Representative Wand: Why “yes” on SB 99?

by Rep. Matt Wand

I have been asked about my yes vote on Senate Bill 99, which directs the OHA to create a business plan for a healthcare exchange in Oregon, to be considered by the Legislature in February 2012.  This bill addresses two options the legislature had to choose from—I chose the option I believe is better for Oregon. We had to choose between option 1:  Letting the President impose an exchange on Oregonians or; Option 2: Pass an exchange ourselves.

It was very clear to all of us at the Legislature that a “no” vote on this bill would be a vote to allow the federal government to impose an exchange on its terms. I believe we did the right thing by creating those terms ourselves for our state.

When faced with a choice between state action versus certain federal action (such as this), my vote will almost always be to keep power at the state level as opposed to the federal level.  I question whether the federal government should have ever put us in this place to begin with, but my power over the federal government is limited to the ballot box and so we must protect what we can with state legislation.

Faced with this, we made the best decision we could with the options we had. Now we will be monitoring it during the interim and a final proposal will be coming in February for a vote.  In the meantime, this bill authorizes the state to put together a plan for consideration by the legislature so we are protected from the federal government.


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Posted by at 11:30 | Posted in OR 76th Legislative Session, Oregon Health Authority | 95 Comments |Email This Post Email This Post |Print This Post Print This Post
  • Al LeMay

    There is a falacy in your reasoning; the fact that we have to do anything. There is no way that either plan will create nothing more than a huge new deptartment that the taxpayers of Oregon will have to fund. Where is the money going to come from? Which budget item will you decrease to fund this? And heck, why not just create programs at will to fix all the ills in society? You and others needs to stop looking to government to solve problems, and stop using taxpayers as a personal ATM.

  • The problem as I see it with this (Wand’s and others who
    voted for 99) approach is that the State of Oregon is falling directly into the
    trap set by the BHO administration. Oregon has the health care cart so far in
    front of the horse that there is, at best, a visual connection based on some
    dubious assumptions. Assumption 1 is that Obamacare will not be overturned.
    This is a quasi reasonable assumption if the next assumption  made is that the courts will uphold the
    individual mandate….. which I think is a very dubious assumption.  Without the individual mandate there is no
    Obamacare. Failing to overturn Ocare in the courts the next assumption that
    would have to be made is that BHO would be reelected and that he would veto the
    legislature’s nullification of Ocare. As Chairman of our local Hospital
    District Board I have been following this closely and Ocare in its current form
    has a very tough row to hoe. The State of Oregon passed SB 99 with the
    assumption that Ocare will come to fruition. When Ocare does not fly, the
    Oregon Health Insurance Exchange created by SB 99 will have no Federal funding
    and therefore will have an unfunded or underfunded program unless they ask the
    Oregon tax payers to make up for the loss of Federal funds. It’s kind of like
    being out on a limb that is 90% sure of being sawed off by either the courts or
    the Fed legislature. The BHO strategy is to move Ocare in the States so far
    down the road that it becomes too costly to undo.  It is a shame that some of our good
    legislators fell once again for the intimidation practices of the BHO
    Administration. Just my opinion FWIW.!!

    • David Appell

      You’re the chairman of a hospital board?? You don’t seem very concerned about the health of Oregonians. One-sixth of the state & country has no health insurance –how much is that costing your hospital? How many more will be without insurance with premiums doubling every 10 yrs? At the current rate of increase a policy for a family of four will be $40k/yr in 2021 — who will afford that? 

      The whole, entire system is collapsing before our eyes, like a vast wooden structure that is cracking and splitting all over the place. It’s coming down even as people are nailing planks all around it…. a Health Insurance Exchange won’t do much to control costs, but at least it will make it much easier for the fraction of people who can afford it to find and purchase a policy. Why are you against that?

      • Take Your Meds

        I think the chairman of a hospital board knows a little more about healthcare than a failed weekend weatherman.

        • David Appell

          I’m not talking about understanding, I’m talking about compassion.

          I’m also not a weatherman. 

          • Moe

            You got that right!!

        • Founding Fathers

          You may be thinking of Chuck Wiese.

      • Gchalv

        David, pull your head out of your progressive a**.  JOBS and free market choice and competition – you know, PEOPLE operating within a market – are the only way to make costs come down.  Government mandates, regulations and blind 3rd party payment are the reason that premiums continue to rise.   

        • David Appell

          The advantages of a free market system do not apply to health care, primarily because (1) you cannot predict when you will need care, and (2) you can’t comparison shop. 

          Buying health care is not like buying shoes. Thus, you need an insurance system. And private insurance systems demand a profit, and a large administrative staff to analyze and deny claims. (*Not* paying for care is, after all, how they make money.)

          The classic paper on this is by Kenneth Arrow:

          “Uncertainty and the Welfare Economics of Medical Care,” Kenneth J. Arrow, The American Economic Review, Vol. LIII n 5 (Dec 1963)

          For a synopsis you can read:

          “Why markets can’t cure healthcare,” Paul Krugman, New York Times, July 25, 2009.
          “Patients are not Consumers,” Paul Krugman, New York Times, April 21 2011.

  • Deborah

    It looks to me like all of you would do well to look at what happened in Tennesee between 1994 and 2004 or so.   TennCare overloaded the system.   One of the things we need to remember is that government is not responsible for our health.  We the people are responsible for our own health.   I don’t need a government nanny to tell me how to take care of myself, even if I develop a serious illness.   My health insurance has gone up, but it’s still very good.   I doubt any agency can improve it for me.  I, for one, wish to keep the health ins. I have and don’t need anyone to tell me I should or shouldn’t.  But state mandates don’t give me a choice. 

    As far as premiums going up, that too is due to legislation and more gov’t regulations overseeing insurance companies which raise premiums.   The more government gets involved, the higher our costs.  Again, look at TennCare.   In spite of their best efforts, they ended up with MORE clients withOUT health insurance, not LESS.  Why?  Because the system became so overloaded, they had to ration care. 
    They ended up kicking some people off the rolls. 
    Take a look at the OHP as an example.  I have friends who are on OHP and medicare.  They’ve had trouble finding good doctors, and getting the care they need.  OHP is already rationing care, yet they wish to add MORE people to their rolls, even though there is a waiting list. 
    In 2009 the Democrat super-majority passed HB 2009, mandating that we do in fact pass something.   Yes, we as a state MUST do something, but not solely because of Obamacare, but because of laws passed in earlier sessions at the state level. 
    SB 99 is not the same as Obamacare.  Does that mean we should have laws like SB 99?  No, it means we had no choice due to previous state mandates.   

