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Guest column
Angela Heider, M.D.

I recently retired from the practice of obstetrics and gynecology at the young age of 32 and after only two years in practice. My reasons are, of course, complex, but they boil down to the impossible logistical, financial, and familial implications of practicing medicine within the confines of the current system. Alarmingly, four of my young female partners have also elected to hang up their stethoscopes – a growing trend. If we are to reverse this trend, we need to reform our health care system.

Some health policy experts believe comprehensive reform is impossible in the absence of a national disaster. I believe we can make a difference but a really important first step is to make insured people understand the necessity of such an endeavor.

True enough, there are millions of uninsured and underinsured Americans who are clearly suffering under our current system. However, there are many more happily insured Americans who are completely unaware of the horrific state of a system they trust whole-heartedly. The fact is, even wealthy Americans are impacted by the looming health care crisis. They just don’t know it yet.

Continue reading The Rise and Fall of Dr. Mom


Guest column
Joel Ario, administrator of the state’s Insurance Division
Cory Streisinger, director of the Oregon Department of Consumer & Business Services

The authors have submitted this Op-Ed (a version of which originally appeared in the
for discussion on this blog.

You're about to have a baby and since your employer switched to a high-deductible health plan, you care about price a lot more than you used to. You're a savvy shopper, adept at using the Web to find the best deal. So you quickly discover www.orpricepoint.org, an Oregon hospital association Web site that tells you the statewide median charge for an "uncomplicated vaginal delivery" is $5,024. More clicking and you learn hospital charges are about 10 percent higher in the Portland area and vary by as much as 40 percent among local hospitals. You're disappointed the site doesn't rate the quality of services. You figure delivering a baby isn't all that complicated, so you're willing to decide based on price. Then things get really frustrating. You learn that the $5,024 is figured on so-called "billed charges" that nobody really pays, just like nobody pays a new car's sticker price, and that this amount might not include other charges, like the anesthesiologist's bill. Your insurer has negotiated a discounted rate, but it only applies to one local hospital. Even worse, the amount is a closely guarded secret - your hospital and insurer won't tell you what it is.

Welcome to the world of so-called "consumer-driven health care" where the rosy rhetoric is well ahead of the reality. You can't find out how much your hospital stay will cost you, but you know it will be expensive. You start to wonder just who can control costs like the multi-million-dollar hospital expansion projects busting out all over the Portland area.

Continue reading Cost Transparency and Affordable Health Care


As a proportion of total U.S. health care expenditures, emergency department (ED) costs are small: 1.9% of all expenditures of which 88% are covered by insurance.[1]  If ED costs are so small, relative to the whole pie, what can trends in ED use tell us about the broader health care system?

I believe trends in ED use – patient type, insurance status, etc – are like the canary in the coal mine. They can tell us when there are serious systemic access problems in the health care system.

Across the nation, 62% of EDs are now overcrowded.[2]  As an emergency physician, I have noticed a specific category of patient that gives insight into the problems with our medical care system. Two anecdotes illustrate what I think is currently happening.

Continue reading The canary in our coal mine


Guest column
Dr. Donald D. Trunkey, OHSU Professor of Surgery

Dr. Trunkey presented his ideas on health care reform at the City Club of Portland on June 9, 2006.

Access to US healthcare is a lottery, and what used to be a “not-for-
profit” system has become a “for-profit” system.

I would like to begin this dissertation with two relatively recent quotes. “We live in a great country that has got the best healthcare system in the world, and we need to keep it that way.” (George Bush, June 2003) “We do have the best healthcare system in the world.” (Bill Clinton February 2000)

Unfortunately, the evidence does not support the two presidents. One barometer of measuring effectiveness of a healthcare system is the average lifespan and the per capita cost. In the United States, we have an average lifespan of 77.8 years, at a cost per capita per year of $4887. In Spain, the lifespan is 79.6 years, at a cost of $1100. In Canada, the average lifespan is 80.2 years, at a cost of $2792, and in Japan, they live an average of four years longer than we do in the United States, at a cost of $2003 per year. Another measure of healthcare system effectiveness is the infant mortality. In the United States, it is 6.9 deaths per 1000 live births. In Denmark, it is 5.3, France 4.6, Sweden 3.4, and Japan 3.2. In fact, in the WHO Global Ranking of Healthcare, the United States is number 37, between Costa Rica and Slovenia, both developing countries.

Continue reading Dysfunctional Care in a Dysfunctional Healthcare System



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