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BALLOT MEASURE 23 -- Wrecking Medical Care for All Oregonians by Jane Orient, MD

Oregonians have the opportunity this election to offer themselves up as guinea pigs for the grand experiment of state-by-state government takeover of medicine.

The architects of the plan are from places like Massachusetts, New York, and Maryland, but they haven't managed to get people in their own states to fall for it yet. They are supposed to have noble motives, and they say appealing things like "everybody in, nobody out."

Or is it really so attractive? What kind of thing entices or forces you in and then won't let you out? A trap? A prison?

The experiment of tax-financed medical care for everybody has actually been tried almost everywhere else, outside the United States. Oregonians ought to look at the results, say to the North. They are everywhere the same: costs spiraling ten times higher than promised, government budgets hemorrhaging red ink, medical facilities rotting, and long lines for care.

Will the outcome be different in Oregon?

One definition of insanity is to do the same thing over and over, expecting that the next time the result will be different. So the academics and political agitators behind this grand scheme might be noble, but if so they are crazy.

The sales pitch is that your doctor, not your HMO, will make the decisions about what treatments meet the definition of "medical necessity." But that term will be defined in Salem, by political appointees or elected officials-mostly from somebody else's congressional district-who have NO medical expertise and NO accountability to individual patients.

These officials have to come up with a balanced budget. Their only tool is price controls. If there's not enough money to pay the going rate for hip surgery, why then they'll reduce the payment, thereby assuring that anybody who does hip surgery loses money. Guess how many people will be willing to pay to do this work? Would you work for negative wages?

If you need hip surgery, you and yours will keep paying those payroll taxes. That money will go to the Plan to buy things like language interpreters, rides to the clinic, contraceptives, wellness checks, utilization monitors, and people to check up on your doctor. If there's nothing left for your hip surgery, too bad-you're a lower priority and will just have to sit in that wheelchair or stay in bed. Or maybe you'd like to take advantage of the State's unique, low-cost physician-assisted suicide plan. That way the Plan could spent more money on alcohol and tobacco abuse programs instead of your hearing aid and bedsore care.

You'll just use your Medicare, you say. Tough luck. All "your" Medicare benefits get paid to the Plan, not to you or your doctor.

Plan proponents claim that administrative costs will be limited to 5%-even though there are lots of new administrative tasks, like assuring that nobody gets better care than anybody else. How will this limit be achieved? Undoubtedly by foisting the work onto doctors and hospitals, who will be forced to do it at no charge, instead of seeing to patients.

For healthy people with low incomes, this Plan may look pretty good. It will soak the "rich" for up to $25,000 per year, every year, while keeping taxes low-temporarily-for lots of voters.

But how many people will pay the huge maximum rates even for their own medical care or insurance, much less for other people's? Not too many; you can safely bet that they will head South, along with the state's best doctors and cash-strapped employers. What then?

Oregonians should ship this plan back to Boston and New York. They need to keep their money out of the hands of government as well as corporate bureaucrats, utopian dreamers, and East Coast carpetbaggers. That's the only way they will be able to control their own medical destiny.

Dr. Orient, a board-certified internist, is Executive Director of AAPS and Professor of Clinical Medicine at the Oregon Institute of Science and Medicine. The Association of American Physicians and Surgeons is a non-partisan professional association of physicians in all specialties, dedicated since 1943 to the protection of the patient-physician relationship.