    There are more effective and better ways to address our problems with healthcare insurance.  BTW our troubles are not with healthcare itself, but the overblown gov’t regulations and some of the insurance companies.   We’d be better off with Tort Reform and Medical Savings Accounts among other options. Gov’t programs (federal & state) do not always offer the best solutions.    We as a state will be learning some things the hard way, if we learn at all.   

    • valley dude

      So we should eliminate Medicare and Medicaid and the VA, correct?

      • Deborah

        Not at all.   I’m not an anarchist.

        • Founding Fathers

          But you wrote “One of the things we need to remember is that government is not responsible for our health.”

    • David Appell

      Government isn’t “responsible” for your health, but it can certainly help when large corporations hold the system hostage and especially when they refuse to sell insurance to people with pre-existing conditions.

      What do you expect such people to do?

      How much longer can you or your employer absorb a doubling of premiums every 10 years?

      How exactly have government regulations driven up the price of health care? That’s a glib response that we hear blamed for everything. 

      When will conservatives realize that the “free market” (which in practice is crony capitalism) cannot provide everyone in a society with health care — something that has been known for 50 years?

      And when will they acknowledge that it’s long been known how to both control costs and provide care for everyone — dozens of developed countries are doing it around the world. They recognize that government can be a valuable tool in the struggle for health and happiness. We don’t have it here for one reason only: corporate greed. Insurers are demanding a cut of the nation’s medical spending by, literally, extracting it at the price of human suffering.

      • Deborah

        Mr. Appell, thank you.  We do agree on one thing;  government is not responsible for one’s health.  “How exactly have government regulatons driven up the price of health care?”    I never said the regulations drive up the price of health care.   I’ll repeat what I said:   Premiums go up due to more regulations.  I mean health INSURANCE premiums.  The more that government requires health insurance companies to cover (our bedsheets for example or maybe Tylenol like in Tennesee at one time) the higher our cost of insurance premiums.  

        “When will conservatives realize that the ‘free market’ cannot provide every one in a society with health care…etc.?”   Gentlemen, allow me to clarify…  I am not talking about healthCARE.  I am talking about health INSURANCE.  I also am not opposed to all regulatory measures.  Our debate is about how and what kind of regulations, not about whether we should have them.   It’s also not about whether or not we should help the poor.  Of COURSE, the poor should be helped!  My issue has to do with ALL of the citizenry being treated the same as the poor.  Thus, the poor are not helped with MORE folks added to the rolls because the system becomes overloaded.  No one is truly helping the uninsured by adding the fully insured to the mandates.

      • Gchalv

        Government health care for all is WORSE than health care free of government market distortion.  There should be a safety net for the poor, but do you understand that universal health care, by overburdening taxpayers and denying health care through rationing, degrades an economy.  It creates MORE poor people and less health, in the end.  

        • David Appell

          Government-run insurance systems around the world disprove your claims. Every developed country in the world has a health care system that is far less expensive than that of the US, covers everyone, and has better results. You seem to be willfully blind and in flat-out denial.

    • David Appell

      > I have friends who are on OHP and medicare.

      I too know someone on OHP. Before it she had no insurance and had a significant medical condition that went largely untreated. Now, on OHP, it is being treated and she is in less pain and discomfort. She hasn’t had any problems finding a doctor.

      Anecdotes are not data.

      • Deborah

        I agree;  anecdotes are not data.   So while my friends cannot be used as data, neither can yours.   Best to do our homework and look at the current situation with OHP.  I’ve not looked at it lately.  Have you?    

        BTW – I am glad your friend has less pain and discomfort.

        • David Appell

          Well, I know that 450,000 people are on the OHP, and that’s 450,000 people who would very likely have inadequate care without it. That’s a pretty big data point, no?

          • Deborah

            450,000 people on OHP does NOT mean EVERYONE should be on it or that EVERYONE should have government running our healthcare or health insurance.

    • David Appell

      PS: Everyone hates mandates until they need coverage for something that isn’t mandated. You usually cannot predict beforehand what your medical problems might be, and something you need mandated isn’t the same as what someone else needs, and vice-versa. So the way to lower costs for everyone is to mandate coverage. Otherwise people are denied care they need, and someday that will include you, if you haven’t been denied already.

      • Deborah

        “Everyone hates mandates…etc.”    This is quite an assumption.   There are good laws and there are bad laws.   Our debate is over which ones are good and which ones are not.  It is true we cannot predict what our medical problems might be ahead of time.   And neither can a government agency or program.   Sorry, I don’t agree that mandating coverage for everyone (myself included) is the way to lower costs.  Again, here I’m talking about health insurance premiums, not just healthCARE.   Which people are denied the care they need, Mr. Appell?  The ones who currently have private health insurance or the ones who don’t?   Surely none of the ones on OHP have been denied care, right?   Or have they?   I suppose one could say that a waiting list isn’t exactly a denial of care, just a temporary setback.
        Again, I suggest you take a look at what’s happened in Tennesee between 1994 and 2004 or so.   Also, look at Japan (before the earthquake).   They were fining employers who weren’t successful enough in making sure their employees were ‘healthy’ because sick people cost the government more money when the government is the one who pays the bills.   Japan has had programs to keep people ‘healthy’ (by agency definition) with mandates on employers to make it happen.

      • GCHALV

        Good grief–health insurance should be for MAJOR health problems, not piece-meal routine, over-use visits.  How many of these “poor” uninsured people have cable tv, an i-pod, a cell phone, a car, and a half-rack of PBR in the fridge…. A LOT.

        • David Appell

          Even routine visits to a doctor can cost well over $100, especially when you do not have insurance and are expected to pay rates far higher than insurance companies negotiate for their clients. Many people do not have that. And many of them do not have ipods. 

        • just doing the math

          All the more reason to level the playing field. I have known people who
          could afford insurance not buy it. I for one would like more people
          paying to the health care system. This may give relief to people like
          me who have been paying for their own plans for YEARS!

          Besides, how do you think the insurance industry makes up for the money
          lost when the uninsured go to the emergency room? From people like me
          in the form of higher premiums.

