Colorado & healthcare reform

Colorado has an unreasonable number of healthcare activists with national prominence.

I'll begin with T.R. Reid, although he's a journalist, not an activist. His Frontline film and upcoming book are and will be important in the debate.

There's Nathan Wilkes, a young father and member of the board of Health Care for All Colorado who speaks nationally on the need for universal, effective, quality healthcare.

There's Donna Smith - who's now in Chicago, but has deep roots in Colorado. She appeared in Michael Moore's Sicko.

David Sirota, the pundit, is here. He's not exclusively about healthcare, but he speaks on the issue, and how it's central to a movement to strengthen the middle class.

Glen Pearson, MD, is former president of Physicians for a National Health Plan.

Rocky White, MD, also on HCAC's board, is running for the State House of Representatives, and is the editor of the reprint of Healthcare Meltdown, a book to read if you're wanting to learn more about the need for healthcare reform.

Elinor Christiansen, MD, was one of the original authors of the first draft of HR676, the single-payer legislation sponsored by Rep. John Conyers (D-MI) and Rep. Dennis Kucinich (D-OH).

In the center there's the 208 Commission, with many of its members being nationally known leaders in healthcare policy, Barb Yondorf in particular, who has co-authored several papers.

On the right, there are Paul Hsieh, MD, and Lin Zinser. The two have an article on "Moral Health Care vs. 'Universal Health Care'" at something called The Objective Standard.

There are a number of single-payer advocates who ignore stuff like this on the grounds that it's mean-spirited. Other activists love to get exercised over this kind of argument, ignoring the fact that most Americans see Zinser and Hsieh's position for what it is - not only mean-spirited but also extremist.

I guess I think it's good to understand where people are coming from, even if you know beforehand that you won't agree. To be a Social Darwinist and still feel good about yourself must require an extreme ability to think in the abstract. For instance, Z&h's first step in fixing what they now acknowledge to be an American healthcare crisis is to repeal EMTALA, the law that requires hospitals to treat people who show up injured or sick at their doors. They'd also eliminate Medicare, Medicaid, and all insurance regulations.

About EMTALA - While the need for the EMTALA law is new, brought about by the distortions of profit in what used to be religious institutions' mission of caring, the underlying value is centuries old - at least as old as Christianity and Judaism.

Z&H give a history of our current crisis, beginning with how Blue Cross/Blue Shield became non-profits, and thereby began to compete with other insurance companies on what Z&H consider an unfair playing field. They believe it became even more distorted after the WWII wage freezes took place, with their concurrent tax breaks for employers offering health insurance.

Z&H compare health insurance to homeowners' insurance, arguing that if homeowners' insurance covered lawn work, painting and remodeling, our homeowners' insurance rates would skyrocket. Especially if the government forced homeowners' insurance to cover poor homeowners...

The problem with that analogy is that homeownership is completely optional - as is, to a lesser extent, upkeep. Health isn't optional. A good portion of what happens to our health isn't choice-driven either. No one chooses their father's stroke proclivity, their mother's and sisters' breast cancer. No one chooses to grow up down river from a chemical plant, or for their mother's crappy prenatal care.

Z&H see Medicare as worse than charity, worse because, they write, people don't realize it's charity. We fools think we've been paying for it via our own taxes.

I'll stop. It's tedious reading someone else's rebuttals to something, and more instructive to do it yourself. The Libertarian notion is that if the healthcare market were simply freed from government meddling it would thrive. It's not a bad intellectual exercise to actually think through what the evidence is against that being true. May even come in handy one day - especially here in Colorado.

Even some of the up-and-coming Colorado politicians are taking notice.

It's too bad the newspapers are out of the loop. Katy Human at the Denver Post does a good job of covering health issues and stories, but the opinion pages have pretty much taken a pass. It would be a public service if they did a better job of covering the issue - with an emphasis on single-payer and modified single-payer, since it is the funding mechanism by which the rest of the world keeps their costs down and provides universal coverage - despite Z&H's ongoing success in ignoring that.

Denver Post vs. the Governor

What is it with the Denver Post and Colorado Governor Bill Ritter?

I'm even seeing this when I basically agree with the criticism. Today it's a good health care story about a 53-year-old guy with seizure disorder who can't get insurance. Me, basically, except I've managed to keep my coverage.

Cover Colorado said they'd insure the guy for $500 a month. Only $100 more than I pay. The one private insurer who agree to take him on had a plan that cost $650. Pretty standard, if you're talking about decent coverage for someone with pre-existing conditions. And how many of us reach 50 without a few?

Katy Human, their health care reporter, writes:

While some Coloradans can't afford health insurance and others have inadequate coverage, Sullivan falls into another problem group — people who are generally healthy and middle-class but can't easily get insurance because of pre-existing medical conditions.

Colorado lawmakers, who promised last year to make health reform a priority this session, are rapidly backing off health-reform ideas after realizing it would cost roughly $1 billion to get insurance to the state's 790,000 people without it.

She didn't mention the fact that Health Care for All Colorado's plan would save the state $1.4 billion annually, and that people like this guy with the seizure disorder would be covered -- but again: Pretty standard fare.

Then comes this quote that provides the pullquote and jump tag that the paper uses. It's from the guy's wife:

"When a government cannot respond to the needs of the people, then there is a real problem," Patty Sullivan said Tuesday. "Gov. Ritter is not our friend on this."

What? It's a great quote, and I agree with the basic premise -- politicians are not providing the leadership that they could on this. Ritter himself told me in front of a crowd that the time isn't right, that the pols need us to do more educating. Standard fare, fair enough. Probably even right by many measures.

