Mad as Hell Doctors: Advocating for single-payer health care

Dr. Samuel Metz, an anesthesiologist from Willamette Valley, Ore., is a member of Mad as Hell Doctors and an advocate for a single-payer health-care system. Mad As Hell Doctors is the creation of two Oregon single-payer advocates, Adam Klugman and Gary Jelinek. Frustrated with their efforts to get single-payer health care into the public eye, they envisioned a small group of motivated physicians who would go beyond advocacy and create a movement that would command attention. That movement began with a tour across the country to raise consciousness of our health care crisis and take the single payer message to Washington DC. This tour coincided with Congressional debates on what became the Affordable Care Act. We learned of the group and asked Dr. Metz to do this e-mail interview.

1. Tell us what MAHD has done since its formation.

Mad As Hell Doctors repeated their transcontinental adventure with several smaller tours in California and Oregon. As a consequence, both states expanded their existing networks of health care advocates to encourage activists to lobby their legislators for action.

Mad As Hell Doctors helped sponsor and host a Portland single payer conference in January of 2011 that drew over 500 people and featured Representative John Conyers, author of America’s national single payer bill HR 676, as the key note speaker. It advocated for Oregon’s single payer bill during  hearings in March of 2011. Michael Huntington and Richard Bruno, both Mad As Hell Doctors, were honored by Physicians for a National Health Program, Mike on behalf of Mad As Hell Doctors for Activist organization of the year, and Richard (a medical student at Oregon Health and Science University) for Student Activist of the year.

2. What are your biggest achievements in MAHD? Do other organizations share your goal, and can you tell us their names and their goals?

Our membership of 50 or so people overlaps considerably with the Oregon chapters of Physicians for a National Health Program, a similar organization of physicians but with a membership of 18,000 around the country. Both organizations advocate for single-payer health care.

A third organization sharing membership with Mad As Hell Doctors is the Oregon Single Payer Campaign. This statewide organization of over 1,000 people was created specifically to write Oregon’s single-payer bill. It is now hunkering down for a concerted effort to make Oregon the first state with a true statewide single-payer health care system. Though Vermont’s legislation will result in nearly complete coverage for everyone in the state, Federal law and some unpleasant political realities compelled it to stop short of true single-payer financing.

3. What do you think the future of single-payer health care is in the United States?  Why? 

Several factors make a state single-payer system (especially a national system) unlikely in the

 

near future. The first is the high level of hysteria in the country generated by politicians using health care reform as tool to advance other agendas: smaller government, increased or decreased access to abortion, stem cell research, job creation, and so on. As long as health care reform is folded into other issues that cannot be resolved easily, little will be accomplished.

Second, the sheer complexity of our health care system makes most Americans more terrified of change than of the impeding collapse. Health care consumes one out of every five dollars in our wallet, obeys few if any of the conventional laws of economics (e.g., if health care costs go up, health care needs do not go down), and suspends a sword of Damocles over American families – most of us are just one hospitalization away from financial ruin.

In the next 10 years, therefore, Americans can count on struggling with our dysfunctional health care system as best they can, as they have done for the past 50 years. Some states may have achieved universal health care with single-payer legislation, but most will face the same daunting challenges they do today.

4. Not to be self-referential, but what do you think of ClearHealthCosts?

ClearHealthCosts can potentially make two interesting contributions to health care. First, it offers patients spending their own money a chance to pick the health care providers and services that are most affordable. A likely consequence is providers will be forced to compete in a marketplace less obscured by ignorance, complexity, and intimidation. Will it bring health care costs down? As insurance companies restrict policies to any but the healthiest patients and offer increasingly higher deductibles, more patients will be faced with the new obligation to pay their own way and pick their own providers. Most patients will have very little money to spare for health care, and therefore be increasingly conscious of every dollar they spend. It will be an interesting venture.

The second contribution to health care ClearHealthCosts may make is academic research. The Dartmouth Atlas of Health Care presents Medicare data revealing the extraordinary variation in health care costs that are totally independent of patient outcome or patient need. Consequently, attention is focused on the flaws in our system that produce three-fold variations in costs for the same procedure performed on the same type of patient. The popular New Yorker article by Atul Gawande in June of 2009 was based on this research.

But we don’t have that kind of data for the rest of us not in Medicare. There is no database that illustrates what variations might exist in any metropolitan area for the under-65 patient population. ClearHealthCosts might provide the data for an entirely fresh look at health care costs around the country. With numbers like that, researchers in health policy could generate extraordinary white papers illustrating yet again how American private insurance financing produces the dismal public health outcomes that place us near or at the bottom of industrialized countries.

5. Is there anything else you’d like to say? 

America will retain the embarrassing title of  the country having most expensive health care in the world and the more shameful rank of 37th in overall health care results as long as it insists on financing health care with private insurance policies that restrict membership to only the healthiest, deny benefits to patients and payments to physicians, and drops healthy patients as soon as they become sick.

Successful health care systems that provide better care to more people for less money can teach us a lot. Lesson number one: single-payer health care is essential to reverse our health care destiny of national catastrophe.

 

*  *  *  *  *  *  *

Samuel Metz, M.D., is an anesthesiologist based in Portland, Ore. He works at hospitals and ambulatory surgery centers throughout the Willamette Valley of Oregon. He is a member of Physicians for a National Health Program and a founding member of Mad As Hell Doctors. You can contact him at SamuelMetz@SamuelMetz.com.