        • Deborah

          Excellent point!   Our entitlement perspective in this country has forgotten that, as I said earlier, government is not responsible for our health.   A properly working system would enable most folks to pay for their own basic doctor visits, but of course that would require smaller gov’t and lower taxes and allowing the people to take care of themselves without meddling bureaucrats.   Our health ins. has gone up with regard to basic care, but we have good coverage for catastrophic care.  Coverage like that should save us all some money with lower premiums, but people would have to get the idea that they are responsible for themselves.

    • valley dude

      We don’t say that people are entirely responsible for their own security. We expect people to take reasonable precautions but back them up with a police department. We expect people to be careful and prudent, but if their house catches on fire we back them up with a well equipped and trained  fire department.

      So why would anyone expect an individual to be entirely responsible for their own health care? Eat well and exercise and get checkups, fine, but if something goes seriously wrong people should be backstopped by the government providing at least funding for care that is beyond the ability of people to pay. Every other developed nation in the world has figured this out and treats access to medicine like access to police or fire fighting. We should all pay taxes or insurance premiums and care is there if and when we need it. That is all Obamacare is. A way to share in costs so we can all have access to treatment.

      Conservatives need to drop this mythology that medical care is an individual matter. It isn’t. Its a matter a decent society takes care of.  

      • Deborah

        Yes, I think you’re correct that the police dept. is a back up for people when they need it in case of a crisis or tragedy.   Is that what you meant?   Ditto for the fire dept.  “We expect people to take reasonable precautions…”  “We expect people to be careful and prudent.”   Is this not personal responsibility?   We DO say people are entirely responsible for their own security, unless or until they are victimized.  I suspect there may be an area where we at least partially agree.  We expect people to be cautious, reasonable, prudent, eat well, exercise, etc. as you’ve mentioned.
        What happens when government decides there are too many sick people with too many serious health problems and insufficient agency resources to go around?  The agencies will ration.  Then what happens to those who truly need it?   What happens to those who have sufficient health insurance coverage now, which BTW DOES cover catastrophic care, but are forced into the same pool as the uninsured?  Both parties will lose out as the agency juggles decisions on who is most in need or who is most deserving or whatever.   Again, please look at what happened in Tennesee in the mid-nineties.   Six out of nine of the Tennesee Congressional delegation voted against Obamacare because of their experience with TennCare.

         “…funding for care that is beyond the ability of people to pay.”   Who decides what that ability is and when and how much and for which medical conditions?   Who defines what ‘seriously wrong’ means?   It will be an unelected bureaucrat in a state or county agency.   That’s basically what we have now actually because the Consumer Business Affairs division, which has overseen regulation of the health insurance industry for many years, interprets the statutes and defines health insurance coverage.  This authority will be moved to OHA however.       

        “Conservatives need to drop this mythology…etc.”    Well, you’re entitled to your opinion and I’m entitled to mine.

        • valley dude

          We do not place 100% of personal security on the individual. have police patrols that deter crime. We have gang intervention programs. We have fire codes and inspectors to make sure buildings are safe. We don’t just wait for the fire or crime to occur. We do collective prevention paid for with tax dollars.

          Yes, public spending on health care has to be limited  to what we can afford or are willing to pay. Rationing the amount of resources made available is one way to manage these limits. But we also “ration” police and fire protection. We don’t have a police or fire station on every corner. instead we use response times, but we do try and equalize that across a community. The rich person is not entitled to a faster response from the fire department than the poor person.

          Since the government can’t or won’t pay for every possible treatment, we either limit what we will treat or we limit the number of people who get treatment. Its “rationing” either way. Very expensive, low result treatments should not be paid for by the taxpayer.  If an individual wants to cover every contingency they can supplement what the government will cover by buying extra insurance. This is the way it is done in most other developed nations. And it works. Extending basic coverage to everyone does not mean preventing extra coverage for those who want and can afford it. Just like having a police or fire department does not prevent you from hiring your own security guard, having a pit bull, or installing an alarm system.

          I don’t know anything about TennCare, but I imagine that like all state attempts at expanding coverage it amounted to a half measure that was under funded, and it probably lacked any ability to control expenses. The Oregon Health Plan had similar problems, though was better than the status quo ante for many people.

          Who decides what care people will get through taxpayer funded medicine? The body politic decides through our representatives who hopefully have the sense to appoint medical and ethical experts to design the system. You may think these experts are unelected bureaucrats, but I think they are experts trained to solve a problem. Fire fighters are unelected bureaucrats, but we entrust decisions on fire response and fighting to them don’t we (within the resources we provide)?

          Yes, we are both entitled to our opinions. But we are not entitled to our own facts. Here is a fact. Every other wealthy nation on earth provides as good or better care for their citizens by making basic health care universal. And they do this at far less cost than what we pay.  What have they figured out that we haven’t?

          • “Every other wealthy nation on earth provides as good or better care for their citizens by making basic health care universal.”

            This is not a “fact.”  Health care systems in England and Canada cannot be said to be providing “better care” then that received in the United States.  People die in those nations waiting for treatments for diseases that in the US they would receive care for regardless of their ability to pay.

          • valley dude

            If you statistically measure the overall health of the populations in both nations, they beat the united States on most health care categories.


            People in Canada and the UK live longer and healthier lives. They have much better access to health care. Some procedures are less available, and you are correct that as a result some people die waiting for treatments. Cancer care in the UK is less than that in the US or Canada for example. But in the US, many people die waiting for treatments they cannot afford or their private insurance refuses to pay for.

            As I said, its a fact. Canada and UK provide better care for far less money than the US.

          • David Appell

            Matt, as VD points out, you’re wrong. See the CIA Factbook:

            For lots of other (mostly dismal) statistics, see Wikipedia under “Health Care in the United States” and references therein.

          • 3H

            That is not true.  Emergency room visits are covered, but not necessarily long term care of chronic diseases.  You also run up against the fact that life expectancy in England and Canada is greater than the United States.  Infant mortality is also lower.  How do you explain those two facts.

            Also, you MAY wait longer for routine visits, but that is not the case for treatment for chronic illness and hospital care. 

        • David Appell

          > What happens to those who have sufficient health insurance coverage 
          > now, which BTW DOES cover catastrophic care, but are forced into 
          > the same pool as the uninsured?

          Again, the PPACA does not require changes in existing policies except to make sure they meet certain minimum standards. If you’re as happy with your existing policy as you have written here I doubt it will be affected.

          And, again, nothing in the PPACA prevents you from buying additional insurance or purchasing other medical care on your own.

        • David Appell

          > “Conservatives need to drop this mythology…etc.”    Well, you’re 
          > entitled to your opinion and I’m entitled to mine.

