Top-down Health Care Doesn’t Work – in Oregon or Anywhere Else

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Governor Kate Brown and Senator Jeff Merkley have staked their legacies on health care – improving it for Oregonians and, in the case of Merkley’s introduction of Medicare-for-All legislation, all Americans. Unfortunately, their solutions rely on the same failed price-control policies that have been tried in-state, nationally, and around the world for decades. 

Oregon’s skyrocketing premiums and deductibles are just one issue caused by the health care policies endorsed by both Merkley and Brown. Another is price controls like those in Medicaid and top-down drug pricing policies – including Merkley’s misguided 2019 “gouging” bill – which inevitably lead to rationing and reduced care. A third is increased emergency room visits, which two studies showed was the result of Oregon’s 2008 Medicaid expansion. 

As a doctor who practiced in Oregon for decades, I believe these politicians want to help Oregonians get better care. But their unworkable policies do more harm than good. 

The failings of something like Medicare-for-All have been especially demonstrated in Oregon. Brown and Merkley have called for everyone to have easy access to quality healthcare through more government programs. This was tried in 2008 when Medicaid was expanded under the theory that greater coverage would lead to better preventive care. Eighteen months later, the first of two studies was published which showed that emergency room use increased among the uninsured by 40 percent – including for a significant number of medical needs which were easily handled in the less costly, more personalized setting of a primary care doctor’s office.

The price ceilings in government-run health care have obvious problems, like rationing in Great Britain’s health care system or the 1999 Boston Consulting Group findings that drug price controls in several European nations dramatically slowed drug development. But they also affect the other end of the price spectrum – doctors who take Medicare while trying to work around such a flawed system are not allowed to charge less to uninsured patients than what Medicare pays.

It is no surprise that in such a flawed system, even great doctors burn out and a) quit or move, b) compromise care, or c) find different ways to provide care.

I chose Option C in 2011 after 14 years in practice and exhaustion from trying to care for patients in an increasingly impossible system. I started a non-insurance practice that took Medicaid and Medicare patients, but not their insurance. My prices were posted, consistent, and predictable. My patients received the personalized care that they deserved -- and I was practicing medicine in a sustainable fashion without well-intentioned but inherently flawed price controls, rationing, and complex rules interfering patient care. 

In 2019, Governor Brown called upon Oregon to reduce health care costs after years of massive premium and deductible increases. Her goals of greater access at lower costs were right; but her price control, government-interference approach will make things worse. Patients need price transparency, choice, and empowerment from doctors they trust to personally care for their health, not government mandates that increase costs and impact care. 

Dr. Kathleen Brown practiced dermatology for 21 years in Oregon and founded Oregon Coast Dermatology in 2011 as an alternative to a broken healthcare system. She and her husband currently live in Montana.

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