21 February 2007

208 Commission news

Colorado's 208 Commission met today at the Colorado Association of Commerce & Industry.

The meeting was the usual mix of boring and curious. It began with the commission's final drafts of their solicitation for proposals to comprehensively reform healthcare in Colorado and their RFP -- that's the request going out in the high-priced business world of economic healthcare systems modeling. A company called Lewin does most of this, but Price Waterhouse Coopers and other companies bid and sometimes get the job as well.

Commissioners went back and forth over the definition of “comprehensive” — as in comprehensive reform — as they’ve done from their first meeting. Commissioner Dr. David Downs, president of the Colorado Medical Society, sensibly said that comprehensive means that a proposal will markedly improve costs, quality and access.

A question came up about what proposals would do to safety net providers, which led to a vote on the definition of safety net.

Pam Nicholson, vice president in charge of advocacy and community partnerships at 
Centura Health, noted with some asperity during this discussion that hospitals have to provide care to everyone who shows up at their doors, whether it’s part of their mission or not. You'd hate to see what Centura's vice president of finance would add to that comment about Centura's mission.

A commissioner from rural Alamosa argued that the safety net is only in place because the system isn’t working. “We’re not here to protect the safety net, we’re here to reform the system.”

Bill Lindsay, president of the Benefits Group, Lockton Companies of Colorado, Inc. and chair of the commission, noted that the question about the safety-net doesn’t mean that the commission would preclude proposals that affect the safety net, but they want to know how it will affect it. “If the changes mean that there will be no need for a safety net after the reform is implemented, that’s fine,” he said.

The report from the evaluation committee was deadly stuff, mostly concerned with items such as whether state procurement rules apply to the commission. Final answer: No.

The evaluation firms will model not only the three to five best proposals, but also what would happen if we do nothing.

Commissioner Linda Gorman, director of health policy at the libertarian Independence Institute, wanted potential effects on innovation, capital formation and consumer choice included in points the evaluation firm would model. Now this is an economist, arguing that you can model health reform's effect on innovation.

Gorman, who is easily the most entertaining commissioner just by virtue of her outrageous statements, also argued over what access meant. She said that if she has a policy that doesn’t give her access to a specialist, then she doesn’t have access. On the other hand, she added that the OECD keeps complaining how uninsured Americans don’t have access to health care, when in fact they do.

She has many times argued that being uninsured doesn't mean that a person doesn't have access to healthcare in America. They go to emergency rooms! Having a policy that doesn't give her access to a specialist, on the other hand, is clearly an issue.

Gorman successfully proposed removing the requirement that firms bidding to evaluate Colorado's proposals have experience doing evaluation in other states. Gorman argued they simply have experience with states OR equally-sized entities, which Lisa Esgar, director of operations and finance, Department of Health Care 
Policy and Financing, State of Colorado, offered could be commercial establishments.

Gorman also successfully removed the requirement that firms applying to be the evaluator submit three letters of recommendation. They now only have to submit three names and phone numbers for references. The commission's staff member was told she didn’t need to call them.

Esgar showed up and had a couple good points to offer — although not the one about commercial establishments — in the midst of what must have been a rough week. She was one of a couple dozen state political appointees to whom the outgoing Republican governor had promised tenure. No way, Colorado's newly elected Gov. Bill Ritter made public this week. Esgar was making $126,000 a year. Ouch.

For those of us hoping to bring true reform to Colorado, the commission's timeline feels like a race to educate — mostly our neighbors, but also the commissioners and legislators.

The commissioners may actually be the toughest students. Most of them are already expert in one or more field of healthcare, which leads them all to think that they're experts in every field. To varying degrees that see the whole through the narrow window of their own experience — and the more extensive that experience, the harder time they have turning to look at the whole.

It's like listening to theologians decrying the anathema of relative morality, completely unable to see what the average person sees perfectly well: That sometimes a rational fourth person would jump off a raft in the middle of the ocean that could only carry three.

The pity is that we've got a healthcare raft that could easily care for everyone if we stopped the for-profits and insurance companies from poking it full of holes. But these particular theologians either can't imagine a different reality, or they're convinced that the hole-pokers can't be stopped, or they're one of the pokers, or they absolutely believe that people should have the freedom to poke holes in whatever they please.

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