          Except that, as many comments here show, the conservative position is largely based on myths, incorrect preconceptions, and a lack of facts.

          • Deborah

            Oh, but the progressives have it all down pat.   Sure.  
            We’ll all be just fine then.

      • Gchalv

        Sir, you are dead wrong.  When America becomes like every other country, truly we are in very bad shape.  Moreover, we currently have by far the best cure rates for all major diseases.  Why is that?  It’s because of the profit motive that leads to medical breakthroughs and innovation.  ObamaCare will destroy not only our system of health care delivery, it will destroy our nation’s economy, too.  

        • valley dude

          What data tells you America has the best cure rates for all major diseases? And if that is true, then why is our life span less than in every other wealthy nation?

          Who says America should become like every other country? What I’m saying is that on health care, other countries of comparable wealth are doing better than we are. That is factually true. If we want to go our own way, fine. But it has already been proven to not work very well.  

          “Obamacare” preserves the current private, employer based health insurance system pretty much as is, but extends coverage to most people who are left out of that system. It is a lousy and overly expensive solution, but still better than the status quo. At least nearly everyone will get a reasonable level of care regardless of their financial circumstances.

        • David Appell

          Gchalv, again, where is your data? 

          According to the 1997 WHO study the US ranked 72nd in “level of health.” El Salvador and Tunisia were higher. Even Mexico was higher.

    • David Appell

      Deborah wrote:
      > I, for one, wish to keep the health ins. I have and don’t 
      > need anyone to tell me I should or shouldn’t.

      The PPACA does not prevent you from getting any care or additional insurance you pay for privately.

      Actually many Europeans buy additional insurance and most of them pay *more* out of pocket than Americans do, not less. And yet still their total cost is less — usually much less –their care is better, and everyone is covered.

      • Gchalv

        There care is NOT BETTER….  5 year cancer survival rate: America, 65%….  England 46%….. Diabetes patients who receive treatment in the first 6 months following diagnosis: America, 93%…. England, 15%…. MRIs per/million: America 71…. England, 14%…. I could go on and on. 

        • David Appell

          Do you have a source for these data? 

          I have no doubt you can cherry pick some categories where the US is better. But overall health care is not. The US ranked 37th in “overall health system performance” according to a 1997 WHO study. UK: 18th, Canada: 30th. In both countries citizens were healthier than in the US. 

          There are more recent WHO studies that show basically the same thing.

          • Deborah

            And you are assuming that the WHO study is reliable.  What other studies have you looked at?

          • 3H

            Well, if you don’t like the WHO study, that is fine.  Do you have one to counter it?  I would be interested in seeing it if you do.  Otherwise you’re just saying “I don’t trust the WHO” and offering nothing in return.  

        • valley dude

          I don’t know where you get your data from. Try reading this:

          The US ranks worst among all advanced nations in diabetic care, but best at cancer care (for those who have insurance).

    • 3H

      A picky point, and I could be wrong, but I don’t think someone would be on OHP and Medicare at the same time?  If you’re receiving Medicare, you wouldn’t be eligible for OHP.  And, if you were eligible for Medicare you wouldn’t replace it with OHP.

      I am happy that you have health insurance, but not everyone has it.   What do you do for the people that don’t have insurance?  Medical savings accounts are great – if you have enough extra cash to invest in them.  Most of the poor (who don’t have coverage) don’t.

      Tort reform has frequently been thrown up as a solution to rising costs – except that, according to the Kaiser Family Foundation, malpractice suits account for only 2.4% of total health care costs.  Tort reform would only lower a percentage of that.  A drop in the bucket and not a substantive solution.

      As for governmental regulation and intrusion – why do countries that have a single-payer system, like Canada, expend a much lower percentage of GDP towards   health care, have longer life expectancies and a lower rate of infant mortality?  Wouldn’t you expect to find the opposite with great governmental involvement? 

      The free market has had over 50 years, since the notion of government funded health care was first broached, to address this problem.  It has not.  How much longer do we have to wait?

      • Deborah

        “The free market has had over 50 years…etc.”    And in the last 50 years since government has bloated itself into an obese system of public agencies, our problems have become worse, not better.    We would have fewer poor people if their taxes went down.   Tax Credits going directly to medical savings accounts would help the poor to save something toward their care.   It’s too late for people my age, but tax credits toward medical savings accounts would help young folks starting out and carry them into their senior years.   

        There’s a clinic in New Jersey that helps the poor.  Doctors who work at this clinic offer low cost services due to the Federal Tort Claims Act, which gives free federal medical malpractice coverage so doctors don’t have to order unnecessary tests to ward off lawsuits.  This keeps down costs of care.   What if the state could pick up the tab for malpractice insurance for doctors instead of medicare or medicaid, which would drive down costs so the doctors could offer lower cost care to more people?   Some doctors might volunteer some of their services at free clinics like the one in N.J. if their malpractice insurance was covered by the state, but it would have to be a trade for medicare or medicaid.   Something to chew on…  saving $ for the state, for the doctors, and helping the poor.    

        I’m tired of the rhetoric about Canada.  Many Canadians come here for their healthcare because theirs is lousy. 

        It isn’t just the malpractice suits that cost us.  It’s the liability ins. premiums that doctors have to pay, and the extra tests they order to cover themselves from a suit.  Did Kaiser Family Foundation look at these costs?     

        No, a person cannot be on both medicare and OHP at the same time.   Sorry if I wasn’t clear.  

        • valley dude

          “We would have fewer poor people if their taxes went down. ”

          If that is true then why to Denmark, Sweden, and the Netherlands to name just 3, who all have much higher taxes than we do, have far fewer poor people in proportion to their populations?

          Medical savings accounts are fools gold. No one but the rich could ever save enough to cover a major medical issue, let alone chronic issues like diabetes.

          Canadian care is statistically superior to the US on most measures. People come here for hip replacements. Since Canadians live longer, they probably need more hip replacements than we do. 

          • David Appell

            And regarding hip replacements, Medicare and Medicaid pay for 70% of hip replacements (

          • Deborah

            And the other commentary on that link is well worth paying attention to in response to Krugman’s blog.   So medicare is a huge success?    Doctors are well paid on this system?   No waiting list?    And we all have so much money these days, especially the feds.

          • just doing the math

            And Canada ranks in the top ten countries of happiest citizens.

