Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Monday, November 04, 2002
    Tomorrow the state of Oregon is voting on an initiative designed to provide the entire state with free health care - Measure 23. This measure supposedly will cover the state's healthcare costs by raising business and personal taxes to add to Oregon's share of the Medicare pool (the drafters claim that this will be offset by the fact that businesses will no longer be obligated to purchase health insurance for their employees, and that individuals will not have to pay co-pays or their share of insurance costs). The measure states it will cover everything. EV-ERY-THING. This means massage therapy, acupuncture, hospitalization, mental health, drugs.

    Let me just say this, people: it won't work. It will not work. I can give you a few reasons:

    1. In Europe, with similar plans, drug formularies are somewhat restricted, and, more importantly, national healthcare systems can drive hard bargains with pharmaceutical companies, which keeps their costs down to a certain extent; the US pays more for drugs than anywhere else on earth.

    2. Corporations will hightail it out of Oregon faster than you can possibly imagine - there goes your tax base.

    3. Everyone on the West Coast at or below the poverty line will move to Oregon ASAP.

    4. Everyone in Oregon will immediately start requesting counseling, acupuncture, massage therapy, etc. They will start requesting the most expensive drugs on the market - granted, they work and work well, and they often keep people out of the hospital, but I really think the expenses of this project will balloon faster than anyone backing this measure can possibly imagine. I can hear the patients now - "Hey, doc, I pay my taxes. I've already paid for this. Why can't I have acupuncture for my (hangnail, stress, weight loss, back pain, etc.)?"

    5. Get ready for long waits. The truth is, you always pay with health care. You either pay with money or with time. Look at the UK health system if you don't believe me, or Canada's. I have several physician friends who are Canadian and chose to come down to the States because of their frustration with the Canadian health care system. You may be able to get acupuncture or massage therapy, or counseling, for free - but if you have to get on line and wait three months for it, is it really going to help you?

    Don't get me wrong, if Oregon wants to experiment with this system, go for it. You go first, guys. We'll be standing on the sidelines watching. If this measure passes it will be implemented in 2005; it'll be interesting to see what happens over the next five years.



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