon. HB 3260 is our plan to avoid failure.

Samuel Metz, M.D. is an private practice anesthesiologist in Portland, OR and Adjunct Associate Professor of Anesthesiology and Perioperative Medicine at OHSU.