Oregon's top doc calls for health care reform

By LAURENT L.N. BONCZIJK
For the News-Register
http://www.newsregister.com/

One of Dr. Klaus Martin’s main missions, as the new president of the Oregon Medical Association, will be to work toward overhaul of the way costs are covering in the American health care system.

Martin, a family-practice physician based in McMinnville, said the workings of both the state’s Oregon Health Plan and the federal government’s Medicare programs leave physicians and patients alike frustrated.

But he said the problem runs deeper than that. He said it also extends to private sector health insurance.

Seeing a patient under the Oregon Health Plan costs a physician money, he said, because state reimbursement is limited to 60 percent of the physician’s fixed overhead expenses. “With the Oregon Health Plan, not only is my time free, but I have to generate revenue from somebody else,” he said, in order to cover his overhead.

He said Medicare isn’t much better. It provides full reimbursement for operating expenses, he said, but nothing for the physician’s time. As a result, he said, fewer and fewer practitioners are willing to see patients under the government-subsidized plans.

Martin said it’s like sending an indigent child to school and telling the teacher he or she is not going to get paid for educating that child.

He said simply shifting the cost of care onto the physician is not sustainable over the long term. “The medical care of the indigent and unfortunate is society’s responsibility,” he said.

Huge malpractice judgments sometimes awarded by Oregon juries add to the problem, Martin said.

He said he can be 99 percent sure that someone coming to him with a swollen knee needs no more than some rest, a good dressing and maybe some prescriptions to reduce the swelling and manage the pain. That runs $100.

But to rule out the unlikely possibility his patient has a torn tendon, and thus protect himself from a delayed diagnosis lawsuit, he will have to order an MRI, he said. And the bill then jumps to $2,100.

Lawsuits are forcing physicians to practice defensive medicine instead of preventive medicine, he said, and that needs to change. Instead of ordering tests just to protect themselves, physicians should be free to make decisions based on their best judgment, he said.

The soaring cost of medical education is also a factor.

These days, by the time he hangs out his shingle, the typical doctor has amassed $180,000 in student loans, Martin said. That, he said, means “they are not being able to see patients who don’t pay adequately.”

He said, “We have to show doctors that they can go to small communities, give primary care and earn enough money to pay their bills.” And that’s not the case today.

Martin isn’t happy with the current private insurance system, either. He said, for example, that a patient with asthma, high blood pressure or diabetes will have a hard time getting anyone to write a policy if there has been a lapse in coverage.

In order to make insurance affordable, the risk has to be spread among the whole population, he said.

He doesn’t favor the kind of single-payer system Canada uses, citing long delays and limited access to specialists.

But he’d like to see a system where health coverage is mandatory, the way auto insurance is. That, he said, would spread the risk enough to make rates more affordable.

Martin said he envisions a system where citizens would buy insurance on their own and get full or partial reimbursement from their employers as part of their compensation package. When they are out of work, the state would make a contribution, much as it does under the worker compensation program.

That kind of up-front investment would enable patients to receive care in a more cost-efficient office setting. Today, the uninsured wait until they are facing critical health challenges, then go to the emergency room – a highly specialized and thus extremely costly venue.
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