Oregon Measure 23

October 30, 2002 12:32 PM

Oregon Measure 23 Oregon's single-payer-health-care referendum: Sanity in the face of returning double-digit annual cost increases (after an HMO-induced respite), or a tax-and-spend, job-destroying nightmare which even the public-employee unions (not well-known supporters of any for-profit system) oppose?
posted by MattD (38 comments total)

You mean here. That's a link from the 96 election, it looks like.
posted by ROU_Xenophobe at 12:45 PM on October 30, 2002

This ballot measure is patently unfair to people that have suffered $749 in civil damages. Unfortunately, it was passed in 1996, rendering my opinion rather moot, methinks.

As far as the single-payer thing goes, I think it would be incredibly difficult for the state to fund it without any federal help. I would advocate a pay-or-play system, where companies have to either provide benefits to employees or pay a heavy tax to the state to be used for publically-funded coverage, plus a greatly expanded medicaid program for those that are under/unemployed would do the trick more cost-effectively than single-payer.
posted by boltman at 12:49 PM on October 30, 2002

ooops, my bad, sorry!
posted by MattD at 1:15 PM on October 30, 2002

The first official "argument against" the measure is a lovely subversive piece of propaganda. I assume anyone post an argument (genuine or not) for just a small standard fee?
posted by khirasaki at 1:17 PM on October 30, 2002

We saw that today at work khirasaki, and had a good laugh.

That "No Unhealthy Taxes" thing is such a load of crap.

HMOs waste 15-30% of every dollar on administration. Medicare spends 3-6%. Savings would be much higher than they're claiming.

Opponents of a universal health program (oops, as they call it, "unlimited health program," claim that these taxes are going to drive businesses out. The Oregon tax is a gradient: if you're a small business, you pay little. If you're a big one, you pay more. If you're a small business in a high-risk industry, you'll end up paying a LOT less. The "increase" in taxes is more like a transfer of funds: instead of paying 100 different HMOs, businesses would all pay one entity.

"New payroll tax would cause employers to leave Oregon."
That's funny, because the Canadian Auto Association just put out a press release supporting the Canadian Single-Payer system, because they can afford to pay workers less in Canada than across the border in Michigan, because their health costs are lower.

And a Life Savers factory just moved north to Canada from Michigan because they can pay workers there $3 less an hour, since health care is included in the package via the government.

"People from out of state could come to Oregon for free health care"
Right. When you're sick, the first thing you think of is, "Where can I move?" Please. People move because of jobs and family. Not health care.

And my favorite: "Canada has a similar national health plan. Canadian residents needing heart bypass surgery have to wait as long as a year to receive the surgery and many die while waiting."

That's just simply false. Canadians that need emergency care get it. And with the increased spending in the US, lines and waiting would be virtually eliminated.

Is it just me, or does it seem like conservative arguments are mostly just over-simplified half-truths?
posted by gramcracker at 1:35 PM on October 30, 2002

Right. When you're sick, the first thing you think of is, "Where can I move?" Please. People move because of jobs and family. Not health care.

I don't think so. When you're sick and treatment is expensive, if the cost of moving to Oregon is much less than paying for treatment yourself, it seems reasonable people would move to Oregon for healthcare.

Anyway, I don't think anything that in one fell swoop will more than double the state budget can be considered sane.
posted by gyc at 1:41 PM on October 30, 2002

Well, the act is very specific that you need to be a legal resident of Oregon to receive the care. Meaning your paying taxes in Oregon. Paying for your own care than. You aren't going to have people who need triple-by-passes showing up in Oregon for the weekend. Come on, if anything, having more people move and become residents in Oregon would be a good thing for the economy, or am I wrong that it has been proven by economists again and again the immigration almost always creates economic growth.

And this wouldn't "double the state budget." The act is very clear that the Plan would be set up as a seperate non-profit corporation. Which will cost less to run and operate than the total expenditures on all the HMOs and insurance providers currently operating in Oregon. So its not as if the government is draining down your money. You're simply paying your health care dollars to a different person than you were before (except for those at the upper end of the income bracket, who will be paying more money overall, but not wildly wildly more.)
posted by pjgulliver at 1:51 PM on October 30, 2002

khirasaki... for $500 you can say whatever you want. For some measures in Oregon people will spend thousands of dollars buying all sorts of arguments either in opposition or in favor, sometimes continuing their rants over the span of several pages. I usually enjoy reading the often huge Voter's Guide more than voting, just because some of the people are way out there.

gyc... I thought the argument was that it was supposed to triple the state budget? Then again my understanding is that the costs overall for the state's healthcare would actually be less since everything would be consolidated, which makes sense.