So on the one hand, I agree that the governor, as the highest elected official in the state has a special responsibility to lead. On the other hand, the Post really viciously attacked Ritter for his support of unions. So I wonder.

Ritter has a press conference today on health care. He referenced cost-shifting the other night on a public television call-in show, a misleading diversion from real solutions. Reducing cost-shifting due to the uninsured has very little potential for saving money under health insurance mandate schemes. If Ritter goes in that direction it would be a great disappointment.

The last part of Human's article was great. It referenced the phased approach to single-payer that Rep. Claire Levy of Boulder hopes to introduce.

Sullivan said she's pinning hope on the few state lawmakers still interested in universal coverage, including Rep. Claire Levy, a Democrat representing parts of Clear Creek, Gilpin and Boulder counties.

Levy said she is looking to introduce a late bill to start building a universal health insurance system in the state by creating an agency to draw up a benefit package and calculate costs.

Eventually, a single-payer system would probably need voter approval.

Startup costs could be high, as much as $15 billion by one estimate, though a nonprofit insurance program would lead to savings for most Colorado families, businesses and health care providers, Levy said.

"I keep hearing people repeat as if it's a received truth that the voters won't pass it," Levy said. "But I hear the same people saying they support a single-payer system. And businesses — especially small businesses."

Greeley Tribune on single-payer

The Greeley Tribune has published a wonderful piece by Tom Linnell on single-payer. He begins,

I am starting to see why all of us -- liberals, conservatives, and independents -- might really like single-payer health insurance. Here are some principles that I believe most of us can agree on: 1) the least possible amount of government involvement in our lives, 2) efficient delivery of services and, 3) freedom of choice for individuals.

Bravo!

HCAC questions report

The Northern Colorado Business Report ran this article on the 208 Commission, which is meeting today to go over their final report to the Colorado Legislature:

DENVER -- A group of health-care professionals who offered one of four proposals selected for review by the Colorado Blue Ribbon Commission for Health Care Reform released a statement Jan. 7 that said it has "deep concerns" about the draft recommendations that appear headed to the state Legislature later this month.

Board members of the Health Care for All Colorado Coalition, which submitted the Colorado Health Services Program proposal to the commission -- sometimes called the 208 Commission -- said the recommendations that are making their way to the Legislature on Jan. 31 won't cover all Coloradans or cut the administrative costs continually increasing health-care premiums.

Board member Michele Swenson said the 208 Commission recommendations fail to address the rising cost of health insurance premiums and would provide taxpayer subsidies to private insurance companies by requiring the purchase of a "minimum-benefit plan."

"They're moving people into minimum-benefit plans and they don't protect families adequately against health and financial risk," Swenson said. "The bottom line is, do we want to increase the bottom line of the insurance industry or increase health-care coverage for all?"

The Health Care for All Colorado proposal was the only single-payer proposal that automatically covered everyone in the state. A financial analysis showed the plan could save about $1.4 billion annually in state health-care spending but would also be the most expensive to implement, costing about $15 billion in new spending to set up.

Colorado Democratic Party Platform on Health: Already Single-Payer

HCAC is working to get the words "single-payer" into the platform, but Colorado Dems do already have single-payer in the party platform. The bold, by the way, is in the original document.

HEALTH

In the United States, as a matter of social justice, we support a quality universal health care system not tied to employment, as a basic right of all citizens. The health of our citizens is essential to the health of our nation. We support:

• financing through one agency (public or quasi-public) that pays the medical providers for the care they deliver, including prescription drugs;
• patient choice of medical service providers and returning medical decisions to the patient and medical service provider;
• reduction of administrative cost and strong cost-containment programs involving input from those who use the system and which cause no significant harm;
• emphasis on prenatal and postnatal maternal care and complete health care for children;
• health care that is no longer tied to employer health insurance coverage;
• an emphasis on preventative health care including for those with disabilities and chronic illnesses;
• increased funding and accountability for mental health care; government funded providers should have users of services on their staff and governing boards;
• educating the public about scientifically sound policies regarding STDS/HIV/AIDS and comprehensive programs for their research, prevention, and treatment;
• increasing availability of hospice care, and home and community based services that address the needs of all, including people with all levels of disabilities of any age;
• providing for the long-term solvency of Medicare;
• increasing availability of shelters and programs for victims of domestic violence;
• federally-funded research and investigation involving stem cells for the purpose of seeking treatments and cures for heart disease, diabetes, cancer, diseases of the nervous system and renal failure; and
• use of medical cannabis prescribed for a patient by a physician.

208 Commission analysis at PNHP

HCAC board member Michele Swenson has an analysis of what's missing from the 208 Commission's final report at the Physicians for a National Health Program website. Michele writes:

The 208 Commission Recommendations fail to address:

• Rising cost of health insurance premiums (82% increase in 6 years in Colorado), as well as copays, deductibles and prescriptions
  
• The U.S. fragmented commercial health insurance system that siphons more than 20 percent of health care dollars to profits, exorbitant CEO salaries, etc. and duplicative layers of administrative waste.
  
• A greater than doubling of median family income spent on health insurance: 7.7% in 1987 to 19% in 2005
  
• As premium costs continue to increase, coverage has decreased: “Insurance does not equal health care.”

This is an excellent analysis, really recommended for Colorado bloggers and journalists who want to understand the issue.

Eliza Carney lauded

Eliza Carney is a major force at Health Care for All Colorado. She's got an amazing stamina and the skills to organize — she's built a great team of healthcare activists in Fort Collins, Colo. She's also smart and funny. So bravo to Cherry Sokoloski, editor of the North Forty News, for this feature on Eliza.

Sokoloski writes:

Her opinions about health-care systems were forged partially in New Zealand, where she and her husband, Jim, lived for a time. New Zealand has universal health care, with the government paying the bills.

