Opinion: Congressional megabill calls for a fresh look at universal health care
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NEWS YOU CAN USE: Tony Germann's Powerful Op-Ed in The Lund Report
HCAO Vice President Tony Germann was recently featured in the Lund Report:
Why do we continue to build on a system flawed to its core and expect a different result? It's time to learn from past mistakes and be bold, doctor says.
|The Lund Report Premium
July 15, 2025
H.R. 1 doesn’t make sense. The math doesn’t work — not economically, and not from a health outcomes standpoint. As a family doctor who delivers babies and cares for elderly grandparents, I can say my most grave misgivings relate to how this legislation relates to health care.
Let’s be honest, though: We haven’t hit the mark on health policy for a while.
I’m a scientist at heart, and if I give someone a blood pressure medication I want to know it reduces the risk of death. Let’s similarly look at the Affordable Care Act passed by Congress in 2010, which largely functioned through expanded Medicaid access, subsidies, and the creation of market-based exchanges. Does the evidence show more people receive their medications and treatments with these interventions? According to survey results in Oregon, we find unequivocally — No.
In 2021
More than 3 in 5 (61%) experienced health care affordability burdens in the past year
More than 3 in 4 (77%) are worried about affording health care in the future;
More than half (55%) of Oregon adults encountered one or more cost-related barriers to getting health care
In the most recent survey (2024) we find worsening outcomes:
Over 3 in 4 (76%) had experienced at least one health care affordability burden;
Over 4 in 5 (83%) were worried about affording health care in the future;
Nearly 3 in 4 (74%) of all respondents had delayed or gone without health care due to cost
By definition, insurance is intended to provide financial protection against unexpected losses. So, do these numbers look like it’s been working?
Now the “Big Beautiful Bill” has fired a shot at the heart of the ACA. People are going to lose health care coverage: 17 million nationwide and an estimated 300k in Oregon. People will stop coming to my office. People will skip taking medications. More will go into bankruptcy. All of our premiums are going up — for all of us. And this is not hyperbole: more people will die. I will be one of the providers signing those death certificates. I will be supporting their family’s grief.
Is this the system we want in 2025? I’m exhausted and so is your health care workforce. Why can’t you find a primary provider? They are leaving medicine in this toxic environment.
So what to do? Should we just go back and reinstate the ACA in 3 years and expand Medicaid, the state’s new Bridge program or the public option? I argue not: Bandaids don’t fix bullet holes.
We keep playing a game that is rigged. Truth be told, the ACA further entrenched the broken rules we play by. Why do we continue to build on a system flawed to its core and expect a different result?
The ACA proposed groundbreaking ideas, but to not learn from its flaws is ill advised. We need to move past stale approaches. Let’s learn from our past experiences and be so bold as to learn what has worked for other OECD countries that deliver better clinical outcomes for their population.
We need clear goals. Let’s re-focus on our core values and principles.
In 2022, we voted as a state for Measure 111, to "ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right." We agreed on the premise of universality.
Meanwhile, the Oregon Health Authority (OHA) has set an ambitious goal to eliminate health inequities in Oregon by 2030.
So let’s not rebuild a system where the majority of people of color and poor are on the unequal benefits program of Medicaid.
Let’s focus on accountability and transparency. The insurance market is opaque, convoluted, predatory and untrustworthy. Look no further than your own experiences. As a provider, I have no idea if your test or medication will be covered. Premiums and deductibles predictably go up well above inflation each year. Prior authorizations are rampant — tools the insurance companies use to prevent the use of a product you paid for!
Why then do we expand managed Medicaid, and consider items like the public option supporting rent-seeking insurers when this faulty intervention continues the status quo of inefficiency and waste? We pay more as taxpayers, enriching private equity investors and shareholders of the insurance and pharmaceutical industries.
I propose our communities focus on creating an authentic solution starting with our values. Look no further than our own Oregon Universal Health Plan Governance Board effort.
Historically, people say a universal health plan in the U.S. is fanciful thinking and politically non-viable. I would offer to them, does the house of cards that we now see falling seem like the right direction?
It’s time for bold, transformational change.
Antonio (Tony) Germann is a family physician centered in rural primary healthcare, clinical health education, public health, and with a focus in the health policy to bring better health outcomes for the most vulnerable communities of Oregon. Currently he is medical director of Salud and Pacific pediatrics clinics of the Yakima Valley Farm Workers clinic system, a federally qualified health center. He is the founder of the Salud Rural Maternal Child Health Fellowship. Dr. Germann is a board member and current Vice-Chair of the Oregon Health Policy Board. He serves as Vice-President of Health Care for All Oregon (hcao.org). HCAO educates about and advocates for an equitable, affordable, comprehensive, high-quality publicly funded universal healthcare system that will improve the lives of individuals, families and communities across Oregon.
