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.”
Showing posts with label Rocky White. Show all posts
Showing posts with label Rocky White. Show all posts
17 July 2007
19 May 2007
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.
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.
27 April 2007
208 Commission in the Post
Jim Spencer, news columnist for the Denver Post, wrote a great column today about Colorado's (208) Blue Ribbon Commission for Health Care Reform's task of finding the best three to five of 28 proposals for comprehensive reform that they've received.
Spencer got right to the heart of the problem when he quoted an advisor to SEIU, who said that what is easiest to administrate — single-payer — may be hardest to approve politically.
This advisor helped Mitt Romney come up with the Massachusetts scheme, which is ticking away — before it even begins — with costs overruns and inadequate plans that people will be forced to buy. "Republicans support the subsidized purchase of private health insurance," he told Spencer.
That is such a mystery to me — but it must be related to what our friend Jack Long says: People are either scared of the wealthy or of the government.
So they'd rather go with inefficiencies that is on course to bankrupt individual families and the government as well, all in the name of free markets. Except if the government is subsidizing private insurance, they're not free markets. Bush's Health and Human Services secretary, Mike Leavitt, recently said that government's role in healthcare should be to "manage markets." If that's the case, why not manage them right, and take private insurance out of the game?
None of the proposals assumes people are not entitled to treatment if they cannot pay retail. The hardest question the commission must answer is the private/public mix in the provision of health care. Still, no one argues for the status quo.Spencer interviewed Service Employees International Union's Colorado point man for health care and Dr. Rocky White, an Alamosa physician, conservative rancher, and Health Care for All Colorado board member. Both SEIU and Health Care for All Colorado submitted proposals to the commission. Rocky was lead author for HCAC's proposal. Spencer described Rocky's proposal as being, "the simplest, most progressive and most controversial of the commission's proposals."
Spencer got right to the heart of the problem when he quoted an advisor to SEIU, who said that what is easiest to administrate — single-payer — may be hardest to approve politically.
This advisor helped Mitt Romney come up with the Massachusetts scheme, which is ticking away — before it even begins — with costs overruns and inadequate plans that people will be forced to buy. "Republicans support the subsidized purchase of private health insurance," he told Spencer.
That is such a mystery to me — but it must be related to what our friend Jack Long says: People are either scared of the wealthy or of the government.
So they'd rather go with inefficiencies that is on course to bankrupt individual families and the government as well, all in the name of free markets. Except if the government is subsidizing private insurance, they're not free markets. Bush's Health and Human Services secretary, Mike Leavitt, recently said that government's role in healthcare should be to "manage markets." If that's the case, why not manage them right, and take private insurance out of the game?
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