For those interested in a glimpse of what the commission’s discussion looks like, here’s a snapshot from Thursday’s discussion of Health Care for All Colorado's single-payer proposal.
Commissioner Mark Wallace, a physician from Greeley who may be closest to being a single-payer proponent on the commission, said that the Colorado Health Services (CHS) Program was a bold proposal, and he liked that. "Rocky is always bold," he said.
He was referring to Rocky White, MD, the Western Slope physician who wrote the proposal. The general agreement and laughter at that from around the table left me feeling as though Rocky was a rather mythic figure, something out of a movie about the Old West.
Mark Simon of the Cross Disability Coalition said that the proposal was unique in that it actually reforms the insurance industry (actually, it does away with it). He criticized the proposal’s claim that Medicare works well, when in fact he says it does not work well for his community. He very much liked the fact that the proposal addressed long-term care. However, he had a question about a 25 percent increase in home and community-based care, finding the following unclear:
Full long-term care will be incorporated over time, with consideration for the increased demand that will occur upon its initial inclusion. In the first year there will be allowance for a 25% increase in home and community-based care (in addition to any savings from institutional care and anticipated savings from consolidation of all current programs for LTC, including 80 federal programs). Long-term care will be financed by CHS, with the exception of ‘room and board’ payments by patients who are not low-income requiring institutional care.
“Increase from what?” Simon asked. He also had concerns about hospitals getting the same payment for everything. What about specialty hospitals, like Craig? They would need more, he thinks.
Bill Lindsay, the commission's chair and president of the Benefits Group, Lockton Companies of Colorado, Inc.
, said that the fact that providers would be reimbursed at the same rate everywhere was both good and bad in his mind. He would like to see some element of quality also being a contributing factor for reimbursement.
Sarah Schulte, the commission's technical advisor, liked the fact that the CHS plan offered two financing mechanisms, especially since most of the other plans had not addressed financing at all.
On that issue, Lindsay had earlier said that he liked the fact that another plan had proposed its own revenue stream that would be insulated from the legislature. Then he realized he was remembering a point from the HCAC plan, not from the one being discussed. (The commissioners — all of them people with jobs — frequently mixed up proposals, something that was completely understandable considering they'd been deluged with thousands of pages of dry descriptions.)
Regarding funding, Lisa Esgar, senior director of operations & finance, State Department of Health Care
Policy & Financing, reminded the commission that there's really no such thing as an insulated fund. All it takes is another vote and the monies are no longer separate. She also worried about hospitals around the state receiving the same funding, as their costs are different, she said.
Elisabeth Arenales, director of the Colorado Center on Law & Policy, liked that the program has a reduction in premiums based on healthy lifestyles.
Dan Stenersen, president and CEO of Shalom Park a long-term care provider, also spoke favorably about the proposal. He said it's well articulated and does a wonderful job of expressing "what we've talked about for the last few months."
There was concern that there was a lack of accountability.
One of the new commissioners, Lynn Westberg, director of the San Juan Basin Health Department, liked that the plan hit the idea of "sin taxes," also that it dealt with the idea of workman's comp.
(Although earlier in the day, in regard to another proposal, there seemed to be general agreement over how bad Pinnacol, Colorado's privatized workers comp, was.)
Westberg said she'd like to see the HCAC plan modeled.
Discussions of other plans included Allan Jensen, an independent life insurance broker warning that Propsal #10, from the Colorado Coalition for the Medically Underserved, could drive away business by requiring employers who do not provide insurance to their employees to pay a fee. For this plan and several others, commissioners wondered what the enforcement would be that required people to buy insurance, especially with guarantee issue. "If it's guarantee issue, why buy it [before you get sick]?"
David Downs, president, Colorado Medical Society, said that plan's requirement was enforced through default enrollment into a public program. They liked that public health and environmental concerns were folded into this plan.
