[Rushtalk] Colorado Pushes for Universal Health Care That?s Governed by the People

Stephen A. Frye s.frye at verizon.net
Sun Nov 15 15:18:47 MST 2015

It's November 15.  This is over 3 weeks old.


At least try to be current.  There are major happenings n the news.


Two days ago, Felix Unger was asked to remove himself from his place of


From: rushtalk-bounces at csdco.com [mailto:rushtalk-bounces at csdco.com] On
Behalf Of Carl Spitzer
Sent: Sunday, November 15, 2015 9:24 AM
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Subject: [Rushtalk] Colorado Pushes for Universal Health Care That?s
Governed by the People


  Colorado Pushes for Universal Health Care That's Governed by the People 
Nathan Schneider 
Oct 23, 2015

First pot, now health. In November 2012, Colorado voters approved a ballot
initiative that made recreational use of marijunana legal, despite a federal
ban. In November of next year, the state will have the opportunity to lead
the way again-this time, by opting out of Obamacare and replacing it with
ColoradoCare, a universal health care system governed by those who rely on
it. Proponents presented far more than the requisite 99,000 signatures
required to put the initiative on the 2016 ballot in Denver today, though
they must be verified in the coming weeks.

ColoradoCare proposes a model that covers every Colorado resident. A tax on
income and employers would replace insurance premiums, but the revenue
wouldn't be subject to the whims of legislators; instead, it would go
directly to a fund overseen by trustees whom the recipients choose. In this
respect, it would be a cooperative-like system accountable to everyone in
the state, independent from the rest of the government and enshrined in the

Proponents argue that ColoradoCare will mean better, more accountable care
at a lower cost. Opponents, including the Koch brothers-funded Advancing
Colorado, say it will be the Obamacare rollout on steroids. But by combining
conservative irritation with the Affordable Care Act with liberal ambition
toward universal coverage, it may actually have a chance in a purple state
like Colorado.

Colorado, also, has a history of building practical, cooperative
infrastructure. When energy companies failed to bring power to the state's
rural areas quickly enough, communities set up electricity co-ops to power
themselves. Credit unions are plentiful. Cooperative business models
accommodate both community-mindedness and the state's libertarian streak.

Irene Aguilar, a physician and state senator, is the chief architect of
ColoradoCare's unique cooperative approach and one of its leading
spokespeople. I sat down with her at an ice cream shop in Louisville,
Colorado, to learn more.

Nathan Schneider: What brought you from medical practice to the state

Irene Aguilar: I was appalled to see how much we were spending on health
care. I often think of one woman in particular who was about 42 and working
as a secretary when she first saw me. Every year I'd drag her in to write
her prescriptions, and she'd say, "I can't really afford these." Because of
this, her numbers showed that she was not doing very well at managing her
disease. By about 50 she had renal failure, and she qualified for Medicare.
I couldn't help her take her medicines, and soon we were paying $70,000 a
year to give her dialysis. Because she was on dialysis three days a week,
guess what-she couldn't keep her job, and she ended up on Medicaid. This was
a woman who had been working. She went on, in her 50s, to have heart
disease, and she had a leg amputated, and at 60 she was dead. That is the
real human cost of the backward way in which we deal with our health care

It was so much more expensive to pay for her to get dialysis, to get all
those heart procedures, to lose her leg, and to be on welfare than it would
have been if we kept her on her diabetes medicines at the age of 42 and let
her control her disease. It's possible to have an alternative that is both
fiscally conservative and socially just; it would be win-win in my mind.

Schneider: How did you start to entertain the possibility of an alternative
like ColoradoCare?

Aguilar: I worked for 28-years-plus at Denver Health, a county hospital,
doing primary-care internal medicine. In 2007, Colorado had something called
the 208 Blue Ribbon Commission for Healthcare Reform. The four plans it
considered included a single-payer health care plan, and the commissioners
created subgroups to consider how the plans would impact certain
populations. Since my daughter was disabled, I applied to be on the
vulnerable populations task force. We learned that if we adopted the
single-payer plan we could have everyone covered and decrease spending by
$1.6 billion a year.

Not knowing anything about politics, I assumed that of course the
commissioners would pick that one-and then quickly found out how much money
there is in health care and how many self-interested individuals were in
that pot. I began learning more about the political aspects of this that I
needed to be more aware of. In 2009 we tried to run a single-payer bill
through the legislature, but the governor managed to kill it. I ran for
office in 2010 in order to concentrate on this. Our setbacks gave me
motivation to listen to the feedback and see we could to modify this and
make it more consistent with Colorado values.

Schneider: How did the initial proposal begin to evolve into ColoradoCare?