"It was much more personal care," with a greater emphasis on wellness, Carney recalled.

Also, doctors did not push for unnecessary surgeries. Her husband had problems with his back while in New Zealand, and his doctor prescribed a body cast instead of surgery. The approach worked.

"We use far too many drugs and surgeries in this country," Carney stated.

Go Eliza!

Rocky Mntn News reports: single-payer the one

This is a nice change: The Rocky Mountain News has published an article fairly positive about single-payer. In "Panel: Only 1 health plan would cut costs: Single-payer cited but 5th proposal still being studied," reporter David Montero writes that,

A proposal to put health care in the hands of the government is the only one of five being studied that would save money, a group working on reforming health care in Colorado told lawmakers Wednesday.

That plan, known as the single- payer system, would cut about $1.4 billion of costs from the current $30.1 billion being spent in Colorado on health care.

And of the original four plans - one submitted by insurance underwriters, one by the public employees union, another by health care providers and the single-payer - only the last was shown to cover all of Colorado's legal residents.

Montero doesn't have it quite right — the plan wouldn't put healthcare in the hands of the government, it would put healthcare financing into a non-profit single pool administered by a governing board — but he did get it right that the single-payer plan is the only one that would save money. He also reported that State Sen. Ken Gordon "said single-payer was the best plan that offered the state savings as well as broader coverage for everyone."

Kaiser disinformation about Colorado proposals

Kaiser's "daily reports" gives absolute misinformation, the opposite of the truth, on the Colorado health care reform proposals. If they weren't expert on this, I'd say it was a misunderstanding. But these guys know what they're doing. This therefore seems malicious.

They write, "The most expensive option would be the government-run single-payer plan, which would cost an estimated $26.6 billion annually."

That's in contrast with the $30 billion we now pay for health care in Colorado.

I wrote Kaiser:

Your daily report is inaccurate. Read the Lewin Group's report on the Colorado reform proposals. The single-payer option is the least expensive, not the most, as you state. One proposal would cost $595 million more; one $1.3 billion more; one $271 million more; and the single-payer program SAVES $1.4 billion.

SAVES! That's the opposite of what you wrote. Please correct this immediately.

This is from the Lewin report:

The Lewin Group Technical Assessment of Four Health Care Reform Proposals (Proof Report)
August 20, 2007 Prepared for: The Colorado Blue Ribbon Commission for Health Care Reform
BETTER HEALTH CARE FOR COLORADO - Provides care through a public program expansion and access to private insurance coverage with low-income subsidies through a Health Insurance Exchange. Individuals who purchase private coverage would have access to a limited core set of benefits, with premiums copays.
467,200 - number remaining uninsured $595 million - increase in health spending

SOLUTIONS FOR A HEALTHY COLORADO - Provides coverage to Colorado residents under a Core Limited Benefit Plan in the private sector and expands coverage under Medicaid and Child Health Plus (CHP+). Low-income people who are not be eligible for the government programs would receive a premium subsidy.
133,400 - number remaining uninsured $271 million - increase in health spending

A PLAN FOR COVERING COLORADO - Provides coverage to Coloradans through a public program expansion and a mandatory private pool for all residents not eligible for the public program. It provides a minimum benefits package in a private pool and premium assistance based on income for those who cannot afford insurance. All plans would provide a comprehensive minimum benefits package, and differ mainly on cost-sharing amounts.
106,500 - number remaining uninsured $1.3 billion - increase in health spending

COLORADO HEALTH SERVICES SINGLE PAYER PROGRAM - A single payer plan that would provide coverage to all residents of the state, including state and local workers, and residents currently covered under Medicare, Tricare, Veteran’s Health, Indian Health Services and Federal Health Benefits programs. Provides comprehensive health care benefits for all - benefits of the Colorado Medicaid benefits package plus
preventive dental. Consumers would have their choice of providers and hospitals within the state.
0 - number remaining uninsured $1.4 billion - decrease in health spending

How is that the most expensive program?

Write them too.

Rocky presents to the 208 Commission

Bill Lindsay, chair of the Blue Ribbon Commission for Health Care Reform, couldn’t believe it.

The independent analysts had just informed the commission that Health Care for All Colorado’s single-payer reform proposal, which would bring universal health care to Colorado via a model similar to that found in other industrialized countries, would actually save money.

“Everyone in Colorado will have increased coverage — and we’re going to save $1.6 billion.” Lindsay said. “It surprises me that we’ll be able to do that.”

Those following comparative studies on health care systems would not have been surprised.

“The single-payer systems always do best,” says Dr. Elinor Christiansen, the past president of Health Care for All Colorado, a non-profit group advocating for single-payer, universal health care. “Why do you think other developed countries can care for all their people at half the cost we do — with equal or better outcomes? They use the cost efficiencies of a single risk pool, better prevention, and best practices.”

The Lewin Group, an independent firm offering actuarial analysis of four Colorado reform proposals, presented their findings to the Blue Ribbon Commission (also known as the 208 Commission) Tuesday. They work out complicated mathematical models — sometimes accurate to within a dollar of reality — that give insight into how much each of the four Colorado proposals will cost and how much good they’ll really do. It’s one thing for a reform proposal to say that doctors will continue to be well compensated and quite another to actually specify how much they’ll be paid; one thing to say that coverage will be expanded and another to say by how much. The Lewin Group’s analysts insist on detail in order to offer their educated guesses on what reforms will do.

John Shiels, a senior analyst with the group, told the skeptical commissioners that Lewin had always found savings when they modeled single-payer systems.

The four lead authors of the various proposals being modeled also had a chance to present to the commission.