At any rate I voted yes for it (everyone in Oregon votes by mail, so most people who are going to vote probably already have). My health insurance sucks so bad for ~$400/month/person that I figure that the state can do no worse, and I already pay so much in taxes that any more isn't going to kill me, or anyone else for that matter. Besides if it kills or maims us, at least the healthcare will be free...
posted by togdon at 2:00 PM on October 30, 2002

The Canadian block for the "move here for free care" argument: new residents are not covered for the first 3-6 months of residency (time depends on province).
posted by bonehead at 2:01 PM on October 30, 2002

MeFi has been there and done that.

gramcracker: nice try at painting all the criticism of measure 23 as evil, er conservative. there is a lot of opposition to it from the left as well, including the aforementioned labor unions, the Oregonian (IMHO, left of center newspaper) and Willamette Week (unquestionably left of the Oregonian).

The measure is flawed in several ways. Many of which I detailed here.
posted by turbodog at 2:33 PM on October 30, 2002

I don't think so. When you're sick and treatment is expensive, if the cost of moving to Oregon is much less than paying for treatment yourself, it seems reasonable people would move to Oregon for healthcare.

Sure is, and did anyone hear about those Somalis who moved to Maine or some shit becuase of the social services offered their? I think we can arrange for them to visit Oregon where they can get free healthcare too.

So there is absolultey no tax hike on anyone to pay for Measure 23? I find that hard to believe. Well logic tells us that.
posted by ZupanGOD at 2:35 PM on October 30, 2002

HMOs waste 15-30% of every dollar on administration. Medicare spends 3-6%.

Gee, that sounds great! Who woulda thought the govt could be sooo efficient?!?

Before we all hand our health over to hose luvable bureaucrats at the Ministry of Health, however, why don't you provide a link with supporting documentation on those numbers, okay?
posted by nobody_knose at 2:37 PM on October 30, 2002

why don't you provide a link with supporting documentation on those numbers, okay?

How about here or here? Or this dates from 1991, but it's pretty comprehensive in its examination of the issues at stake. There's also the more recent example of HMO profligacy in taking Medicare money:

One report found that some plans spent Medicare money meant for administrative costs on entertainment. The other shows wide differences in the amount of Medicare dollars plans spend on administrative items.

The first report, based on a study of nine plans, identified about $4.7 million in administrative costs that did not comply with federal guidelines that other Medicare program participants must follow. Of that amount, nearly $1.6 million was used for entertainment. Examples include $249,283 for meeting costs that included food, gifts and alcohol at one plan; $157,688 for a party celebrating the 150th anniversary of one plan's parent company; and $106,490 for sporting events and theater tickets at four plans.

The report also showed that five of the plans overestimated administrative costs by an average of 100%, for a total of $116 million in 1997, and that five wrongly allocated a total of $3.2 million in outside costs to Medicare.

Okay?
posted by riviera at 3:04 PM on October 30, 2002

ZupanGod: ooooh no, there are taxes aplenty with measure 23. Personal income tax in Oregon is already at 9% (one of the highest in the US). Measure 23 would jack that up to 17%. As mentioned before, payroll taxes also increase.

Taxes aside, the 2 other things that make M23 unworkable are the Oregon Health Plan (great coverage for the poor, free for the poorest) and "capping" administrative costs at 5%.
posted by turbodog at 3:08 PM on October 30, 2002

turbodog: 17% state income tax plus federal? Yikes!

Do the voters in Oregon realize how this will kill economic growth in the state if they vote this measure in?
posted by ZupanGOD at 3:29 PM on October 30, 2002

Thanks for those, riviera.

Again, turbodog, taxes go up, but you don't see a bill when you go to the doctor, and you don't pay one. No copayments, either. As far as payroll taxes: Technically, yes, taxes go up, because it's considered a "tax" because it's going to the government, but it's instead of healthcare costs for employers. The new "taxes" go to the single-payer entity, but employers no longer have to pay health care insurance costs to insurance companies. It's not new money. The check's just made out to a different entity.

