11 January 2007

208 Commission news

The Colorado Health Care Reform Commission's proposals committee met this morning to pound out what the document should look like that will soon invite the world to submit proposals for comprehensively reforming healthcare in Colorado — in particular reining in costs and expanding access to the currently uninsured and underinsured.

Commission chair Bill Lindsay made an appearance, although he's not a member of this particular committee, in order to stress the "comprehensive" part of the legislature's mandate to the commission.

Lindsay is as polished, gracious and smart as an Olympic skater is polished, graceful and smooth. He's really a pleasure to watch. That said, he's also amazingly opaque. I think he has agreed to turn his life over to this effort for the coming year — and that's no exaggeration, he's working full-time at this — because he's proved himself successful in the business world, and now wants to make a change, to really do something worthwhile for Colorado.

I want to believe that, and so will do so as long as it's feasible.

After thanking the commissioners on the committee for their hard work, Lindsay said that the group needed to commit to finding a proposal that offered comprehensive reform. Why?

"Until we address getting people covered, we can't address cost and quality," he said.

A second reason was the fact that "comprehensive" was the legislature's charge, and as commissioners they all had agreed to address it.

A third reason: Colorado's new Governor Bill Ritter had told Lindsay he intended to put his own reform efforts on the back burner, even though healthcare reform was a primary promise Ritter had made to the Colorado electorate. If the commission doesn't follow through on comprehensive reform, however, there will be a strong movement to create another commission. This commission’s work may simply be lost.

The final reason though, said Lindsay, trumped all those. In the last week, he said he had talked with the Medical Society, the Metro Chamber of Commerce, and half a dozen other groups. "The level of expectation is very high," he said. "We will have let down the people of Colorado if we don't come up with a comprehensive plan."

Linda Gorman, a commissioner from the libertarian Independence Institute, didn't see it that way. "Name a comprehensive reform that has worked anywhere in the world," she said. "Comprehensive doesn't work."

Lindsay demurred.

"So you don't care how many people get hurt," Gorman said.

And that's the way it goes with Gorman.

A friend recalls when Denver's RTD was working to get their successful light rail line through the Southwest Denver corridor in the mid-1990s, Independence Institute people were there too, "mucking up" the hearings.

He said he attended hearings that were planted with the institute’s “ideologues spewing the party line to oppose mass transit and accusing others of being the 'ideologues.'"

He urged that those of us hoping for real healthcare reform take comfort in seeing how unsuccessful the institute was in stopping mass transit. That line has been operating for years and is packed.

Other highlights from the Jan. 11 proposal committee meeting included Barbara Yondorf, the committee's chair and senior program officer at Rose Community Foundation, saying that although it might seem that she and other commissioners are primarily healthcare industry professionals, they are also consumers. She spoke emotionally about her husband, who is covered by Medicare, and other family members on Medicaid. "We should bring our personal experiences [to the discussion]," she said.

Lindsay noted that every other state's healthcare reform commission had an actual budget and three times as much time.

Allan Jensen, a commissioner who is an insurance man, worried about fluffy questions guiding those writing proposals. "Garbage in, garbage out," he said.

Linda Gorman argued that health coverage isn't the same as insurance, and that "the only way you can assure quality is to assure some kind of choice. So a good question [for proposal writers] might be, what kind of choice does patient have under your program?"

When she says stuff like this, I realize that she's actually a secret advocate for a single-payer system: You choose your doctor; you and your doctor choose your hospital; and the government pays.

Choice and competition — exactly what the doctor ordered.

Another commissioner agreed. "Obviously health outcome is an element. Patient satisfaction is an element."

The group talked a bit about the difference between proposers describing what cost shifting would take place under their proposal and an evaluating firm doing that analysis.

"Who's going to pay for [a particular proposed change]?" Jensen asked. "The majority of insurance is now private. Will that shift?"

Elisabeth Arenales, a commissioner whose day job is director of the Colorado Center on Law & Policy, noted that "significant savings could be put back into the system [with reform, but] I want to be sure we're not asking people to do sophisticated analysis."

Eric Ammidown, a commissioner who is director of employee benefits for Qwest, said what he was concerned about was whether costs to employers and employees would be more or less than now.

Ammidown has made some cogent points over the course of this meeting and others.

In a discussion on evaluating proposals after they come in, it was suggested that healthcare be scored in a way that gave points to necessary care — for cancer, for instance, or injuries, but that left regular check-ups and such up to individuals.

Ammidown compared that to waiting for the car to break down rather than paying for an oil change.

"I think we’re looking for more than just access.,” he said at another point. “If everyone has access to a lousy plan, that’s not what we’re looking for."

A bit later, Yondorf and Gorman got into a back and forth about whether coverage, as put forth by the legislature, meant insurance.

Yondorf finally asked commissioner to raise their hands if they thought the legislature meant insurance when they wrote coverage. From where I sat, I saw only Yondorf and Dr. David Downs, president of the Colorado Medical Society, raise their hands.

Interesting. Again, this seemed to put Gorman on the side of a single-payer system, which doesn't see coverage and insurance as being one in the same. Who would have guessed it?

Commissioners argued about how to define "affordable."

They decided that "portability" should be part of their criteria.

Gorman seems to reflexively squabble, as though she can't help but be contrarian. Perhaps that's why she so often sounds like she supports single-payer. Or not. Here she's arguing against lower costs.

"Cost-containment means global budgets. I'd rather see value in healthcare."

(As if the two were incompatible? That's not what the studies show, which find that there's often greater value and patient satisfaction with cost-containment.)

"Lower costs. So we're going to be like Canada."

And here’s her analysis of the real problem:

"Really, the problem in healthcare isn't taking care of the average guy with average expenses. It's taking care of people with specialized needs."

In a public comment period, Barry Keene of Keene Consulting suggested the group look at how effectively a proposal uses healthcare dollars. What percentage goes to healthcare rather than vanishing in administration?

"Or down some government rat hole," muttered Gorman.

When an elderly man who identified himself as from a Mennonite assembly suggested that they consider the World Health Organization's criteria, Gorman shook her head and buried her face in her hands.

She then angrily said that the WHO rated Morocco's healthcare system ahead of the United States because of its equity, and challenged him as to whether he thought that was reasonable.

Speaking of equity, would it be preferable if the commission had an Angry Ideologue that matched Gorman from the opposite side? Someone who hobbled every discussion with petty, but often clever, contrarian arguments?

It’s similar to the discussion that’s taken place over the last decade regarding Democratic tactics and strategy in response to the Republicans changing the rules: it’s suddenly street rugby instead of cricket, old chap.

Should the Ds play nasty too? Would that corrupt us?

Who knows.

It’s also a reflection of Dems always trying to find compromise, to be the grown-ups in the room, to actually run the government. But they’re compromising with people who want to drown government in some Southern bathtub. Great Society — we’ll show you great society…

Kind of like how I imagine a libertarian's idea of healthcare reform.

Healthcare reform? We'll show you healthcare reform. And suddenly there's no more Medicare, Medicaid, V.A. and whatever else. And we're all on our own, in our own individual risk pool. Of course, if they're in charge we'll also be needing our own individual militias should we desire police protection, and digging our own individual cesspools, should we want flush toilets.

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