Luckily, Dr. Rocky White from Alamosa, author of Health Care for All Colorado’s single-payer proposal, hadn’t been present when Lindsay had explained what the authors should discuss.

Lindsay had opened the day-long meeting by saying that the authors would talk about what modeling criteria had been problematic for them, and how they had arrived at their proposals’ assumptions. That’s pretty dry stuff compared to what Rocky offered.
The lanky 6’4” rancher physician told the commission that he’d been raised in an evangelical, Republican family in Nebraska, and carried those values with him when he moved to Alamosa to practice medicine and raise his family.

In 1986 he was one of 24 physicians to join together in a medical practice in Colorado’s rural San Luis Valley. “Only one of those 24 physicians was a Democrat,” Rocky told the commission. “We believed in the free market system.”

But they were paddling upstream with medical economics, in particular rural medical economics. “Fall of 2004, we went broke,” Rocky says. “We were working our butts off, seeing more patients than we could handle, and we still went broke.”

Part of the reason for that is because 23 percent of the San Luis Valley’s population is on Medicaid. Another 28 percent is on Medicare. Rocky’s practice loses 30 cents on the dollar with Medicaid. They break even with Medicare.

Worse, the uninsured population in the San Luis Valley is at 28 percent. “Everything that’s screwed up and wrong with our healthcare system is magnified there,” he says. “I began to study earnestly. Why were there so many uninsured? Why were we going broke? Believe me, the last thing I wanted to do was decide single-payer was the answer. But until we take away the profit motive from the financing of healthcare, we cannot fix our system.”

Rocky notes that he’s not a natural enemy of health insurance. He was, in fact, the medical director of an insurance company for four years.

But he also sees the system from the point of view of a provider, from the point of view of his patients, and from the point of view as a business owner. “I’ve seen all four sides,” he says. “I’ve seen people die because they delay their healthcare because they couldn’t get insurance. If we’re going to do this, we should do it right.”

A couple years ago, the Cortez area state legislator, Mark Larson, called Rocky and asked him to write a single-payer bill that Larson could take to the legislature — just to begin a dialogue. Rocky wrote a bill, and after Larson saw it he phoned Rocky. “Are you nuts?” he asked.

Larson didn’t want to introduce the bill after all, but he did want to establish a Colorado commission to study reform. Deanna Hanna and Anne McGihon also worked to pass that bill, Senate Bill 208 — thus the 208 Commission. “Instead of a commission to study single-payer, it became a commission to study healthcare reform,” Rocky told the commission. “I think that’s great. Between all of us we’re going to come up with a solution. The choice isn’t between right and wrong, left or right, but values. Do we value everyone having healthcare? Or are we going to continue to value Wall Street more than that? Don’t get me wrong — I value Wall Street too. But there’s something else that I see beyond my own 401k. Beyond that is the health of Colorado.”

The commissioners’ first questions were centered on profit. Barbara Yondorf, senior program officer with the Rose Foundation, asked if the Health Care for All Colorado Plan — which is titled the Colorado Health Services Plan — was like traditional Medicare for all.

“Absolutely right,” said Rocky.

Steven Summer, executive director of the Colorado Hospital Association, confirmed that profit was eliminate from financing but not from delivery of healthcare.

Summer also noted that if everyone were on Medicare, we’d have a bankrupt system. Rocky agreed that was the case, but only because Medicare dollars come out of general funds and because it has to work in our current flawed system.

Steve ErkenBrack, a West Slope commissioner with a non-profit health insurance plan, went back to the question of profit. “Do you envision removing all profit, so there would not be for-profit hospitals?”

Rocky reassured him that there would still be for-profit hospitals, providing a core set of benefits for every Coloradan. Those benefits were based on Medicaid benefits — which are actually very good, albeit with very bad funding. “I would say that most of you with private insurance don’t have coverage as good as Medicaid gives.”

Elisabeth Arenales, director of the Colorado Center on Law and Policy, asked about the benefits package. “My sense was that benefits might fluctuate, depending on the budget,” she said.

Rocky agreed that might be the case, but that the Colorado Health Services Plan had to begin somewhere. “We may find that we’ve saved so much more money that we can offer more benefits,” he said. “The point is that it won’t be the legislature deciding what the benefits should be, and we’re not going to have six board members of an insurance company deciding that they’re not making enough money, and cutting benefits.”

The Colorado Health Services Plan will be administered by a publicly accountable board.

Arenales asked what the thinking was on dental and eyeglasses.

Rocky agreed that those items should be in the plan.

Lisa Esgar, senior director of Operations and Finance, Colorado Department of Health Care 
Policy & Financing, pointed out that Medicaid benefits were good for children, but not good for adults.

The back and forth was lively and continued until Lindsay, the commission’s chair, urged the Lewin representatives to present their analysis on the plan, which would answer many of the group’s questions.

That analysis and the rest of the analyses aren't yet at the commission’s website, but baseline material is.

Commissioners did ask the inevitable questions about what if the federal government wouldn’t cooperate with the program. Lewin agreed that to make the Colorado Health Services Plan work, all the government dollars going to other plans would have to be captured.

ERISA came up as well. That’s the 1974 federal law that keeps states from requiring that businesses provide benefits for their employees — so that national employers wouldn’t have to offer a different set of benefits for worker in each state,

“We’re going to make an assumption that this will go forward,” said Rocky. “We outlined and addressed the ERISA concerns in the proposal. If we’re going to have a single-risk pool, we have to have a single-risk pool. To let large companies take their young healthy employees and carve out a place for themselves defeats that. We can’t be scared of the ERISA boogeyman.”

PDA for single-payer healthcare

The Progressive Democrats of America have a great story up on their website about last Sunday's rally for single-payer universal healthcare.

