208 Commission's Fifth Proposal

Colorado’s 208 Commission met Thursday to hear from a harried John Shiels of The Lewin Group on the results of the modeling of their own, fifth proposal for comprehensive healthcare reform in Colorado.

Their proposal is a mosaic of plans designed to shore up the leaks in covering Coloradans. Admirably, the plan attempts to offer “single-payer” to those of us who do not believe in the private insurance market and would like to buy into something like Medicare.

It would be similar to programs that allow you to buy “green” energy, in a way — with this rather large difference. You would be at the mercy of politicians wanting to gut it for ideological reasons, and you would not have the protection that British or Canadian citizens have. There, when they vote for a politican or party that promises to “cut the fat” from public expenditures, voters know they may be personally hurt when it's healthcare on the chopping block. That’s the reason behind keeping Social Security for the wealthy. When a program benefits everyone, it’s more bullet-proof.

A single-payer program only for those of us crazy enough to pay for green energy (we are mostly the same people, aren’t we?) is pretty vulnerable to attack.
Witness the slimmed down benefits that the fifth proposal gives people wanting to buy into Medicaid for all — the rational being that if you made the benefits too rich, everyone would want in. But isn’t that the point?

Shiels also presented a couple of charts showing how little the single-payer portion of the fifth proposal saves in comparison with the Colorado Health Services Plan. Because, Shiels pointed out, the benefits from single-payer come because it is, in fact, a single-payer. If it’s just one more payer, that doesn’t really help much.

The fifth proposal as it now stands would cost $1.4 billion more, according to the Denver Post. Health Care for All Colorado's single-payer plan, the Colorado Health Services Plan, would save $1.4 billion.

The commissioners decided to call the plans by numbers, instead of their crazy appellations, i.e., Healthy Colorado, Better Health for Colorado, Healthy Solutions for Colorado….

The commissioners also heard the final reports from the four advisory task forces: rural, vulnerable populations, providers, and business.

Kelly Esselman of the Mountain States Employers Council in Denver said that the business people in her task force had not really understood single-payer, and that once they found out more they were supportive of paying 4 percent or 6 percent payroll tax to cover their employees. However, they thought it would be better done at a national level than state level.

We can live with that!

BJ Scott, president of Peak Vista Community Health Centers in Colorado Springs, gave a less inspiring report from the providers task force. I’d heard that the providers were overwhelmingly positive towards single-payer. Their analysis of the various proposals seems to show that. It was difficult to say what the providers thought from the overview. I guess it was realism, the providers telling the commissioners what they’d like to see within the bounds of what is feasible.

Or not.

Scott emphasized that the group was concerned about the ongoing process of reform going in one direction. They didn’t want reform "to end up in Michigan when they thought they were going to Texas." So they wanted to see the action steps, and to see a strong plan for reform.

That’s feasible but single-payer isn’t?

She said that providers said it’s not so much how much they get paid, but rather how they get paid, with the implication being that providers are sick of fighting private insurance companies.

Commissioner Linda Gorman, from the Independence Institute, evidently picked up on troubling communitarian attitudes from the providers — what sounded like generalities to me evidently sounded alarming to her. She said that the task force’s report indicates a lot of agreement on things “I know are highly contentious.”

Gorman wanted to know just how much disagreement there had been on those broadly held do-good notions.

Complete consensus, said Scott.

A doctor in the audience who had served on the task force spoke up to agree — and also to say that while the proposals focused on financing, the providers were concerned about the delivery mechanisms. If the infrastructure of care isn’t fundamentally reorganized, he asked, how will you flatten the negative trends now occurring?

Commissioner Arnold Salazar said that the rural task force had only finished their report a couple minutes earlier, and that it would be emailed to commissioners soon. Basically he said that the rural folks were uneasy with workforce issues. They don’t like employer mandates, and the employer mandates’ possible effect on already fragile rural economies. He also noted that many rural areas have access to urban amenities, but truly frontier areas are isolated.

They had a lot of discussion around the need to have access to care if there are mandates. The safety net in many rural communities is the primary source of health care. Public health systems are also very important. Salazar also said that it’s difficult to establish providers in rural areas over the long term. “The moment they’re done with loan repayment they move back to urban areas,” he said.

The rural folks agreed that there needed to be more focus on oral health, behavioral health, and substance abuse.

Colorado’s laws against “co-location,” where different kinds of providers aren’t allowed to practice out of the same facility, don’t necessarily make sense in rural areas. Salazar also said that telemedicine isn’t the answer. First of all, it’s not a substitute for care, but also the infrastructure is in cities and not available in rural areas.

In rural Colorado, public health systems are very important.

The rural task force also felt leery of geographic ratings, which they felt could negatively impact rural communities.

The task force evidently advised using public health systems and protecting the work they’re able to do.

Sounds like single-payer to me.

The vulnerable populations task force issued the most complete report, pages of information that I’m going to give short shrift to here. Hope to do better tomorrow...

Arthur Powers of Thrive, a support group for people living with HIV and AIDS, spoke about their group’s work.