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Samuel Metz, MD, of Southwest Portland is vice president of Oregon Physicians for a National Health Program and a founding member of Mad As Hell Doctors.

Samuel Metz, M.D.One might think single-payer health care is antithetical to American free markets. One would be wrong. Single-payer is as American as the Liberty ship.

In fact, single-payer health care was invented by an American capitalist, Henry J. Kaiser, who went on to build nearly 3,000 Liberty ships in World War II (most of right here in Portland).

During the Great Depression, Kaiser employed thousands of workers toiling in Western deserts, far from towns and farther from hospitals. He conceived three brilliant ideas that improved business and, collaterally, benefitted workers. (Actually, the ideas were brainchildren of his company physician Sidney Garfield, plus company executives Harold Hatch and Alonzo B. Ordway. Kaiser was astute enough to implement them.)

These brilliant ideas were simple: (1) If he kept employees healthy, they'd be more productive and he'd make more money. (2) If he kept employees and their families healthy, he would attract and retain productive employees and he'd make more money. (3) And if he eliminated insurance companies except as accountants, his administrative costs would drop and he'd make more money.

He was right. He implemented these ideas and made more money.

This single-payer model worked so well it became the preferred format of large American businesses. If your company employs more than 5,000 people, the odds are greater than 9:1 that you receive health care through private single-payer plans, just like Kaiser created. Today, 60% of fully employed Americans get health care through single-payer plans.

Industrialists label this form of employer-sponsored health insurance as "self-funded," but it applies the same principles pioneered by Kaiser and implemented in Willamette River shipyards.

First, everyone contributes to a pre-paid, community-rated health care plan. "Pre-paid" means making contributions when healthy, not sick. "Community-rated" means contributions are independent of job responsibilities, health, or age.

Second, everyone enjoys the same set of comprehensive benefits. "Comprehensive" does not mean "unlimited" — it means "treatable conditions get treatment." Anyone can purchase more benefits. But no one is denied the minimum.

Lastly, any patient can see any provider, and provider payment reflects value of service, not value of insurer. Insurance companies, if consulted at all, provide accounting only — providers, patients and employers enjoy a life without insurance forms. Even insurance executives feel relief.

Large businesses applying these single-payer principles receive ample reward: Health care costs less than commercial insurance. Employers like lower costs; employees and families like health care.

This American single-payer model quickly spread internationally. Now, every other high-income nation features universal health care, and a dozen use variations of Kaiser's single-payer plan. All these nations provide better care to more people for less money than the U.S.

Single-payer succeeds not only in private America, but in government as well. Public health care plans (all single-payer variants) exceed commercial plans in patient satisfaction, optimal outcomes and lower costs.

It's not just the poor, or even middle class, who benefit from single-payer. Even the richest Americans would get better health care at lower cost in a single-payer nation than at home.

Rich or poor, private or public, employer or employee: Single-payer health care provides you with better care for less money than commercial insurance.

Take a tip from "Uncle Henry" Kaiser: Single-payer is as American as apple pie — and it's better for your health.

Samuel Metz, MD, of Southwest Portland is vice president of Oregon Physicians for a National Health Program and a founding member of Mad As Hell Doctors. He was a member of Oregon's 2018 Universal Access to Health Care legislative work group and of the Oregon Medical Association's 2018 Universal Health care Task Force. He is a current member of Oregon's SB 770 Task Force on Single-payer Health Care.


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