208 Commission picks 11 plans

On Monday, The Colorado Blue Ribbon Commission for Health Care Reform culled their 28 proposals down to ten — wait... make that eleven.

1) Better Health Care for CO - SEIU
2) Solutions for a Healthy Colorado - CO State Association of Health Underwriters
3) A Phased Approach to Achieving Universal Health Coverage in Colorado - Kaiser Permanente
4) Comprehensive Health Care Plan for CO - Club 20
5) An Individual Based Insurance System Combining Free Market Principles with an Appropriate Role for Government - South Metro Denver Chamber of Commerce
6) Connecting Care and Health for Colorado - CCHI
7) Community of Caring – Colorado Community health Network
8) A Plan for Covering Coloradans - Committee for Colorado Health Care Solutions (Barbara Yondorf is very fond of this plan)
9) Healthy CO Now - CCMU
10) CO Health Services Program – HCAC
plus:
11) FAIR — Brian Schwartz

Number eleven, a libertarian free-market plan submitted by Brian Schwartz only received two votes out of more than 150 possible (each commissioner present — 22 or so — could vote on seven proposals). For the most part, only plans that received 10 or more votes were passed. However, libertarian commissioner Linda Gorman said there was no need for her to return if it weren’t chosen and so it became the 11th proposal to remain.

There was almost no public comment during this meeting, and thus commissioners’ remarks, some of which mixed up proposals or included misinformation, went unchallenged.

Commissioners spent a lot of time comparing the single payer proposals, as most agreed that one of them should be chosen for evaluation. The six pure single-payer proposals together garnered 22 votes — 26 if Balanced Choice is counted. That meant that the single-payer type of reform got more votes than any other single category other than one. The commissioners said that proposals 16, 17, and 18 were very similar. (Those were from Health Care for All Colorado; Stuart Zisman, a professor at the University of Northern Colorado; and Nathan Wilkes, whose 3-year-old son's hemophilia has meant that the Wilkes not only have to gather their strength to best care for the physical needs of their son, but that they also must frantically scramble — every year — to keep insurance. I can't imagine the stress.)

During the single-payer discussion, Linda Gorman opined that there are two kinds of single payer, one with no private market competition, as in Canada, she said, and the NHS model, as in Great Britain. She differentiated between Wilkes’ and HCAC’s plan, saying that Wilkes’ plan was more like the Canadian model with "no competition."

Regarding HCAC's plan, she said it is problematic to limit spending to the growth in GDP.

Commissioner Alan Jensen, a health insurance underwriter, remarked that Wilkes' proposal, like the Canadian model, takes away the ability to choose providers. (These remarks obviously indicate misunderstanding about single payer and the Canadian system.)

Sarah Schulte, the commission's technical advisor, noted that HCAC's plan had no copays, whereas the Zisman plan did.

Commissioners liked another single- payer plan's focus on promoting wellness. (That plan being from retired CU professor Edwin McConkey.)

Another commissioner stated that HCAC's plan has more explicit benefits (that can be redefined) and a stronger program of reimbursement based on providers' quality of care.

Commissioner Mark Simon commented that he likes the HCAC plan except for the lack of consumer oversight of the program. He did not like the political appointment of the governing board.

Commissioner Elisabeth Arenales suggested that the HCAC plan would be the right single-payer plan to go with because of the group’s strong organization and support.

Commissioner Arnold Salazar said that consideration would make him vote against the HCAC plan.

Arenales countered that the commission was hoping to get a plan through the legislature, and that strong organizational support, such as that provided by HCAC, would help make that happen.

Commissioners decided to go with the HCAC plan as their single-payer model chosen even though commissioners liked many of the points in other single-payer plans.

Although the commissioners did not categorize the Balanced Choice plan as being a single-payer, they liked its rich benefits package and specification of itemized bills to patients to control fraud. Simon spoke to the risk of a two-tiered system of health care; he also praised it as the only plan that addressed non-residents.

Sarah Schulte, the technical advisor, rated a single-payer plan submitted by PULSE highest of all 28 plans.

Of the nine plans that Schulte scored as having at least two “high”s and no “low”s, five were single-payer plans: those submitted by HCAC, PULSE, Edwin McConkey, Nathan Wilkes, and Stuart Zisman.

The other four plans that scored high were those from Kaiser, the South Metro Chamber of Commerce, the Colorado Community Health Network, and the Committee for Colorado Health Care Solutions.

When commissioners voted on the plans, the results were far different.

HCAC’s plan and Stuart Zisman’s plan each got six votes; Nathan Wilkes’ plan and the Balanced Choice plans received four votes each, and Edwin McConkey’s plan received three votes.

Although the PULSE plan received only two votes, the commissioners were reluctant to take it off the table because of its innovative methods, specifically, the idea of a health care team of physician, nurse, social worker, and ombudsman. One commissioner remarked that PULSE was the only plan limiting administrative costs.

High vote getters (from 10 to 14 votes each) included the four non-single-payer plans that Schulte rated high, but also plans from SEIU (the Service Employees International Union), Club 20 (a conservative business group from Western Colorado), Colorado Consumer Health Initiative, and the Colorado Coalition for the Medically Underserved.

Several commissioners said that core benefit of the Insurance Underwriters' proposal was inadequate (capped at $50,000 a year, which Simon said was sure to create more uninsured). Commissioner Jensen, who has been chair of the underwriters, said at an earlier commission meeting that there is no need for comprehensive reform; one or two changes would reform health care. This proposal received seven votes.