“We spend hundreds of billions of dollars on this war, so don’t ever tell me we don’t have the money!” Michael Moore told a cheering crowd on the steps of the Capitol building in Denver. His speech was the climax of a Health Care for All Colorado rally which began with Colorado PDA speakers Evi Klett and Steve Wangh and included Michael Huttner of Progress Now, Nathan Wilkes of Health Care for All Colorado and Donna Smith, who appears in Moore’s new film, SiCKO.

That story also quotes Colorado Democratic Party Vice Chair Dan Slater’s newsletter, where he told readers his position on single-payer universal healthcare:

I'm sold.

I'm sold in large part because I was lucky enough to snag tickets to the local premiere of SiCKO, Moore's new documentary about the health care system in America, last night. The movie makes sense, and it leaves you outraged at what has happened to America. I really, really, really encourage each of you to take time to see it. It smashes the right-wing talking points about universal health care into shards, and it does so with a wonderful sense of humor. One talking point we always hear is how expensive universal health care would be. A British member of Parliament really nailed it on the head in the movie:

"If we can find money to kill people, then surely we can find money to heal people."

The Lasik surgery myth

The guy in the audience stood to declare that Lasik surgery shows that if the free market were just allowed to work, it would work in healthcare just like it does everywhere else. Lasik's costs just keep going down.

This is a cherished myth on the right. Because a one-time, walk-in surgery's costs have dropped, they'd like to believe that little Thomas Wilkes' $4,000-a-day factor for hemophilia would also drop. Eventually.

Suppose it did — suppose it dropped 20 percent a year, like Lasik surgery has. By 2009, perhaps Thomas' daily costs for that medication would just be $3,000 a day. Perhaps the Wilkes could afford that. Of course, that medication is just one part of their costs — all together Thomas' treatment costs about $1 million a year.

The fact is that the cost of catastrophic illness and injury under free market conditions would be beyond reach for most of us. We'd just have to hope we didn't get sick or hurt and know that we'd die if we got cancer or were hit by a bus — leaving our children orphaned.

We can't afford to be on our own when it comes to healthcare. We have to pool the risk, and be smart about funding preventive care.

I attended the Northern Colorado Business Journal's Health Care Summit today, mostly to hear "The Great Single-Payer Debate" between Dr. Cory Carroll, a single-payer universal healthcare advocate, and Republican State Senator Shawn Mitchell.

That debate was originally to have been between a Blue Ribbon Commissioner and Dr. Carroll. Weren't the commissioners supposed to keep an open mind about possible solutions?

There were also "healthcare heroes" awards, one of which went to Dr. Glenn Pearson, who was given the award for his work supporting Physicians for a National Health Plan. It is so refreshing that a business journal would recognize Dr. Pearson's work like that. I hope they're not penalized by insurance companies pulling advertising. It was a brave move.

Dr. Carroll, a Health Care for All Colorado supporter, gave a great presentation on why business should support single-payer universal healthcare.

He made the point that as long as there's the 1986 EMTALA law — that's the Emergency Medical Treatment and Active Labor Act — which requires hospitals to care for people in dire need of treatment, that the "free market" really can't work in healthcare. Hospitals would have to be able to turn away victims of car accidents, if they could not pay. Now while that may fit in with the Independence Institute's libertarian values, it's certainly not "What would Jesus do?"

"For a true free market system to succeed, those who cannot pay do not get care," Dr. Carroll said.

This is something those against single-payer universal healthcare play both ways. On the one hand, they complain that government intervention has distorted the market, and that's why it doesn't work. On the other hand, they say that we don't need single-payer, we just need to strengthen the safety net. But not government, I guess. Although anyone from the hospital associations or from charitable organizations will tell you that there's no way that charities can afford to replace the government safety net. Single-payer universal healthcare could, however.

Dr. Carroll included a David Letterman-style top ten reasons why business should support single-payer universal health care. I missed #2, but here are the rest of his reasons:

10. The single-payer system will reduce liability insurance and workers compensation costs for businesses.
9. Single-payer will eliminate the costs and headaches of running a health benefits program — no more annual negotiations with insurance companies.
8. Single-payer will eliminate complaints from employees about the company's health plan.
7. Single-payer will reduce incentives to hire part-time workers.
6. Single-payer will curb medical bankruptcies and free up money for spending on consumer items.
5. Single-payer will reduce the overall costs of covering employees.
4. Single-payer will eliminate retiree benefit costs.
3. Single-payer will reduce absenteeism because the workforce will be healthier.
2. Dunno.
1. Single-payer will allow health care costs to be controlled and predictable, eliminating a major source of business uncertainty and a barrier to planning.

Dr. Carroll also gave the audience a brief history lesson on universal healthcare, with dates that other countries adopted universal health care — the 1800s for Germany — and failed attempts in the U.S.: 1935 for FDR; 1948 for Truman; and 1994 for Clinton.

Sen. Mitchell was smart and funny. He offered the standard criticisms of single-payer universal healthcare — that the U.S. does best for breast cancer and that you might have to wait for a hip replacement in Canada — and managed to make it sound as though the U.S. system was always best and other countries' systems wracked with problems. His foundation seemed to be that yes, primary care was good in those countries, and you were probably happy with your care as long as you didn't need a specialist, but once you needed a specialist you'd be best off flying to the U.S. for care. Which isn't true at all.

All the same, he was personable and funny — and seemed open to learning more about single-payer. He seemed to think that those other countries were moving towards the U.S.'s system, which has no bearing in reality. The Canadian Supreme Court saying that auxiliary health insurance should be legal does not in any way equate to those countries moving more towards our system. People in the rest of the industrialized world mostly assume that Americans have universal healthcare too. Doesn't everyone? Those people who do know — and more will soon, because "SiCKO" will be a hit internationally — feel sorry for us.