For Plan #11, a Community of Caring, Barbara Yondorf, senior program officer, Rose Community Foundation, said, only partly tongue in cheek, that she loved its language, and whatever plan the commission chose, she wanted to use its language – like "community of caring," and "safety-net stabilization." Commissioners also liked how the plan called for a paradigm shift on how Coloradans view health care; there was a problem with portability with this plan; no mention of long-term care; David Rivera, former state commissioner of insurance, likes the big risk pool here; Lindsay likes strong prevention and patient education. Someone described this proposal as a private sector single-payer plan. The plan generated Tabor questions for Lisa Esgar; in fact, she said, they needed to discuss Tabor in relation to all the plans. Allan Jensen worried about the plan putting insurance companies out of business -- although, he said, that might not be all bad. Bill Lindsay said it had similar concepts to the pool purchasing models of the '90s, the Federal Employee Health Benefit program, which worked well some places.
Yondorf's comment on language prompted Dr. Wallace to praise another proposal for its use of the word, "eschew."
A couple of commissioners said that proposal #12 was their favorite -- a Plan for Covering Coloradans. They liked its purchasing pool concept; its emphasis on quality and information technology. Lindsay wondered about the two-year phase in. Simon said it doesn't address long-term care. Peg Burnette, chief financial officer for the Denver Health and Hospital Authority, one of the new commissioners, said it was like single-payer but realistic. Dr. Downs said it addresses the delivery system, which he said was the elephant in the room. Donna Marshall, executive director, Colorado Business Group on Health, likes how it tiers providers by quality, and how well the premium collection process was thought through. Julia Greene of SEIU likes the "connector," the governance board, and the phase-in. Dr. Wallace pointed out that a previous proposal had elements that entered the housing market; this one has elements addressing getting grocery stores into every neighborhood and obesity in the schools. He wondered how realistic that was.
19 May 2007
United Healthcare buys Lewin
How is that going to affect their modeling? UHC is a loser in healthcare delivery — will Lewin show that?
13 May 2007
Mother's Day weekend
Sarah and the baby are visiting. Babies are wonderful and exhausting. I have no idea how Sarah manages by herself.
HCAC's take on a Denver hearing
Michele Swenson, an HCAC board member, took notes at the Denver 208 Commission public hearing in Wheatridge, Colo., on Thursday, May 10.
Shamelessly sharing her observations with the world:
With just a couple exceptions, people seemed to either call for single-payer or call for options that only single-payer is capable of providing.
I'd put the mental healthcare advocates in that category. There were quite a few people speaking to the shameful lack of mental healthcare in this country. We jail people instead of caring for their mental health needs. Now there's a cost-effective plan.
A physician who taught comparative health systems at CU's med school was a disappointment. He told the commissioners that he'd heard people say they wanted everything for everybody — quality and convenience for all — and that was impossible. Therefore, the commissioners were going to have to be courageous in saying that we couldn't have it all. He said that the people of Colorado would also have to be courageous and understand that we can't have it all.
After all, who do Coloradans think they are — French? Canadian? German? Swiss? Israeli? British? Norwegian? Swedish? Belgian? Dutch?
Silly Coloradans. Universal healthcare is only for every other industrialized country in the world. Those people can make it work. We can't.
Do you believe that?
Shamelessly sharing her observations with the world:
There were seven commissioners at the hearing: Carrie Besnette, Bill Lindsey, Arnold Salazar, Julie Greene, Donna Marshall, Joan Weber, and David DownsI turned in my comments at the hearing — calling for quality, universal access, and cost-effectiveness that could ensure sustainability. Single-payer, in other words.
Three hours of public comments included a representative of the Colorado Association of Health Underwriters who spoke in favor of mandating individual coverage — without addressing problems of private insurance cost. He mentioned all those people buying ski passes instead of insurance.
The chair of the Progressive 15, a 15-county rural area in northeast Colorado, spoke to the lack of providers and affordable insurance. He mentioned all those people buying food instead of insurance.
Many spoke of the need for primary preventive care. One doctor said primary care is undercapitalized in the United States: Inadequate reimbursement keeps down the numbers of primary care providers.
Bill Sample of the Balanced Choice group (a proposer group whose proposal has been eliminated by the commission) said the Balanced Choice plan had been miscategorized. It serves as a transition plan to single payer, he said. He hoped that the commission would revisit aspects of the plan that they had set aside for reconsideration.
Nathan Wilkes, another single-payer proposer, spoke about his struggle to retain insurance for his family after his son was born three years ago with hemophilia. Wilkes also submitted a single payer proposal that the commission has set aside.
