208 goes for principles

The Colorado Blue Ribbon Commission for Health Care Reform met today as part of a two-day retreat.

Their goal was to put their cards on the table, so that everyone understood where the others stood on reform, and to begin adopting principles to guide them in choosing a proposal and understanding their common values.

Of course, everyone already knew how Linda Gorman felt. She’s the libertarian from the Independence Institute, who has spoken out against comprehensive reform — the commission’s mandate from the Colorado Legislature.

Dan Stenerson, president and CEO of Shalom Park, a long-term care facility, suggested these “buckets” for organizing principles:
• Healthcare that would be universally available for anyone who lives in Colorado
• Measuring accountability
• Client-managed

“Client-managed” became “client-centered” at Steven Summer’s request. Summer is executive director of the Colorado Hospital Association.

Dr. Elinor Christianson, president of Health Care for All Colorado, suggested to the group that they vote on the Institute of Medicine guidelines and the Colorado Medical Society guidelines, both of which were drawn up after months of consideration.

The Colorado guidelines are:

1. Coverage - Health care coverage for Coloradans should be universal, continuous, portable and mandatory.

2. Benefits – An essential benefits package should be uniform, with the option to obtain additional benefits.

3. Delivery system – The system must ensure choice of physician and preserve patient/physician relationships. The system must focus on providing care that is safe, timely, efficient, effective, patient-centered and equitable.

4. Administration and governance –The system must be simple, transparent, accountable, efficient and effective in order to reduce administrative costs and maximize funding for patient care. The system should be overseen by a governing body that includes regulatory agencies, payers, consumers and care givers and is accountable to the citizens.

5. Financing – Health care coverage should be equitable, affordable and sustainable. The financing strategy should strive for simplicity, transparency and efficiency. It should emphasize personal responsibility as well as societal obligations, due to the limited nature of resources available for health care.

The IOM guidelines are:

1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient centered, and equitable.

Commissioners heard from Martha King of the National Conference of State Legislatures, who warned them that what they were doing was difficult, and could be sabotaged by a single ideologue. To succeed, members needed to all buy into their common mission.

King also said they needed to constantly remember that it’s legislators who would adopt or not adopt their proposal, and that those legislators would be obsessed with gauging how it would play in Paonia (a small, Western Colorado town).

She argued that everyone needs to give a little and also to check their egos and ideology at the door.

Two commission members today shared family stories. Barbara Yondorf, senior program officer at the Rose Community Foundation, said that her daughter, adopted at age six from a troubled family, had succeeded despite the odds arrayed against her. Other children in her daughter’s situation, Yondorf said, might not have been so successful. Those children should not be condemned for not making the choices that a privileged child would have made.

Christy Blakely, director of Family Values in Colorado, an advocacy group for families with children with special needs, said that she was finally able to sleep on the night that her daughter had been awarded government services.

Despite their similar frustrations with the system, Yondorf and Blakely had different view on plans with high deductibles. Yondorf thought once people chose those plans they should stay with them, understanding that they’d made their choice.

Blakely said that some of her hardest conversations were with parents with high deductibles that left them unable to care for their children.
Commissioner Grant Jones, executive director of Denver’s Black Church Initiative, also spoke about family, saying he felt education and outreach should be a key part of any reform — something his “Uncle Sherman” could relate to. “My eyes glaze over on some of this content,” he admitted.

Commissioners talked about whether they were interested in pursuing deciding which populations would be eligible for a subsidy in a program like Massachusetts, or covering everyone.

The concept of universal coverage was not dismissed out of hand. Bill Lindsay, chair of the commission (and president, Benefits Group, Lockton Companies of Colorado, Inc.) said at one point that What Dr. Rocky White, a single-payer advocate in Western Colorado, had done was interesting, but….

Is that “but” inevitable?

Lindsay also said, however, that he didn’t personally understand “how you move ahead with equity if you don’t have more people in the system” — meaning larger risk pools.

Lisa Esgar, senior director of Operations & Finance, Department of Health Care 
Policy & Financing, State of Colorado, spoke about the waste in the system. “How far do we want to go?” she asked. “Medicaid, poor programs pasted on top of one another over the years. Do we look at financing? Restructuring? The low-hanging fruit is poor organization.”

Esgar recently traveled to Europe as part of a Marshall Memorial Fellowship group, looking at government systems there.
She told me that she had been impressed with European healthcare.
Perhaps she’ll share her experiences with the commission.

David Rivera, Colorado’s outgoing commissioner of insurance, as usual had nothing to say.

A commissioner who is an advocate for the disabled said he believed that healthcare is a right; that payer sources should be merged; that efficiencies should be improved; and that he hoped to see both better utilization and consumers be in control.

“We cannot continue with the current three-tiered system,” he said, listing the tiers as being the system for people with good private coverage; people with Medicare or Medicaid; and people with nothing.

One of Gorman’s only comments of the day was to say that her frame was very different. She believes that the focus for reform should be on individual incentives, not the system. She finds it unreasonable that Colorado insurance companies are legally able to give better rates to people who haven’t submitted a claim in the past year. She flatly said that preventive care doesn’t work. Maybe vaccines, but nothing else. She used the cost of colon screening here — which seems a favorite of conservatives to prove this point. She said that she hears other commissioners promoting myths.

Carrie Besnette, vice president of The Daniels Fund, took issue with that later prompting Gorman to say that her background is academic, where people stand in a room and yell at each other until someone wins their point.

Gorman was absent for much of the afternoon.

Other presenters were Lori Weigel of Public Opinion Strategies, and Leo Tokar of Kaiser Permanente. Both had so much to say that I’ll cover their presentations in other posts later this week.

After dinner, Kathleen Stoll, director of policy for Families USA, and Nina Owcharenk, senior policy analyst at the Heritage Foundation, spoke about their joint work on forging consensus on a comprehensive reform plan adopted by sixteen groups, including their organizations, AARP, and Kaiser.

It’s a plan I think is unsustainable because it doesn’t reform the private insurance model that has served the United States so poorly.

And if you’re in favor of single-payer, that’s key.

But it’s an achievement, nonetheless, and the two women advised this commission on how they could also reach a consensus.