Conservatives everywhere are in favor of cost-effective universal healthcare, which means single-payer universal healthcare or a slight modification of it. The U.S. right is the exception that proves the rule on this. What's more, the best of them, if they only had the facts in hand, would surely join their Tory brethren.

Denver rallies for Michael Moore & single-payer healthcare

About 2,000 Coloradans came from as far as Pueblo to rally at the state capitol yesterday to show our Colorado politicians that we support Michael Moore's call for single-payer universal healthcare.

With Moore's latest film "Sicko," this movement now has a truly charismatic figure to draw attention to the outrageous injustice that passes for a healthcare system in the United States. For anyone scoffing that a self-depreciating and overweight guy from Flint, Mich., could be charismatic, go hear him speak. He's really very good. And even better, he's a brilliant documentary filmmaker.

How anyone could walk away from this film unmoved is beyond me. And while healthcare is its theme, Sicko approaches it in a systemic way — in particular how the slightly taxes that the French, British, Canadians pay is not resented in those countries because they see a tangible benefit to their lives from those taxes — healthcare, for starters.

He added it up for the audience after Sicko's special preview. In France, for instance, there's universal education through the university level — how much do American families spend on increasingly unaffordable higher education? He asked the audience what they were paying monthly in student loans and although one person answered $800, $200 a month was average. Add that to an average of $500 a month for healthcare, a similar amount for childcare and other services that famililes there get for free or for highly subsidized rates, and in fact we're the highest taxed people in the world. Except we call our taxes premiums and tuition, and thus can be persuaded that we're better off.

The crowd brought amazing signs. Most of the rallies I go to are for candidates, where the signs are all the same. No two signs were the same yesterday.

Donna Smith calls for action

Michael Huttner of ProgressNow, Evi Klett of the Progressive Democrats of America, and I spoke to the crowd first, and then Nathan Wilkes spoke, warning the crowd that those of them who thought they had good healthcare coverage probably were mistaken. He had thought the same before getting the news that his son Thomas had been diagnosed with hemophilia. Health insurance companies have been trying to get rid of the Wilkes family ever since. Thomas, evidently is nothing more than collateral damage when it comes to maximizing shareholder profit. Nathan introduced Elinor Christiansen, MD, the president of Health Care for All Colorado.

Elinor spoke eloquently without notes: She's been fighting this battle a long time.

Next to the microphone was Donna Smith, one of Health Care for All Colorado's newest members. She emailed me her remarks, and I'll simply share them rather than try to condense:

Remarks by Donna Smith, Aurora, Colo.

DENVER -- My name is Donna Smith. Today I stand here as a member of a very exclusive club. I am one of only a few Americans featured in Michael Moore’s new movie, SiCKO. And I am part of an even more exclusive group of just eight Americans who traveled to Cuba with Michael to receive medical care.

Trust me, as much as I’ve grown to respect and enjoy Michael Moore and his crew, this club that isn’t one for which you want to qualify. Each of us in the film has lost much at the hands of the American private health care system. Some lost everything they owned after a lifetime of hard work – like we did; and some lost their lives.

The stories you will see on the screen during SiCKO represent tens of thousands of other American tragedies. As we stand here today, 50 Americans will die today without the necessary care they needed simply because they couldn’t afford it.

But you and I together are in another not-so-exclusive club with more than 250 million fellow Americans, we are the health insurance card-carrying club – we are Coloradoans, we are Americans – we are brothers and sisters, mothers and fathers, neighbors and friends at great risk due to the lack of universal health care.

Having health insurance no longer means having peace of mind. If you get sick and you are insured you may find yourself underinsured or worse – unable to get necessary care. You may have premiums rising so high that you can no longer afford both housing and health insurance. You may have deductibles and co-pays that effectively and efficiently squeeze you away from seeking care. You may have collectors pursuing medical debt hound you to the point of garnishment and humiliation – as we did. You may have an employer that no longer wants you covered by the group health insurance plan with rising premiums and huge deductibles. And you may not know these things until in the grip of a health care crisis with no options and no ability to dig out.

But our club is a powerful club too, my friends. We have what we need to change this broken health care system. We have voices to speak up, we have pens and computers with which to write and we have the ballot box in which we will send the clearest statement of our membership creed:

No Coloradoan, no American, should ever want again for basic health care. No American family should face financial ruin because someone gets sick. And certainly not one more American should die because he or she was denied treatment. Universal, single-payer health care is within our reach and it our duty and responsibility to push for it.

Though many of our elected officials will scatter like bugs when they are forced to take a stand on this issue or heaven forbid stand in unity with Michael Moore, it is up to you and me to hold them steady to the cause. They must fear our voices and the loss of our votes more than they fear the loss of health care lobby money for their campaigns or the threats of negative ads against them if they do not tow the private health care line.

It is no longer enough for our leaders to protect life only while it is in the womb. To be cared for when we are sick is a basic human need and a basic human right.

Forty years ago, in April of 1967, speaking at the Riverside Church in New York, Dr. Martin Luther King, Jr., said,” Of all the forms of injustice, inequality in health care is the most shocking and inhumane.”

Reach deep into your minds and hearts Colorado. Are we willing to be shocking and inhumane any longer?

Half measures will not do. Universal, free health care must become reality.

On the day I left Denver to meet up with the Michael Moore production crew in Miami, the front page of the Rocky Mountain News had a story about Anna Nicole Smith’s body and where it might end up. Page one, my friends. On page 14, there was a much smaller story about Nathan Wilkes and his family right here in Colorado. Though fully insured, they are living the same healthcare nightmare faced by so many of us today.