Health Care for All Colorado members testified persuasively. Board member Howie Wolf, M.D., emphasized that insurance does not equal access; that sustainability is vital, and that high deductibles prohibit primary care. The Massachusetts plan is failing, he said, as shown by their falling rates of primary care and immunization. George Swan, a retired hospital administrator, spoke about the thousands of insurance plans, of value streaming, and eliminating the inefficiency of high overhead costs. Brenda VonStar, RN, also spoke about her experience as a provider to underserved populations who can't get needed care. HCAC board member John Valvano told the commission about Tommy Douglas, who brought single-payer-financed, universal healthcare to Canada. A poll recently found him to be the most admired Canadian of the last century. John said we needed to maximize health care dollars and cut unnecessary administrative costs. Health care access should reflect society's values.
Norin Elfton, Dave Bean, Bob Carlston, and Shelly Cohen also gave effective commentaries. Commissioner Donna Marshall asked Dave Bean for a copy of his comments. Dave described our current system as being adversarial. He emphasized that we don't want to have electronic medical records before we have universal access to health care: Otherwise all knowledge shared with insurers will be used against us.
I asked Donna if she was aware that victims of domestic violence have been unable to obtain any kind of insurance.
Barry Keene emailed his comments, asking the commissioners to use the criteria that they had come up with at the expense of so much time. Barry noted that they didn't use that criteria in their first elimination round of proposals.
My emailed comments noted the importance of a health care system of sustainability, with its other implied elements of access to primary preventive health care, controlling inflationary administrative costs and the current practice of cost-shifting. I suggested that the principle of "common good" is vital, because nothing other than true systemic health care reform could so quickly improve the quality of life for everyone, while improving the U.S. economy and freeing people to realize their true creativity.
With just a couple exceptions, people seemed to either call for single-payer or call for options that only single-payer is capable of providing.
I'd put the mental healthcare advocates in that category. There were quite a few people speaking to the shameful lack of mental healthcare in this country. We jail people instead of caring for their mental health needs. Now there's a cost-effective plan.
A physician who taught comparative health systems at CU's med school was a disappointment. He told the commissioners that he'd heard people say they wanted everything for everybody — quality and convenience for all — and that was impossible. Therefore, the commissioners were going to have to be courageous in saying that we couldn't have it all. He said that the people of Colorado would also have to be courageous and understand that we can't have it all.
After all, who do Coloradans think they are — French? Canadian? German? Swiss? Israeli? British? Norwegian? Swedish? Belgian? Dutch?
Silly Coloradans. Universal healthcare is only for every other industrialized country in the world. Those people can make it work. We can't.
Do you believe that?
Don McCanne's quote of the day
Don McCanne, former president of Physicians for a National Health Program, has a list he calls the healthcare quote of the day.
A couple people forwarded this one to me. In it, Don has cited a new CNN poll (pdf) with this question:
30. Do you think the government should provide a national health
insurance program for all Americans, even if this would require
higher taxes?
64% - Yes
35% - No
2% - No opinion
Don doesn't just leave his readers with one item to think about — he also quotes Catholic Healthcare West's study on Health Security in America (May 9, 2007, also a pdf), in which respondents said:
The time has come for universal healthcare in America. (72%)
We need universal healthcare in America, even if it means
increasing taxes. (63%)
Don writes, "If these poll numbers were cast at the ballot box, this
would constitute a clear mandate from the American public. So why do
we keep hearing that national health insurance is not politically
feasible?"
The answer may be because those poll numbers have been the same for decades. They fall pretty easily, with just a few million dollars worth of well-planned propaganda. Americans are easily scared. Politicians know it.
A couple people forwarded this one to me. In it, Don has cited a new CNN poll (pdf) with this question:
30. Do you think the government should provide a national health
insurance program for all Americans, even if this would require
higher taxes?
64% - Yes
35% - No
2% - No opinion
Don doesn't just leave his readers with one item to think about — he also quotes Catholic Healthcare West's study on Health Security in America (May 9, 2007, also a pdf), in which respondents said:
The time has come for universal healthcare in America. (72%)
We need universal healthcare in America, even if it means
increasing taxes. (63%)
Don writes, "If these poll numbers were cast at the ballot box, this
would constitute a clear mandate from the American public. So why do
we keep hearing that national health insurance is not politically
feasible?"