As far as I know, measure 23 would get rid of the OHP and start anew with a single-payer plan, yes?

Yes, administrative costs at a maximum of 5% is possible. Try Canada or another single-payer country. You get rid of profits, extra forms, billing information systems, administrator salaries to approve (or for HMOs, hopefully deny) claims, salaries for paper pushers, operators, etc., and it starts to add up. All that mess, versus one form. The doctor fills out a form, sends it to the payer, and the payer... pays!

Disgusting fact: We spend more money per year on health care administrative costs than the ENTIRE defense budget.

Fastfact: Unions were anti-universal health care in the early 1900s, too. They wanted to use health benefits as a bargaining tool with employers. Too bad employers are dropping coverage left and right, no matter what the unions say. (And it's not all unions... Ohio chapters are in support of universal health care.)
posted by gramcracker at 3:40 PM on October 30, 2002

Regarding the issue of whether welfare benefits cause migration, the evidence is mixed according to this paper by the Urban Institute. I tend to think that it is largely untrue, simply because low-income people tend to rely on informal support networks like relatives, friends, and signficant others in addition to public benefits to make ends meet. Welfare benefits alone just are't enough to live on.

Somalis and other refugees, of course, would be the most likely to for increased welfare benefits since they don't have the same kinds of established informal support mechanisms within particular communities. Being a former resident of the Maine town (Lewiston) where the Somalis were moving to, I can assure you all that the influx is unquestionably a positive thing for an extremely insular town. The feds pay for most of the social services that they receive through the refugee resettlement program anyway. The only reason it was in the national news was because of a pretty spectacularly offensive letter sent to Somali community leaders by the mayor of Lewiston telling them to find somewhere else for their relatives to live.
posted by boltman at 4:00 PM on October 30, 2002

Seizing the income of Oregon citizens by force to give to others who did not earn it is fair?
posted by ZupanGOD at 4:04 PM on October 30, 2002

Yes.
posted by boltman at 4:07 PM on October 30, 2002

Seizing the income of Oregon citizens by force to give to others who did not earn it is fair?

The money would be going to health care professionals as payment for services rendered to the people of Oregon. Seems earned to me.
posted by mr_roboto at 5:33 PM on October 30, 2002

1) Will people who live in Washington but work in Oregon (not uncommon) be exempt from the extra tax or will they qualify for the medical care?

2) What is the effect on things if rather than drawing the ill, it pushes away the healthy. I haven't used a doctor's service in many years and if faced with the prospect of putting out an extra 8% of my income to pay for medical care I won't likely need I would be very tempted to move out of Oregon.
posted by obfusciatrist at 5:53 PM on October 30, 2002

obfusciatrist, you should be seeing a dentist twice a year. Do not underestimate the importance of good dental health. Your gums will thank me for this advice!

Do you have health insurance now? If so, you pay for it somehow, even if the mechanism isn't obvious to you. If you can live comfortably (i.e. no constant paranoia about potential illness) without heath insurance, more power to you: you're a braver soul than I.
posted by mr_roboto at 6:06 PM on October 30, 2002

While I appreciate both sides of this issue, those who decry the increase in taxes should consider that healthcare will be paid for in one way or another.

All those people who have lost jobs won't be able to afford the COBRA rates for health insurance. Where will they go? How about the working poor who have to choose between outrageous premiums or clothes for their children?Invariably, they turn to the public health system (i.e. county hospitals ) where the bill will be footed to a large extent by the local taxpayers

As a homeowner, I watch my property taxes continue to rise with a large portion of the monies going to fund the county hospital system. This can only get worse if nothing is done to remedy the current problems.
posted by sillygit at 6:55 PM on October 30, 2002

rivierea, gramcracker:

Did you actually look at the links you posted? They don't support the contention that medicare spends less on admin costs than HMOs. In fact, your link says that Medicare spend MORE per patient -- almost $20 more per person per month more.

