This is the second of three diaries about the Health Care Town Hall Meeting that I attended last Saturday. In my previous diary (SquareState and DailyKos versions), I introduced a few of the people involved in the Meeting, the current state of Colorado's health care system and discussed the principles the Commission is operating under. In this diary, I will discuss the proposals as I understand them. There were a number of good questions asked post-presentation and I will spend time on those in my next diary.
A big thank you goes out to State Sen. Brandon Shaffer (Senate District 17), Dr. Mark Wallace, Elisabeth Arenales, and all the attendees for spending their Saturday afternoon discussing an issue that quite frankly needs even more attention.
A small refresher and the proposals after the flip.
State Sen. Brandon Shaffer (Senate District 17) hosted the meeting and I want to thank him again for taking time out on a Saturday to do some work. He was the Prime Sponsor of S.B. 06-208, which set up the Blue Ribbon Commission for Health Care Reform. Sen, Shaffer joked that he inherited the bill from the previous legislative session when a similar attempt to create the Commission failed. Two Commission members were also present to provide some information and answer questions from the attendees. Those two members were Dr. Mark Wallace (Founder, Northern Colorado Health Alliance) and Elisabeth Arenales (Healthcare Program Director, Colorado Center on Law & Policy), both of whom were appointed to the Commission by Speaker Andrew Romanoff.
One critical piece of information: the Proposals are being reviewed by a consultant firm: The Lewin Group from Baltimore, MD. I haven't looked into this group at all yet. If anybody has information on them, please share in the comments. All of the details on the Proposals come from their preliminary findings. They are all subject to revision, which will likely occur, according to the Commissioners.
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Onto the proposals:
- Better Health Care for Colorado-
proposed by Service Employees International Union
- Solutions for a Healthy Colorado-
proposed by Colorado State Assn. of Health Underwriters
- A Plan for Covering Coloradans-
proposed by Committee for Colorado Health Care Solutions
- Colorado Health Services Program-
proposed by Health Care for All Colorado Coalition
From least to most change:
- No new mandate. Everything is hunky-dory and runs as designed. Expands Medicaid, provides private insurance coverage through Exchanges, allows workers in small firms to purchase coverage.
My recommendation: Do not choose this one! It slightly expands what's currently "offered". The current system doesn't work: human beings don't receive care and the profits of the industry go well beyond obscene.
- Individual-only mandate. All CO residents would be required to obtain coverage, except those covered under Medicare, Tricare, and Federal Employee Health Benefits.
Given my current level of experience looking at health care proposals, I think this would probably be better in some ways than the system currently in place. I like that everybody (theoretically) would have some level of coverage. I don't like that the responsibility falls completely on individuals getting themselves covered. There are too many devils in the details: what kinds of coverage will be offered?; does the system remain skewed towards better care being available to the highest bidder?
- Individual and employer mandates. Employers would be required to offer an adequate level of coverage or pay an assessment. Coloradans would be required to maintain a minimum level of coverage or face a penalty. (There was a comment on this I'll talk about below.) Would create a purchasing pool that combines individual, large group and small group markets.
I like the pattern being established. This plan would spread some responsibility away from individuals and onto employers. That's not the best arrangement, but better than punishing only individuals for not obtaining their own insurance coverage. That said, I don't like the incentives set up here: they're all negative. Gee, I wonder which world-view set this plan up? "Do what we tell you or you'll be penalized!" Oh and assessment vs. penalty: how do you like that language?
One of the best questions of the Meeting came up at this point: "What does the Commission consider the definition of 'Coloradan' to be?" Wow. The Commissioners weren't overly eager to define the word. They did what they could: they stated that each Proposal uses the term and each Proposal has its own viewpoint on what they mean. What was left unsaid was when they plan on tackling the issue and who will be responsible for the definition. I suppose either the Commission or the Assembly will ultimately be the deciding body.
More than one practitioner stood up and made sure everybody was aware that #1 there are undocumented workers in this state and that will always be the case and #2 those folks will look for care just like those who are 'documented'. The same general mechanics apply to everybody: the longer an individual waits for treatment, the more expensive that treatment will eventually become. So instead of over-burdening the system with really sick people, whatever system we decide to enact needs to treat everybody with quality care. And thank goodness there are people trying to treat everybody now: they recognize that opportunity and fairness needs to be an integral part of their jobs.
- Single-payer plan. CHSP, as currently envisioned, would colver all CO residents (person who has resided or worked in CO for at least 3 months) and employers would be allowed to purchase additional coverage.
Now we're talking sense. This would be administered by a publicly owned not-for-profit governing board. Administrative overhead cannot exceed 5% of total spending. Darn near everybody gets covered. It would be financed by a 4% employer payroll tax and an individual/family income tax surcharge.
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The charge to the Commission was to come up with 3-5 Proposals and deliver a report about each to the CO General Assembly by Jan. 1, 2008. The fifth Proposal slot is being reserved by the Commission. Dr. Wallace and Elisabeth informed us that the Commission's plan is to come up with a Proposal that includes the 'best' features of all the Proposals that were submitted. As of Saturday, they had no additional information about their Proposal as they hadn't put it together yet. This raises an interesting question: How much time will the evaluating consultant, Lewin, or anybody else for that matter, have to review their plan? Dang, I should have thought of that on Saturday. Maybe I'll email the Commission.
The group also discussed health care in a somewhat general sense. I think it was either Sen. Shaffer or Dr. Wallace who brought up that the states can and should act like incubators of ideas and policies. Colorado, along with a decent number of other states, is coming up with what we think is a better system. Obviously, some are going to come up with better systems than others. During this whole process of course, we should be continuing to apply pressure at the national level to implement a system for the country. I think this strategy is a good idea. If a majority of states come up with their own plans and citizens keep pushing their national representatives (including presidential candidates), the free-marketeers' job of killing single-payer-style plans gets harder every day. Neither our society nor our economy will fall apart. Rather, I believe both will markedly improve with time. A healthy population is a productive and happy population. Oh wait, that's exactly what the neocons don't want. Gee, I'd really hate to put their fear-based society plans on retreat....
So tomorrow I will share the questions that came up after the presentation, the conversation that resulted, my questions that were answered, and try to work it all into a larger picture. If you haven't yet, take a gander at SquareState's Zappatero's post about a very important detail that is shared in SiCKO. Also, nyceve has an interesting piece up today about the corporate media carrying the corporate health care industry's talking points around for them.