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of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto
Measure 23: Oregon Single-Payer Initiative - AAPS Analysis
Measure 23 may be read at www.healthcareforalloregon.org/printing.htm. Here are some observations on what the plan actually says or clearly implies, from the viewpoint of a patient and a taxpayer:
- The Plan will decide on your medical care. Proponents claim that your doctor will decide what is "medically necessary," but that term will be defined by the Board, which controls the licenses and payment schedules for all medical practitioners.
- The Board dictating "guidelines" for medical practice will be made up, by design, almost entirely of persons who have no expertise in medicine. Of five to be appointed by the Governor, one is to represent "health service providers" and one is to represent "alternative health care providers" (but apparently doesn't have to be a "provider" himself). Board members are to be "publicly accountable"-that means not accountable to individual patients. Appointed ones can be fired by the Governor, and elected ones can be booted out at the next election (up to four years later), if they have offended enough voters in their own congressional district.
- Instead of being used for the sick, funds will be diverted into other uses: language interpretation, medically related transportation, and health promotion and preventive services (by definition, medically unnecessary though possibly beneficial care of the healthy). Will more people be driven to resort to Oregon's legalized physician-assisted suicide?
- The Board will set the prices for all health-related goods and services. It has to produce a balanced budget, and there will be no copayments or other brakes on demand, so it will have to underprice many important goods and services. This means shortages and poor quality.
- Scarcity is intended: 2% of the first year's operating budget may be devoted to retraining displaced health care workers for work in other fields. (2% x $19 billion = $380 million) If services are expanded to include everyone, and yet are to involve fewer caregivers, this means that many if not most people will get less care than they do now.
- Savings are supposed to come out of "administration." This is to be accomplished by decree: no more than 5% shall be spent by the Plan for administration despite all the administrative demands that are made on it (such to monitor utilization of all services, i.e. whether you get too much care; to check for discrimination, i.e. some people getting better than average care; and to study the reliability and cost-effectiveness of the care offered). This means the Plan will do what Medicare and Medicaid do: shift the administrative costs out of their budget and load it onto doctors and hospitals, who will have less time and resources to care for the sick.
Everybody should know how efficient government systems are at administration: motor vehicle division, public schools, the IRS, the post office, Amtrak, etc. Who could believe that Oregon Health Care will be any different?
- All government health benefits will be paid to the Plan, not to you or your doctor. If you receive services under the Plan, any benefits that you may have will be paid to the Plan. In other words, the Plan is in charge.
- Both income and payroll taxes will increase steeply. Even if costs are no higher than proponents admit ($19 billion per year)-instead of much higher, as has happened in all other government programs such as Medicare-the necessary taxes will wreck the economy and impoverish the State.
Just how big will the tax bite be? Oregonians will face an additional payroll tax of up to 11.5% on top of the 15% federal tax on payroll (that is supposedly split with the employer-a ploy designed to deceive people about how much of the fruits of their labor is seized by taxes). This means that an Oregonian whose labor produces $50,000 worth of value to his employer will forfeit 26.5% (or more than $13,000) of it in payroll taxes, if he is in the highest tax bracket (which is undefined). Then he'll pay another $4,000 in the health care income tax in addition to federal and regular Oregon income tax.
"The maximum tax that any taxpayer will pay under this plan will be $25,000"-EVERY year. How many Oregonians pay as much as $25,000 in health care costs, including employer-sponsored insurance, in ANY year?
How much of an Oregonian's income will be taken by the Plan? That money will buy medical care primarily for other people, as the Plan sees fit; it may or may not include any for himself and his family. Oregon's top-bracket health care taxes-payroll plus income-would add up to 11.5% + 8% or 19.5%. Since all revenues now going into federal and state programs would be diverted into the Plan-assuming that HHS grants the needed waivers-that means a chunk of the Oregonian's other state and federal taxes should be counted. Medicare alone adds nearly 1.5%. If one-third of the cost of the Plan is supposed to be covered in this way, then more than one-quarter of the wages of Oregonians in the top tax brackets will be consumed by the Plan (19.5% + 1/3 x 19.5%).
Some people will be exempted from some of the taxes, so they will be more likely to vote for the plan. For example, persons with incomes no greater than 150% of poverty will not pay additional income tax, though more payroll tax will be taken from their earnings-if they still have a job.
Jane Orient, M.D.
AAPS, 1601 N. Tucson Blvd. Suite 9, Tucson, AZ 85716
Tel.: (520)327-4885. E-mail: [email protected]