            As far as higher taxes, you have to take into consideration all the money people
            in the US spend on health care, when comparing the US with those countries
            that have “single payer systems” (for lack of a better word) 

          • Deborah

            I’ll be sure to ask my Canadian neighbors about this.   Where is your data for ‘happiest citizens’?

          • 3H

            LOL.. Ok.. let me ask your for your data for your assertions.  I have not seen any yet.   You’ll notice that we (liberals) have by and large supported much of what we have said.  I do not see you and the conservatives doing the same in this debate.   I think it’s fair to ask you to do the same.

          • Deborah

            Fair enough.  Much of what I have is hard copy, and sitting in a box.  I don’t have links at present, but I will tell you where I received my info on Japan…  simply by Googling ‘Japan – Healthcare’.  I did find some online articles that peaked my interest, which I can dig out if you’re interested.  But I’m sure you can Google as well as I can. 

            My initial interest was from an article in Parade magazine 2 years ago.  I don’t know if I still have it.   For Tennesee Healthcare —  World Magazine, April 24th, 2010  by Edward Lee Pitts.  Title:  ‘A History Ignored’.  Sorry I don’t have a link.   Frankly I don’t like reading online.  I prefer hard copies in my comfy chair.  I can do some digging around for Tennesee however and post any links I find., but I’m not thrilled with taking time to do that until July.   Much of what I get is from conservative think tanks (except for some mainstream media) which you guys will simply thumb your noses at anyway.

          • 3H

            Ya gotta be careful of what source you cite from Google.  The don’t rank or exclude on the basis of the authority of the website.   I would believe the WHO before I’d believe in Frank’s Everyone’s a Commie website.

            I assume you meant Canada since that is the country we were talking about?

          • Deborah

            Google can take me to a reliable website or an unreliable one.   I also would likely trust the WHO over ‘Frank’s Everyone’s a Commie’.    LOL     But I also must say that putting the words ‘world’ and ‘health’ in the same sentence does not make it reliable.    I could ‘create’ a group called ‘National Health Restoration Council’ or something like that, but that doesn’t make it reliable.   I do tend to gravitate to groups I’m somewhat familiar with, like The Heritage Foundation (and they have a website), but as I said before you guys will just reject the kinds of sources that I have respect for.   The piece in Parade magazine 2 years ago about Japan and obesity/healthcare caught my attention and I simply googled key words until I found a news source that appealed to me.   I can dig thru my box if you’re really that interested.   I suspect each of us has our favorite sites for research.       

            I don’t mean just Canada.   I mean Japan (although since the earthquake they have their poor hands full).  I looked at Japan a few years ago (online).   I don’t remember the source but I made some hard copies, which as I said is likely in one of my boxes.   I also mean Britain and other countries.   I don’t know that much about Britain.  I did some online research a few years ago and found some articles.   I’m not sold on European healthcare.   I believe you’d mentioned that they include private health ins. now?    

            As I’ve said earlier, Oregon is likely to find out one way or another since we now have OHA and will have the insurance exchange.    I think we’ll regret it.   If I’m wrong, I may have a little egg on my face but I’ll have better healthcare access.  I can survive that, and I don’t mind being wrong about something if it benefits me and people I care about, and the underdog.   

            I don’t think I’m wrong though.   I think we’re going to discover some unintended problems with what’s been done. 

          • Deborah

            And BTW, I looked at the link provided by valley dude—  


            It just says a U.S. team did research, doesn’t say who, although it makes mention of the Amer. Journal of Epidemiology.   One sentence in the article caught my attention:  “And although a larger share of Americans are uninsured or under insured compared to populations in England or other European countries, even groups with good access to health insurance experienced worse health than people in England.”    

            If this is true, than improved access to health insurance will not improve our health. 

            The article also states that the researchers say it’s an unresolved puzzle as to why health status differs so dramatically in these two countries.   And it quotes a spokesperson from the England Dept. of Health;  “Whilst in some areas our outcomes may be favourable compared with those in the US, we are still clear that we have a long way to go before we achieve outcomes comparable with the best performing health systems.   That is exactly why we are modernising the NHS.” 

            Saying that ‘England has better health so we should model our healthcare system after theirs’ falls flat, at least from this data.        

        • David Appell

          > Many Canadians come here for their healthcare because theirs is lousy.

          Do they? Do you have data on that claim? 

          Also, how many Americans go abroad for affordable medical treatment, so-called “medical tourism,” or to Canada or Mexico for affordable prescription medicines?

        • David Appell

          > It isn’t just the malpractice suits that cost us.
          This is another myth. Litigation costs and malpractice insurance add only about 1% to medical costs in the US. There are lots of articles on this that are easily found; see, for example, 

        • just doing the math

          “I’m tired of the rhetoric about Canada. Many Canadians come here for their healthcare because theirs is lousy.”

          No they do not. I have known several people with dual citizenship. They have a
          health problem, up to Canada they go.

          Besides their system is not entirely free. Canadians do pay a very reasonable
          premium for their health care.

          Why have other countries been able to provide their citizens with affordable
          health care? Why is it when there is a mere mention of a single payer system
          their are cries from certain groups that the US is sliding into socialism? If that
          is the case one may call our public education system or our library system
          socialistic entities.

        • 3H

          “I’m tired of the rhetoric about Canada.  Many Canadians come here for their healthcare because theirs is lousy.”
          This is a myth – actually believe that less than 1% choose to come here for their medical care.   The ones that are counted as using are hospitals, etc.., are already here for other reasons.  Very few Canadians come down here to use us for their medical care.  

          I can’t let the irony pass – “…
          gives free federal medical malpractice coverage so doctors…”   FEDERAL coverage.  Governmental interference.   You’ve just argued against your central points.

          Please note that the insurance is provided to clinics and health professional volunteers.  It does not limit medical malpractice awards or claims for liability which is the focus of tort reform.  

          And to your answer about KFF – yes they did look at those costs.

          • Deborah

            Not really.  As I’ve said, I’m not an anarchist.  I’m not arguing for no gov’t but for limited gov’t.  I want gov’t to leave me and my health insurance alone.   It’s fine the way it is and I don’t need lawmakers to come along and ‘improve’ something that isn’t broken. 

          • 3H

            So as long is it works for you it doesn’t matter how it doesn’t work for a significant portion of our population?   I don’t think you intend to sound that callous.   How do we get health coverage for those that can’t afford it?  Or do we simply talk about individual responsibility and wash our hands of it.   If they can’t afford it, it really is there fault and we should do nothing?