The answer may be because those poll numbers have been the same for decades. They fall pretty easily, with just a few million dollars worth of well-planned propaganda. Americans are easily scared. Politicians know it.
11 May 2007
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.
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.
05 May 2007
Healthcare plans in Rocky Mntn News
The Rocky Mountain News' editorial pages has been against single-payer financed healthcare. The News is generally considered the more conservative of Denver's two dailies — but also the paper that does more and better local reporting. It's doing good journalism in following Colorado's 208 Commission.
The 208 Commission, otherwise known as Colorado's Blue Ribbon Commission for Health Care Reform, was created by the Colorado legislature to advise the legislature on the best course forward in comprehensively reforming Colorado's healthcare system.
The commission put out a request for proposals for comprehensive reform, and they received 28, including one from Dr. Rocky White, a board member of Health Care for All Colorado. HCAC has endorsed that proposal, as has the Colorado Nurses Association.
The Rocky Mountain News ran summaries of four of the proposals in today's paper:
SEIU's,
Club 20's,
HCAC's, and
the South Denver Metro Chamber of Commerce's.
My name appeared with the HCAC summary — fair enough, since I did write it, but I was fortunate to get a lot more editing help than I'm used to. From that description:
The 208 Commission, otherwise known as Colorado's Blue Ribbon Commission for Health Care Reform, was created by the Colorado legislature to advise the legislature on the best course forward in comprehensively reforming Colorado's healthcare system.
The commission put out a request for proposals for comprehensive reform, and they received 28, including one from Dr. Rocky White, a board member of Health Care for All Colorado. HCAC has endorsed that proposal, as has the Colorado Nurses Association.
The Rocky Mountain News ran summaries of four of the proposals in today's paper:
SEIU's,
Club 20's,
HCAC's, and
the South Denver Metro Chamber of Commerce's.
My name appeared with the HCAC summary — fair enough, since I did write it, but I was fortunate to get a lot more editing help than I'm used to. From that description:
Everyone would be covered and be funded through individual and business contributions and federal tax dollars. The plan would offer better benefits, including mental health, dental, optical, home-health and long-term care, than any single private plan does today. Each resident would choose a health-care provider and choose a hospital.
Providers would stay in private practice and compete for business, but all payments would come out of a single health fund. Everyone (except for the very poorest Coloradans) would contribute to the fund. No one would need to fear bankruptcy because of health-care costs.
Colorado Health Services would basically be a publicly owned, not-for-profit insurance company, similar to a public utility. A board, accountable to the people, would manage the program. Administration would be under five regional boards.
Colorado Health Services would reduce administrative costs since everyone would be covered by the same comprehensive plan. Physicians and patients could make health-care decisions based on patient need and not insurance company policy. Doctors, hospitals and nurses would no longer need extra staff to negotiate billing with hundreds of companies and thousands of policies. The program would provide for retraining displaced workers.
03 May 2007
Understanding healthcare financing
I've been waking up mornings thinking about this powerpoint slide from AMSA. Except I didn't remember it was from AMSA — the American Medical Student Association, a strong supporter of single-payer.
Check out their powerpoint presentation page, and click on "Overview of the U.S. Healthcare System" for the powerpoint source for this slide -- and it's far better seen that way.
Note the arrow that goes to individuals/businesses from the government — that's the $100 billion in tax subsidies for employer-based insurance. Employees, through those subsidies, receive health benefits as a tax-free compensation, and employers can deduct the cost of the benefits because they're a cost of doing business.
Also note the government payments to private insurers — for the health benefits of millions of public employees and their families. The subsidies and the payments to private insurers are two elements of government funding that often get left out of people's conception of what the government pays for.
Now see how easy it would be to just eliminate the "private insurers" element of the diagram. Just erase it — so that the arrow coming from individuals/businesses went to the government instead. Much simpler diagram, eh?
That's what single-payer would look like.
More MRIs? Who's paying?
Dr. John Daley in New Hampshire writes a rebuttal to an anti-single-payer editorial:
In New Hampshire, approximately 135,000 citizens lack health insurance, and for those who have it many can't get all they need. The MRI wait may not be long, but many people can't see their doctor, much less get an MRI. Now with health savings accounts and high deductible plans I have insured patients refusing their MRIs due to the cost.
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