Expense comparison
Average administrative costs per member per month

Commercial HMO: $21.24
Commercial POS: $25.73
Indemnity and PPO: $19.04
Medicaid: $21.22
Medicare: $40.44

posted by nobody_knose at 7:07 PM on October 30, 2002

obfusciatrist, you should be seeing a dentist twice a year. Do not underestimate the importance of good dental health. Your gums will thank me for this advice!

Sorry, I never really think of dentists as medical expenses (weird mental thing), but you're right. I do see a dentist and I pay for it out of my pocket.

Do you have health insurance now? If so, you pay for it somehow, even if the mechanism isn't obvious to you. If you can live comfortably (i.e. no constant paranoia about potential illness) without heath insurance, more power to you: you're a braver soul than I.

I have catastrophic insurance. If something happens and the bills get over $20,000 or so I will have coverage. But pretty much anything up to that I am paying for. I am comfortable with this because I consider the risk of such an expense to be acceptably low and could scrape together $20K if I really had to.

But otherwise, if I have to pay a couple hundred every couple years so a doctor can tell me I have the flu (and I've been lucky and not even had that expense for quite a while; August '98 was the last time I saw an M.D.) that is still much cheaper than paying for insurance.

So far, over the course of my adult life this plan has me way ahead and I accept the risk that tomorrow I'll be hit by a bus and be way behind.

But comprehensive coverage for even minor medical expenses is not worth 8% of my salary to me (that would make insurance almost equal to rent as an expenditure) and as cold-hearted as it seems, the health of the person next door certainly isn't worth 8% to me.

But I would still like to know if Washingtonians working in Oregon (I grew up in Vancouver, WA., so this is an obvious question to me) will be exempt, eligible, or simply screwed.
posted by obfusciatrist at 7:36 PM on October 30, 2002

Or if you're like me, you knocked out "no" for EVERY initiative, because it's a terrible way to run government - there's a reason we're a representative democracy.

And Oregon has no economic growth to destroy anyway - the unemployment rate is neck-in-neck with France and Harlem last time I was there. Here in Boston, where I'm at college, jobs that pay minimum wage DON'T EXIST - even convenience stores will pay you 8, 9 bucks an hour with no experience. In Oregon, I had to apply 19 places last summer, and got one job, $6.50 to work in a cafeteria.

In any case, Oregon needs less government. And Oregon already has a health plan for the poor. Why should I, who want to choose my health provider, be forced to take the state's choices?
posted by Kevs at 8:22 PM on October 30, 2002

Good points Kev..

IMHO, The biggest obstical to why socialized medicine never really works, and private insurance sometimes has such a hard time staying affordable as well is becuase once people think that they have been afforded this health care entitlement whether it be through this measure or regular insurance and HMO's, people go in for every stubbed toe, rough cough, and sniffle.
posted by ZupanGOD at 8:41 PM on October 30, 2002

Or if you're like me, you knocked out "no" for EVERY initiative, because it's a terrible way to run government - there's a reason we're a representative democracy.

Yes! Thank you!

If there are elected representatives receiving salaries from taxpayer money, shouldn't they be the ones researching these issues and deciding what's in the best interest of the population, instead of leaving the decision to individual citizens who generally do little more than skim summaries of the initiatives?

Democracy doesn't mean that people have to vote on everything. That's the very reason we elect representatives -- to research the issues and make educated votes on them.
posted by oissubke at 8:42 PM on October 30, 2002

nobody: The numbers cited by riveria on administrative costs are pretty universally accepted as correct as far as they go. This peer-reviewed article from the New England Journal of Medicine is one of many commonly-cited sources that has some evidence on this question. Also, the government itself has (not surprisingly) endorsed these numbers on administrative costs as correct. (can't find a link right now, you'll have to take my word for it, or hunt around on www.cms.gov)

Conservatives attack the numbers, with maybe some justification, as somewhat misleading because they are low at least in part because the Medicare spends much less than HMOs (as a percentage of their budget) on things like fraud detection and utilization review, which would ostensibly save the program money in the long run despite raising the share of administrative costs. However, one must not forget that much of private premium dollars also go to totally useless things like huge executive salaries, profit, and advertising.

