This is the third of three diaries about the Health Care Town Hall Meeting that I attended last Saturday. In my first diary here and here, 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 my previous diary (SquareState and DailyKos versions), I talked about the Proposals and my standpoint on what they had to offer (or not, as the case might be). In this diary, I will share the questions and comments that attendees brought up.
A small refresher and the questions after the flip.
Thank you again to State Sen. Brandon Shaffer (Senate District 17), Dr. Mark Wallace, Elisabeth Arenales, and all the concerned citizens for spending their Saturday afternoon discussing this issue. It's importance has only been reinforced in the past few days (h/t Zapp & TBTH) as Bush thrusts his compassion in our faces by threatening to veto legislation that would expand health care to poor children. I'm sure there's a word for that kind of person...
State Sen. Brandon Shaffer (Senate District 17) hosted the meeting and was the Prime Sponsor of S.B. 06-208, which set up the Blue Ribbon Commission for Health Care Reform. Two members from that Commission 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.
The charge to the Commission is to come up with a report on 3-5 proposals that they feel changes the current system to the CO General Assembly by Jan 1, 2008 (originally Nov 2007). The Commission has held a number of public meetings. They will continue to do so for the remainder of the summer and through this fall. The level of citizen involvement in those meetings by the public varies according to each meeting, we were told, though there should be a minimum chance to make commentary.
I'm going to provide plenty of opinionated commentary. I will headline the questions by marking where they begin in bold.
First question (and one of the most critical): How to define a Coloradan (in response to the first Principle the Commission came up with under which to operate).
Response: There are currently many different definitions through the different plans.
I want to reinforce the importance of this definition because it's going to have far reaching effects on a number of other issues of which immigration and education are only a couple. We will soon deal with another important definition: what is a person in Colorado? These issues have lots of common ground and will likely end up impacting one another. The sooner we have a conversation about that, the better.
Second question: Has mental health been talked about yet?
Response: There is no guarantee that it will be included in the final recommendation (which is appalling and immoral), but the Commissioners assured us it would be discussed.
There was no indication that it had been discussed to any extent. I'm not sure if it has been talked about or not, unfortunately. If it hasn't, it certainly needs to be. I can't imagine Gov. Ritter would let the conversation move on too much further if he had an inkling that it might go unnoticed.
Third question: How will 'pre-existing conditions' be treated under the recommended proposals?
Response: Didn't answer question. Commissioners danced and weaved around this one.
Pre-existing conditions are one technique that current insurance corporations use to either deny coverage or make the coverage so expensive that the individual has no choice but to go without coverage and/or treatment.
Fourth question: How are developmental disability-related issues being incorporated?
Response: Some avoidance here too. They did say they were being considered, but no details yet on how. Elisabeth did bring up that skinny benefits packages illicit a philosophical dilemma.
I heartily echo Elisabeth's viewpoint. And I would go a step further: it generates an ethical dilemma. In no way do I want to create a system that works only for narrow-minded "healthy" and "normal" people. It leaves too many populations at risk for being moved into the "un-normal" or "un-healthy" categories that are pushed now.
Fifth question: An attendee pointed out that there appears to be underrepresented in the Task Forces that have been set up by the Commission. (I forgot about to mention this in my previous diaries.)
Response: Commissioners feel that neighborhood meetings (such as the one we were at) takes care of this.
Ouch. As a citizen, I have to disagree, especially with the response. It's great that they're doing meetings in neighborhoods and inviting the public to their meetings with the ability to provide input. But to say that citizens don't need a task force based on those facts is pretty short-sighted IMO. And let me be quite frank: I think they should be having citizen-centered task forces providing input as well as business and provider input. Including Rural and Vulnerable Population task forces and not a broader patient task force makes little sense to me.
Sixth question (and candidate for question of the meeting): Is health care a right or a privilege?
Response: Sen. Shaffer took this one. He said that he personally felt it is a right but that to manage expectations, we should avoid that frame so that we can remove the politics and ideology from the debate and get something done.
With all due respect to Sen. Shaffer, I think he really dropped the ball on this. I think the reason our system is broken to the extent it is is due in large part because we haven't discussed health care in terms of being a right; that it has been viewed in this country as a privilege. That's why the affluent get the care they do and why the poor get the care (or not) they do. I absolutely believe that we have as much a right to quality health care as any and all the other rights we've laid claim to in this country. I think the way our system is set up is testament to how seriously debased our social morals are.