Earlier this week on a movie screen in the middle of Manhattan, my dignity and my voice began to return. No longer shamed by my inability to stay financially afloat in a sea of health care debt, I will not rest until every American has access to free, universal health care.

My husband Larry and I rode from Manhattan through Philadelphia and into Washington, D.C., on a bus dubbed the SiCKO bus with nurses from throughout the country led by the brave and dedicated nurses from the California Nurses Association. We had nurses with us from New Jersey, New York, Pennsylvania, Massachusetts, my home state of Illinois and of course from California. Everywhere we stopped, we were met with cheers and support for the nurses and their message: Universal health care now for all Americans.

And now I’d like to introduce to you the man who restored my dignity in SiCKO and who fights for justice in health care throughout this land. He is an Academy Award winning and Cannes Film Festival winning filmmaker, and an American patriot in the truest sense. He is also here to inspire us to keep up the fight right here in Colorado.

She then introduced her "SiCKO commander-in-chief," Michael Moore.

Sicko, Healthcare rally coverage

Sara Crocker of the Denver Post did a good job covering the story. She led with Moore telling the audience that we'll see single-payer universal care within our lifetimes (wait — we're hoping for 2008!) and she listed Moore's charge to politicians: "to take a four-part pledge: to support free, universal care; to eliminate private insurers; to regulate phamaceutical companies; and to refuse money from the health care industry. 'In fact, let's get the money out of politics all together,' he said."

Raj Chohan of CBS4Denver also did a good job, ending with this:

Critics of the movie say it fails to critically explore the potential downsides of a single payer system including delays in care because of what they call the rationing of service.

"I'd be willing to wait a couple of weeks," said Moore. "Statistics Canada, which is the governmental statistics office in Ottawa will tell you the following: there is a 4 week wait in Canada to see specialist. There's a 3 week wait for diagnostic testing. And there's a 4 week wait for elective surgery."

Moore's movie appears to make a compelling case for a single payer socialized system. And it underscores a real problem with health care in the United States.

Now there's some radical reporting: there is a real problem with healthcare in the U.S.

Fox got it wrong. Their reporter — or maybe his editor — repeated an earlier, erroneous story that Moore was here to support a nurses group. Fran Ricker, the new director of the Colorado Nurses Association, called me Sunday morning to apologize for having been out of town and out of the loop on the rally. She was wonderful, and did everything she could Sunday morning to get nurses to the rally.

In fact, Moore was in Colorado to promote "Sicko" and to do that while promoting single-payer universal healthcare. The Colorado Nurses Association does support single-payer universal healthcare, and we at Health Care for All Colorado are lucky to be working with them. They have clout — witness the fact that the Denver Post edited out the names of all the other sponsoring organizations for the rally.

Rationing care

I heard a story yesterday that renews my belief that so many Americans have been affected by the slow-motion disaster of our current healthcare system that we will be able to change it.

I was at the Denver Conference on Homelessness, handing out brochures and talking with people about single-payer financed healthcare. I was with a sharp, intelligent and lively Health Care for All Colorado volunteer, Ruth Gilbert. It was Ruth's 84th birthday.

We heard about homelessness from the people with whom we shared a lunch table, and we told them about the need for universal healthcare. As if they didn't know.

One of the women at the table had lived in Britain for a time. She spoke with awe and respect for their system.

Another women at the table then spoke up. She said her 30-year-old daughter had been diagnosed with Hodgkins Disease — cancer that starts in the lymphatic tissue. The ill daughter missed a lot of work during the course of her treatment and lost her job.

When the daughter lost her job, she lost her insurance. And here her mother stumbled a bit in the telling — her family had been under a lot of stress with the illness, and they hadn't managed to do what, perhaps, might have been done so that the ill woman's coverage could have continued. Perhaps.

So should that be a death sentence? Add into your consideration the fact that the daughter has three children. She completed her chemo, but not her radiation.

We are the wealthiest country in the world. Should this woman's children be motherless because their mother cannot pay for cancer treatment? Should scrambling for a way to pay for treatment, should the humiliation of losing her job and not being able to pay, should potential bankruptcy — hell, potential homelessness — be a part of her reality now? How might that stress be affecting her chances for survival?

How is depending on charity in a situation like this, rather than according this woman and her family the dignity of healthcare justice, a conservative or American value?

Sicko at Cannes and HCAC on KRFC

Tomorrow night's "Imagine Action" program, 6 - 7 p.m. on Fort Collin’s KRFC (88.9 FM or online here), will focus on health care reform. Guests will be Health Care for All Colorado and Physicians for a National Health Program member Dr. Cory Carroll, a local family practitioner and president of the Larimer County Medical Society; Rudy Deutschmann, president of the State Association of Health Underwriters; and HCAC board member Eliza Carney, who will discuss the 208 Commission and the political process around health care reform.

The call-in number is 970-221-5065.

In more international single-payer news, take a look at Salon’s feature article on Michael Moore’s new film Sicko. It will do your heart good.

Author Andrew O’Hehir writes that Sicko is

both a more finely calibrated film and one with more far-reaching consequences than any he's made before. Moore is trying to rouse Americans to action on an issue most of us agree about, at least superficially. You may know people who will still defend the Iraq war (although they're less and less eager to talk about it). But who do you know who will defend the current method of healthcare delivery, administered by insurance companies whose central task is to minimize cost and maximize shareholder return? Americans of many different political stripes would probably share Moore's conclusions at the press conference: ‘It's wrong and it's immoral. We have to take the profit motive out of healthcare. It's as simple as that.’