          • Deborah

            No, of course not.  And no, I don’t intend to sound callous.   I think there should be some help for those who truly need it.   but including me and others who are capable of taking care of ourselves with our own private health ins. does not help these people.  It only overloads the rolls, and will eventually hurt them more than it helps them.  Again, what happened in Tennesee is the best example I can think of.  When people have something for ‘free’, they tend to overuse it.   Lawmakers from both parties helped restructure TennCare in 2004.  

            As far as people being unable to afford it, I can think of some people where it really IS their fault.  Even then, I don’t think we should do nothing.  But I think we need to be very very careful about what we legislate, because legislation affects EVERYONE and NOT EVERYONE is the same, or has the same circumstances, lifestyle, physical problems, etc.

          • valley person

            If you currently have private insurance that you buy on the open market or if you get it through an employer, then you have not been “include” in Obamacare except to the extent you might qualify for some help paying your premiums. Obamacare made 3 main changes:

            1) It requires everyone to chip something in for insurance. No more free riders.
            2) It requires states to create insurance pools with minimum standards from which individuals and small businesses can choose which policy to purchase. (it also gives states the option to try something different as long as they can achieve comparable results).
            3) It expands Medicaid eligibility.   Or as you say, help for those who truly need it.

            I don’t know what you mean by “overloading the rolls.” Health care economists all say having everyone in the pool will lower overall costs.

            Obamacare is not “free” except for the desperately poor. And anyway no one over uses chemo or dialysis or heart surgery because it isn’t costing them out of pocket. People may go to more checkups if they don’t pay directly, but who cares? That is low cost and useful for catching things before they get to be a more expensive problem.

            We are careful about what we legislate. It took 50 years of effort before this nation finally got a comprehensive health care law. It took a solid year of hearings, debate, votes, more hearings, more votes, more debate, and so forth before the Obamacare bill passed.

          • Deborah

            “…to the extent you might qualify for some help paying your premiums.”   I don’t need or want the gov’t to force its ‘help’ on me to pay premiums!  We can pay our own bills!    “…requires everyone to chip in…etc.’     Well, we’ll get to try these things out here in Oregon.   It will be interesting to see.   Ditto your #2 assertion.    “#3…expands Medicaid eligibilty”      
            All at cost to taxpayers, the government’s ATM machine.   Again, WHO defines who needs it and who doesn’t?   

            By overloading the rolls, I mean far too many clients utilizing a system to the point the system can’t handle the numbers of people/added benefits signed on.   The problematic result is even those who are truly in need end up destitute and without adequate care due to INCREASED rationing.   Again, TennCare is a good example.  There was not enough accountability in the system, and patients from other states signed on.  Tennesee should have put caps on non-residents.  TennCare almost bankrupted the state in less than a decade according to my article (which I’ve cited elsewhere in our debate).   The enrollment numbers surprised everyone in the initial stages.  I suggest you google TennCare and perhaps you’ll see what I mean.  

            New enrollees had private insurance before TennCare, but businesses dumped their employees onto TennCare because they were facing higher costs (again according to my article).  Maybe Oregon’s efforts will be different.   I hope so.   It looks like we’ll find out one way or the other.   

            A few other comments I wish to make about TennCare;  people moved into the state because benefits were so lucrative, thus swallowing almost 40% of the state’s budget.  In one decade, costs spiraled out of control.   They created a new income tax to address costs to the state.  Both Republicans AND Democrats struggled with it.   A state audit had found $6 million paid to insure 14,000 deceased persons (which is why I commented about accountability).   Over 16,000 clients lived in other states.    Prescription medicine costs also skyrocketed because clients went to doctors for over the counter drugs so they wouldn’t have to pay for it (again according to the article).   Yes, the cost was lower for THESE people but there were so many of them using even benefits they did NOT truly need that the state (taxpayers) was unable to fully bear the costs.    This is what I mean by overloading the rolls.   

            Doctors and hospitals also shifted costs to charge more to private insurers because providers are ALWAYS paid less in socialized medicine (medicare is one example).  Private insurers then raise their premiums.  More people thus become uninsured or underinsured.        

            If you don’t believe me, you can research this online.  There should be some updated info by now.   I’m not going to research it for you.  

            Both liberals and conservatives can learn something from TennCare IMO.  

               “Healthcare economists…etc.”   Which ones?    Having everyone in the pool will NOT lower costs, but I think we’ll find out the hard way similar to Tennesee.   This is a complex issue and there are no easy answers.    Take a look at Massachusetts.   I need to research that state myself and get updated.   I encourage you to research what’s going on there.   If their plan is working (which I doubt) we can learn something.    

            “People may go to more checkups…  but who cares?”    It’s not that simple.  Think about it!   This is not simply about ‘preventive care’ but overused care.  The taxpayers will care when costs spiral out of control, and so will the next set of legislators (regardless of party).

            This is not a liberal or conservative issue.   This is a healthcare and economic issue.  It affects us all, liberals and conservatives alike.   We all need medical care at some point in our lives, and we all need money to live on.   That’s the premise from which I begin.    

            Thank you for hanging in there with me, even though there’s been some heated exchanges.   In closing, I ask simply that you mull over what I’ve presented here and also do some research as I’ve suggested above.           

          • 3H

            “I’m not going to research it for you.”
            Then in the future I think you should not ask others for proof.   Otherwise you’re imposing a burden on other  posters that you’re not willing to impose on yourself.  Obviously anything I can find on the internet you can as well.  

          • Deborah

            You’re right.  I am sorry.  I was being protective of my time, but I imagine others are as well.   Give me a few hours.  I will post some links soon.   Thanks.

          • Deborah

            Okay, here is the first link as promised.  More to follow later.  


        • 3H

          “We would have fewer poor people if their taxes went down.”
          So, historically speaking, were there fewer poor people when tax rates were lower?  

    • 3H

      Also, most like you care is rationed as well Deborah.  Unless you have a Cadillac plan (which the vast majority of us with health insurance do not) there are things your insurance will not cover and their are caps on the things they do.   The number one reason for personal bankruptcy in this country is because of debt incurred from health care related bills.  Many of those people had health insurance. 

      • just doing the math

        Not only are there caps, my own personal experience dealing with an HMO
        (you know the one that was video taped in California, patient dumping) trying
        to get care for someone with a terminal illness was a living nightmare. You
        would be surprised at how much delay and denying that goes on in our
        own healthcare system. I like to call it “embedded death panels” where the
        care is denied until you die.