Seventh question: Is the Commission looking at a 2-tier system: one that acts as a minimum safety net available to everybody and the second that is available to those who can afford it.
Response: The range in Proposals currently covers coverage to all to multi-tiered coverage.
No stinking tiers, dang it! See my above response.
Eighth question: What glass box is around CO? Are we trapped in our current paradigm?
Response: Not necessarily a glass box. We're looking into a lot of ideas and are talking to a lot of experienced people.
Good response. How much they're reaching out to talk to people is somewhat limited, IMO though. More on that later.
Ninth question: With respect to the Task Forces discussed, how much will Colorado people actually have a say in what's approved?
Commissioner Response: Seven years ago, there were many meetings around Colorado to try and change the system. Coloradans wanted single payer then and didn't get it. [No duh.]
Sen. Shaffer's Response: If you don't get what you want, storm the capital.
Wha-what? Shaffer's response was exactly what I was thinking. Given the way he said it, I believe he meant both literally and figuratively. If we don't get what we want, it's our duty and responsibility as tax-paying citizens to demand from those we elect to make change. If they don't it's also our duty and responsibility to enact change. Unresponsive representatives shouldn't be in control of things. Of course, the fact that only two terms can be served in each chamber doesn't necessarily work to our advantage. Institutional memory and familiary with issues suffers at our expense.
Tenth question: There are three plans that perpetuate the for-profit system in some way. Where is the choice? The status quo is not our idea of choice.
Response: We think the plans contain enough choice.
I agree completely with the questioner here.
Eleventh question: Ethics is not on the list of Principles. Why not?
Response: It is incorporated into other Principles. Fair is on the list, it encapsulates some ethics. Not completely, we recognize this, but enough.
I hate to quibble, but fair isn't ethical. That's why they're too different words: they mean different things. I don't think it's a matter of semantics. Without ethics on the list, is there a possibility it might be overlooked in this complex decision-making process? I don't know. I think it's possible (not likely) and further think it was a good question.
*****
Okay, so that did it for the gathering. I had some other questions, of which I sought out Sen. Shaffer and Elisabeth to ask two. A third also came to my friends' mind and was asked to Dr. Wallace.
My question to Sen. Shaffer: I understand the charge to the Commission and what is trying to be accomplished. Has any thought been given to what the step after writing and passing legislation might be in the form of checking on the program after say 3-5 years and reevaluating things then? Certainly, not all things will make it into the first pass, or mistakes might be found through experience, etc. What will be done then?
Sen. Shaffer's Response: We haven't thought about that yet. It's a good question and we'll take a look at it. Maybe a sunset policy or something else to generate a review.
I find this shocking, quite frankly. We're going to initiate this grandiose plan and have no method in place to track its progress, its successes and failures? Oh my gosh. Please, Sen. Shaffer and everybody else: get hopping on this now. This kind of detail cannot be left to chance or the hope for good intentions in the future. Get into detail on how the program will be evaluated.
My question to Elisabeth: Has the Commission considered employing a forum or wiki to help interact with more people? I say this without having looked at the site, but wondered what your thoughts were.
Elisabeth's Response: No forum or blog is available. People can email or call us. I just found out what a wiki is and since I'm the Communications Director, I think I'll let other Commissioners know about it and try to get one up.
Yay for technologies! I certainly wish they would consider some kind of forum. Maybe a different FAQ section with Commissioner responses. Oh well.
My friend asked Dr. Wallace whether the Commission had spent any time discussing their plans with foreign officials. Dr. Wallace responded that they hadn't. He realizes the benefits of talking with folks who currently have their own systems.
I think this is a gross oversight by the Commission. How much time and money and care and altered lives will be wasted because they didn't talk with folks who are familiar with potential pitfalls??
*****
My view that this issue is complex has only been reinforced by both the meeting and the things it brought up to me personally since then. I applaud Sen. Shaffer and the Assembly for getting the Commission set up. I applaud the Commissioners for tackling this complex beast. I want to close with something I wrote in the first diary:
This is an incredible opportunity to enact real change on an issue that affects us all. Find meetings that you can attend. Then show up and ask hard questions. Write to the Commission. They won't pass along our desires if they don't know what they are.