I fully support national single-payer health care, but I also think that program design is extremely important for it to work. If it is done right--if the incentives for doctors, patients and payers (uh, payer) are structured correctly--then it could be far more efficient and egalitarian than our current bastardized public/private system, which is quite irrational, inefficient and unfair. If it is done half-assedly, then it would be a nightmare.
posted by boltman at 9:36 PM on October 30, 2002

oops, just realized that my link is the same as one of riveria's. oh well, it is a good one, maybe it was worth posting twice.
posted by boltman at 10:26 PM on October 30, 2002

boltman: Does the $13.5 billion lost to improper payments to dead people and etc consist of medicare administration?
posted by ZupanGOD at 1:41 AM on October 31, 2002

They don't support the contention that medicare spends less on admin costs than HMOs. In fact, your link says that Medicare spend MORE per patient -- almost $20 more per person per month more.

Um, do you look at the links, yourself? Quoting a flat cost directly to refute claims about a percentage cost, without any additional information -- the percentages are addressed in the other links -- is really, really sloppy thinking.

once people think that they have been afforded this health care entitlement whether it be through this measure or regular insurance and HMO's, people go in for every stubbed toe, rough cough, and sniffle.

No, they don't. That's just a bloody myth. The NHS, for example, places a great deal of emphasis on preventative health care, because it has the national mandate to do so. Whereas the private insurers in the USA have no real impetus to encourage preventative care, and don't mind the 'worried well' coughing up for a brain scan every time they have a headache.
posted by riviera at 6:04 AM on October 31, 2002

No ZupanGOD, although the amount lost is somewhat speculative. If you had actually read my post, that was my point. Medicare has somewhat of a problem dealing with fraud, mostly because Congress won't appropriate the funds for adequate fraud prevention, which is probably because Congressional Republicans like being able to lambast the Medicare program for not controlling fraud.

Of course, let's not forget that the private insurance industry has a wee bit of a fraud problem also.
posted by boltman at 6:07 AM on October 31, 2002

boltman: On June 26 the House passed the Social Security Program Protection Act (H.R. 4070) by a vote of 425 to zip. The measure is designed to crack down on Social Security fraud and abuse and strengthen penalties against representative payees who improperly manage the finances of Social Security recipients.

If only the Senate would act! Those damn pesky Republicrats!
posted by ZupanGOD at 6:42 AM on October 31, 2002

Now only if those Republcrats would get a medicare fraud bill together and pass it.
posted by ZupanGOD at 6:53 AM on October 31, 2002

On fraud:

1) There's gonna be fraud in any system. Plain and simple. Just like boltman said, it's in the private system too.

2) With a national health program (or, in this case, a state-wide one), it's much MUCH simpler to track and stop fraud. If *every* physician is billing the government, you can start to find averages and ranges and standard deviations of billing. If Doctor X in Portland is doing 50 MRIs a month, and Doctor Y is doing 300, something is going on. In the current system, where private insurers only get their own billing information, it's much harder to track.

Most of the US health care data comes from Medicare and Medicaid--that's where the government can get its numbers. In Canada, Japan, everywhere else--the countries can get much more accurate statistics, because they have data on every person in the country.

ZupanGOD: It's semantics, but important: Single-payer national health insurance is NOT socialized medicine. Everything is still private in a single-payer system (besides the VA and other government run facilities). Many people try to call it 'socialized medicine' to scare people away.
posted by gramcracker at 9:06 AM on October 31, 2002

But comprehensive coverage for even minor medical expenses is not worth 8% of my salary to me (that would make insurance almost equal to rent as an expenditure) and as cold-hearted as it seems, the health of the person next door certainly isn't worth 8% to me.

posted by obfusciatrist at 7:36 PM PST on October 30

You really only spend 8% of your salary on rent!?! That's it, I'm moving to Oregon. Even if you were making $5000 a month that's only $400 dollars a month for rent. Here that'll get you a place where you share a bathroom.
posted by Mitheral at 2:56 PM on October 31, 2002

One other point about fraud prevention in Medicare: the doctors absolutely hate it and lobby against any attempts by the government to control fraud. Partly this is because fraud prevention means audits and more government interference with their practice. Partly it is because questionable, but not clearly illegal, Medicare billing practices abound among providers. Doctors know how to work the system to maximize what they see as their just compensation for services rendered. Cracking down on fraud means that all those little quasi-legal loopholes will be closed and many doctors will lose money.
posted by boltman at 2:38 PM on November 1, 2002