      • Deborah

        Do you have the stats/data source on this?   I know folks who had bankruptcies for other reasons, so I can’t agree with your assertion unless you can supply some empirical evidence.   However, I can see where this can pose a problem for some.  But even if some people do file bankrupties due to healthcare costs, this is an insufficient reason to legislate universal health coverage for the general populace.

        • 3H

          “I know folks who had bankruptcies for other reasons, so I can’t agree with your assertion unless you can supply some empirical evidence.”
          I didn’t claim all were for medical costs – so you are likely to find some who filed bankruptcy for other reasons.

          If you are going to doubt, which is fine, I think it would be good for you to provide evidence for your assertions.  Since you have not backed up anything you have claimed, you’ll understand that I really don’t accept anything you have claimed.  Just keep in mind that it is only fair that you play by the same rules you demand of others.  

          For bankruptcies:  “Illness or medical bills contributed to 62.1% of all bankruptcies in 2007”


          • Deborah

            Please see my earlier reply.   I’ve made many mistakes because I don’t usually get involved in online debates.   But I agree that rules should be the same for all posters.   I will post links soon, but be aware that even then I am sure you and some others will not accept my assertions anyway.   As I said earlier, I think Oregon will have to learn the hard way.   I did look at your link on bankruptcies.  A valid point you make here.    This is one of the better links I’ve seen.  

            HOWEVER (and again I’m being somewhat protective of my time) each of us could post links and info until we’re all blue in the face, but I’m not optimistic that we’ll embrace each other’s point of view on this issue.   I am for limited government.  Apparently you think gov’t can help the poor and the uninsured by growing another agency (correct me if I don’t adequately understand your position).   It’s not likely that we’ll agree, but perhaps we can at least think about and consider the other person’s point of view.      

            I’m aware that as I ask you to consider my position, I’ll need to consider yours.   Fair enough.   I assure you I’ll think, study, read, and talk to people on BOTH sides of this issue.   Will you do the same? 

            I think there’s a better way than growing more gov’t.  I can post links that offer something to chew on.   Meanwhile, as I’ve said before, this is a complex issue and there are no easy answers.   I still say that we can’t help the poor by putting people like me in the same pool.   My mind just can’t get around it.  

            I wonder how we’d do if we could take the anger and cynicism out of our debates?    (I don’t mean just you guys;  me too.)   

            This is also an emotional issue because we all have friends, family, and ourselves who utilize medical care and some of us have family and/or close friends with cancer, diabetes or a disability.   Believe it or not I do empathize.  I have a family member with cancer.   I have a friend with a disabled child.   I have a friend with a disability.   I’m sure other posters do too.   Our personal experiences color our debates, but we try anyway.  


          • Deborah

            Actually I’ve done some back up of my claims from a link v.dude provided.   I don’t think you’re listening however.    


            Here is another:   

            And last but not least: 

            In the last link, the U.S. is rated #6 in quality of end of life care.  The U.K. #1 so according to this data the U.K. is the best place to die.   I don’t know whether it’s the best place to live however.   The U.S. is not given first place, but it’s a long ways from #33 and #34 (Brazil and Turkey).   Didn’t someone here say that other developed nations have better health care than the U.S.?   According to my last link data above, the U.S. ranks well above Norway, Germany, France, The Netherlands, Sweden, Denmark, and Japan (and others) in quality of end of life care.  

          • 3H

            Thank you for your responses, and I do understand about being protective of one’s time.  I do appreciate you willingness to debate, and although we not fundamentally change each other’s mind, the cordial tone and back and forth is good.   Too often debates degenerate into being flippant (which I’ve been guilty of), and it’s nice to actually discuss the issues with someone who is not looking for an excuse to be snide and demeaning.  I haven’t look at your links yet, but I’m going to.  I just wanted to thank you upfront.

          • Deborah

            Ah.   I suspected you might hang in there with me if effort was made.  Your tone is different than the others.   Yes, debates do degenerate because there’s a degree of anonymity in these postings.   But also because health care is an emotional issue that touches us in some of the most personal areas of our lives.  But, yes, the back and forth is good.  It makes me mull over the issue more.   I also appreciate the cordial tone and your willingness to at least look at why I have the views I hold. 

            It raises my ire when someone (I don’t mean you necessarily) lumps me in with all other conservatives, accusing me of embracing myths, etc. when they don’t know me, they don’t know how much reading, listening, and research I’ve done.   We conservatives are not all alike.   I’m a pretty independent thinker.  (Most of my friends are too.)    I like to look for solutions to problems that are outside the mainstream, like breaking a new trail in the forest.    I don’t like to hear my colleagues call names, be sarcastic, or demeaning.   But I don’t like it if liberals do it either.  It breaks down communication;  then none of us gets anywhere and we’re all just wasting our time.  

            So…   You’re welcome.   and thank you too for hanging in there with me.   I do hope the links I provided give you some good, and interesting, food for thought.  I hope I typed them in right.   Let me know if you have trouble accessing any of them.

          • 3H

            I understand the frustration with being lumped.  Sadly it occurs across the political spectrum.  Read the most recent article by Walter Huss – he does exactly the same thing, and I find it greatly frustrating.  LOL.. I just wrote a post that should have said “many conservatives” instead of just conservatives.  mea culpa.

          • 3H

            Unfortunately, the realclearpolitics link is broken.  

            The article from WSJ is interesting – and I have no doubt that it is reported accurately.   TennCare had problems because it was successful, but ran out of money and couldn’t contain costs.   In much the same way that OHP ran out of money.   

            I have yet to see a viable plan that will serve the health care needs of the poor coming from Conservatives.  Sadly, they focus is on cost with little concern on how to provide health care services to those in need.  

            I have read the criticism of both TennCare and OHP – that they ration care, and the don’t serve all of the poor.   The fact is, there is nothing that would replace those services.  There would be no health insurance for the poor, and they would have to rely on health care by emergency room.  This is why I am a big fan of single payer  😉

            The final link is ranking End of Life care, so is limited in its scope.  I will note however, that the United States is No. 6.  You’ll please note despite the criticism of the Canadian model, that Canada is ranked higher than the United States in End of Life care (Death Panel Care?).   

          • Deborah

            Let me try the RealClearPolitics link again…     


            If it’s still broken, I’m sorry.   The title is ‘Lessons For Health Care Reform’    by Reps. Marsha Blackburn and Phil Roe.   Mr. Roe is a physician who has experience under TennCare.  Date of article is July 22nd, 2009.   If you can’t access the above link, perhaps just going to the Real Clear Politics website will work.  The article is still there.          