Sicko purposefully does not focus on the 50 million or so Americans who don't have health insurance, as scandalous as that is, but on the horror stories of middle-class working folks who believed they were adequately covered. There are so many of these they begin to blur into each other: the woman in Los Angeles whose baby was denied treatment at an emergency room outside her HMO network, and died as it was being transferred hours later; the woman in Kansas City whose husband was repeatedly denied various drugs his physician prescribed for kidney cancer, and who in the last stage of life was denied a bone-marrow transplant that could have saved his life; the woman who was told her brain tumor was not a life-threatening illness, and died; the woman who was told her cancer must have been a preexisting condition, and died.

If the Salon article whetted your appetite for more reviews, here’s one from The Guardian:

His question: what has happened to the idea of universal healthcare in the United States?

In four tidy acts, Michael Moore spells out the facts. Act one: 50 million Americans have no health cover, and 250 million who think they do, through costly health insurance schemes ($2,000 per person a year), are often denied treatment when they need it….

Act two: when did it all start going wrong, asks Moore. The answer: in August 1971. President Richard Nixon and his adviser Edgar Kaiser plot to break the system. "The less care they give, the more money they make," says Nixon, caught on tape….

Meanwhile astute national publicity campaigns have demonised the concept of universal healthcare by associating it with "socialised medicine", which in American English translates as "Soviet medicine" - the kind such oppressive regimes as Canada, Britain and France have adopted for their citizens….

Act three: Moore pays these regimes a visit….

Act four, the most powerful: Moore decides to test the US administration's claim that Guantánamo Bay prisoners get the best free healthcare in the world. He takes 9/11 volunteer rescue workers, whose health problems were not covered by the state because they weren't on its payroll when they ran to help, to Guantánamo Bay in Cuba….

And lastly, the news, also in The Guardian, that the U.S. government is trying to impound Moore's film – a claim that’s hard to dismiss considering everything else in our country’s recent past. “Now, according to movie mogul Harvey Weinstein, whose Weinstein Company is behind the film, the US government is attempting to impound the negative.”

The pretext would be Cuba. Moore had applied for permission to travel there but received no reply until this month, when “the treasury department notified Moore that it was investigating him for unlicensed travel to Cuba.

Watch a trailer for Sicko and more on Moore's website.

HCAC makes the final cut!

The Health Care for All Colorado proposal to the Blue Ribbon Commission for Health Care Reform made the final cut and will go on to the evaluation firm, Lewin, for analysis. In fact, the proposal was the only proposal in yesterday’s discussion that seemed to have a clear mandate to go in – all the others were batted back and forth, some of them because they were so similar to one another that they didn’t offer clear enough differences for separate evaluation, others because of questions about their merits.

Here is a round-up of the four plans that will be evaluated, with their numbers. The plans names are similar, and although it would have been just as easy to refer to them by the submitting entity, i.e., HCAC’s plan, SEIU's plan, or the underwriters’ plan, commissioners were referring to them by number.

HCAC’s proposal (#16) the Colorado Health Services Plan, was submitted in coalition with the Colorado Nurses Association, the Older Women’s League, and the Physicians for a National Health Program. Rep. John Conyers is in favor of state efforts like ours, and we expect that he will endorse the proposal as well.

The proposal is a single payer, publicly financed program that covers all primary, preventive, specialty, surgical care, automobile and work-related injuries, prescription drugs, mental health services, chiropractic, dental, basic vision, audiology, home health, long-term care, and hospice services, among others. Under this program, all providers and hospitals would be paid the same for the same level of service, thus competing by the quality of care provided. Through it, every resident has equal access to program benefits. There is no opt-out provision.

It calls for a statewide, fully integrated information technology network to track outcomes, utilization and expenditures. Colorado Health Services would be a non-profit government “insurance company," administered and governed as a public utility with five districts.

The other proposals to be evaluated are those submitted by the Committee for Colorado Health Care Solutions, the Service Employees International Union, and the Health Insurance Underwriters.

A Plan for Covering Colorado (#12), submitted by the Committee for Colorado Health Care Solutions, requires all Coloradans to have health insurance. A fee would be assessed through income tax filing that would cover the uninsured. Employers would pay a portion of the employees' health insurance or an assessment to the state. This plan would create a single purchasing pool that could negotiate rates and plans, and which would have guaranteed issue and community rating. The plan would create the Colorado Health Insurance Purchasing Authority, which will define benefit packages. The standard set of benefits would be based on effectiveness and cost. The authority will also decide guidelines for performance of providers and determine the amounts paid to the providers.

Better Health Care for Colorado (#2), proposed by Service Employees International Union, provides premium assistance for purchasing private coverage. It would provide Medicaid-funded insurance subsidies for those under 300 percent of the Federal Poverty Level (FPL). Those subsidies would cover all of the premium’s cost for those at 100 percent of the FPL; with pro-rated subsidies for those up to 200 percent of poverty to ensure that they don’t spend more than 5 percent of their income on premiums. It would provide a basic benefit package (with annual benefits capped at $25,000 to $50,000) with no deductible through a pool. The plan would also allow individuals to use the subsidy for employer-sponsored insurance. This plan would also reform Medicaid by implementing pay-for-performance for Medicaid hospitals and Medicaid long-term care facilities and other methods.

Solutions for a Healthy Colorado (#5), submitted by the Colorado State Association of Health Underwriters, requires all Coloradans to have health insurance in a reformed market that would include guarantee issue product in the individual market. It would also require guarantee issue of a core benefit plan in the individual market that would include a “Core Limited Benefit Plan” that all carriers would be required to offer with guaranteed issue and with modified community rating. The government would subsidize purchase of the limited benefit plan for those up to 250 percent of the FPL. All provider reimbursements would be tied to one common basis, adjusted for performance on quality benchmarks.

Thursday's 208 Commission discussions

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.

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.