            My response to some of your above remarks—    re: “…yet to see a viable plan that will serve…   coming from conservatives.”       Welllll, I’ve yet to see a viable plan coming from either conservatives or liberals.    I still say there’s a better way and we just haven’t found it yet.   We human beings are imperfect and not seeing a solution that isn’t right before our eyes doesn’t mean there isn’t one.   I keep saying this is a complex issue.     I will discuss this with some of my colleagues.

            Would you mind explaining what you mean by single payer?  I’ve not researched health care in depth and am still trying to learn, however if I had a vote today, I’d still go more for a free market approach because of my belief that gov’t does not have all the answers.  No human groups of people have all the answers.   

            Allow me to restate that I am not for NO gov’t, but for LIMITED gov’t.  And while we’re at it, I’m also for ACCOUNTABLE gov’t.

            To your assertions about rationing care but there is nothing that would replace those services—   so services that are not cost effective and end up hurting people who were dependent on it is better than free market?   I acknowledge that we DO have problems with private ins., but again I believe that’s partly due to gov’t interference.    I suspect I won’t agree with single payer plans, but I’d like to hear your definition of it first.   

            We have a PPO.   Our employer partly covers the premiums as part of salary.   It works for many, many people.   If these people can keep what they have, perhaps more poor people can be helped.   I do think Medicare should be traded for OHP or something like that.   Let the states figure out their own systems instead of the feds running it all.   I’m just brainstorming here.   Meanwhile, I don’t like that seniors don’t have a choice about Medicare, but that they MUST be on it even if they don’t need it (someone told me yesterday).   This is part of the problem I have with gov’t running things…   forcing its help on those of us who don’t need or want it.   This does not help the poor.    Let people CHOOSE whether or not they want help from the gov’t!   Although even this will pose problems, which I can elaborate on later.

            You don’t say anything about my very first link, by the Russian Healthcare Economist who defected to the U.S. many years ago (I think ’89).  I’m still in the process of reading his article myself as it is 6 pages.    

            Conservatives focus on cost partly because they see that it doesn’t truly help the poor IN THE LONG RUN.   Again, we’re not all alike.   One of the major problems with TennCare is that employers dumped their employees off of private plans to save business costs.   Those employees, who HAD private ins., were forced onto the public plan just to have ANY health insurance.   Because of this, the public option became overloaded, and even the poor who were previously helped, got dumped.  This is why we talk about cost.   There surely must be a way to help the poor without making ALL of us poor with these kinds of mandates.  TennCare ended up with FEWER insured people, not MORE insured people.   That’s not a good solution for the poor.   If that happens, the poor were better off before gov’t stepped in. 

            When they write legislation, how are they going to make sure employers don’t dump us (myself included) off of our private ins. to save business costs?   In Tennesee, people who were previously insured ended up UNinsured.   If that happens to me, I’ll know who to thank.   And again, these kinds of problems do not help the poor.  

            To your assertion about Canada having better end of life care…   yup, they’re #5 and the U.S. is #6.   But as you pointed out, this is limited in scope.   So Canada’s having one ranking # higher than the U.S. in end of life care doesn’t mean we should model ALL of our health care around Canada.    I don’t buy that people live longer in Canada.   I’d have to see the research, and from more than one entity. 

            I think we should look at what’s happening in Massachusetts, but I won’t have time to research that until July.   

            Sorry this is so long.
            I have GOT to get off of this computer.   I’ll check back here again in a few days.

  • Gambler

    Oregon MUST enact this exchange so that the little people, like me, can continue to get free health care, counseling, addiction treatment, dental, vision, etc. I can not possibly afford all that myself. However, the state has plenty of money to help people like me and I welcome the assistance. This way I can use my money for the video poker. So far I am under about $7K but I just know that I will hit the winner soon.

    • David Appell

      We all have vices, faults, and bad habits. Every single one of us does something that isn’t good for our health and well-being. People shouldn’t be expected to be saints in order to get the health care they need to live without physical or psychic pain, to learn, to grow, and to prosper.

      • Gchalv

        Psychic pain?   Man, liberals are something to behold. 

        • David Appell

          Mental health. A lot of people have problems with it, in case you didn’t know.

      • Gambler

        Thanks for understanding. I must have it and I must have it free.
        That is the American way.
        Now, off to the poker machines!~!

        • 3H

          No – I prefer, “I’m  sorry you’re child is sick, but I need my money for my second house in the Hamptons.”

  • Mmcconoughey

    I don’t agree, Representative Ward because Oregon’s track record of new programs and their management is not obviously better than the record of the federal government. 

    Note, for example, that despite meeting twice as often as legislators in Texas, the legislator failed to write a new bottle bill that could  distinguish between bottled medicines and the more common soft drink bottles.
    Now, citizens are told to rely on the “intent” of the legislature.  This is sloppy law writing, no matter which parties were responsible.

  • Greg Halvorson

    Matt, you are a JOKE!!   ObamaCare needs to be REJECTED WHOLESALE, and it may well be.  To operate on the premise that SOCIALIZED MEDICINE is going to be accepted by the American people is to operate on the premise that the Constitution is DEAD!!  

    • David Appell

      Single-payer systems are not “socialized medicine” — they’re socialized insurance. Doctors, hospitals, suppliers, etc. are all still privately operated. (The UK is a notable exception to this.)

    • David Appell

      Single-payer systems are not “socialized medicine” — they’re socialized insurance. Doctors, hospitals, suppliers, etc. are all still privately operated. (The UK is a notable exception to this.)

  • Poseur

    Whenever I need free health care I just go to the emergency room. It has worked for me everytime. I never pay anything and they are good to me.
    Why do anything different? What we have now is pretty nice.

  • Deborah

    2nd reply…   sorry.     I read the link about malpractice suits (below).  So I’ll back off on tort reform, however I did notice that there was only one Florida study from 1996, then another one in 2002.   I did appreciate the person’s comments about ‘defensive medicine’ and I did notice the comment that no one has a good handle on defensive medicine costs.   I also noticed that costs for doctors, according to the article, can vary by region (cities or counties).  If that is the case, the same would be true for Oregon i.e. costs for doctors would vary in different parts of the state.   But when we legislate, we legislate for the whole state.   How can varying costs be adequately addressed?

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