Aguilar: In 2009, Atul Gawande published an article in The New Yorker called
"The Cost Conundrum." He profiled the impressive health outcomes in Grand
Junction, Colorado, alongside those of McAllen, Texas. I went and visited
with people in Grand Junction to learn more about what they were doing
differently. There, [insurance company] Rocky Mountain Health Plans
collected all the payments and paid providers the same, no matter who the
individual patient's payer was. They paid them about 80 percent on
fee-for-service and kept about 20 percent to be given on a reward basis
based on quality of care and patient satisfaction. Unlike my experience as a
provider, providers there did not have a disincentive against seeing certain
people because of the insurance they had. ColoradoCare is sort of a blend of
Rocky Mountain Health Plans and single-payer.

Schneider: A lot of people seem afraid of entrusting health care to the
government-"death panels" and so forth. Does the Rocky Mountain model get
around that?

Aguilar: Rocky Mountain Health Plans, at the end of the day, is still an
insurer. In ColoradoCare, we're all putting our money in, so in some ways
it's a cooperative. But it's different from a cooperative because you don't
have to put money in if you don't have a lot of money. The pure cooperative
people tell us to stop calling it a cooperative, both because it's mandatory
and everybody doesn't pay the same. But we like to call it a cooperative
because the board is accountable to and elected by the people in the state.

Schneider: Tell me about where that money comes from.

Aguilar: You collect the funds through a premium tax-a 6.6 percent employer
tax across the board and a 3.3 percent individual tax. If you're
self-employed, it's the whole 10 percent, but because it's tax deductible it
ends up being less than that. The funds are collected through our taxes, but
they're transferred into a separate authority that is run by its own elected
board of directors.

Schneider: What does that revenue buy?

Aguilar: We had a fiscal analysis done by Gerald Friedman, an economist at
UMass, Amherst. He anticipated that with the Affordable Care Act, health
care would be about 19.4 percent of the gross state product, and if we were
to switch to this model, it would be closer to 15 percent. By Obamacare
standards, the level of care would be the very top-Platinum Plus-covering 90
percent of your total health costs. We added in no copay for primary care
and low copayments that the primary-care provider can waive if necessary to
prevent longer-term costs. We also had it priced for everyone in state,
regardless of documentation status, under the knowledge that we would not be
turning people away for emergency care, so it made more sense to have
up-front preventative care available for all the people who lived in the
state. Vermont's single-payer policy imploded because it was way too
expensive for them. It's a small state. But we have the numbers.

Schneider: Do you think Colorado's more conservative voters will go for it?

Aguilar: There are people in the legislature, primarily Republicans, who
focus on what is and what is not government's responsibility. They really
don't want health care to be government's responsibility. But I was invited
to present the initiative in Glenwood Springs on the Western Slope, which is
historically pretty conservative. I ate at a cafe there where all the
waitresses carry guns. I was impressed, though, with how well people in
small communities like that understand how the current system works against
them. Our rural areas have significantly higher rates for their plans and
lower benefits. When somebody in those communities is sick and can't get the
care they need, it's somebody people know. They asked me a lot of questions,
and they seemed to like my answers. I didn't sense any hostility.

Schneider: What will the strategy be for passing this initiative?

Aguilar: I think it will be really important to involve doctors and nurses,
making information available in their offices and ensuring that they know
enough about it to answer a few basic questions or refer patients elsewhere.
Of course, there are people who make billions of dollars off of our
dysfunctional system, and they will spend millions of dollars trying to
convince medical professionals that this will be more harmful to them than
what they have right now.

Schneider: Do you know who those opponents are yet?

Aguilar: I don't. I would expect Big Pharma and for-profit hospital
systems-maybe all hospital systems. It's hard to tell the for-profit from
the nonprofit these days. People often ask about what happens to insurance
companies. I answer, "What happened to vinyl record companies?" It varies.
An HMO like Kaiser could continue to exist because they would get a monthly
payment-it just wouldn't be from an employer, it would be from this premium
tax. An insurer like Rocky Mountain could continue to be an administrator
for the system.

I actually had a lobbying breakfast with United Healthcare. They said to me
that when Vermont passed its plan, they spoke to the governor about wanting
to be the administrator for the Vermont health plan. So I don't think that
insurers would go away, but they'll have a different kind of role, because
there is still fiscal management to be done, just as with Medicare.
Estimates suggest that this kind of plan will create more jobs in the health
care industry in terms of delivering service, but it's a shift in what kind
of jobs provided. The overall savings also means a certain amount of extra
income that's available in the economy to do things other than health care.

Schneider: What do you think the chances are that this plan will actually

Aguilar: Colorado is usually seen as a leader, as a state that is trying to
do the right thing. I think there's sort of a sense that it wouldn't be
unusual for a state like Colorado to try and do something new, since we've
been so proactive in other ways. I give it at least 50-50, and the optimist
in me gives it 52-48.

There's this documentary that was done for PBS by T.R. Reid, who is part of
our coalition, called Sick Around the World. In one scene, he's talking with
a former president of Switzerland, and she talks about how in 1994 they
passed universal health care by a narrow margin. There were many people who
were so angry that they said they were going to leave the country. Ten years
later, there were very few people who were not thrilled with the program.
Knowing what I do about health care, I can't help but hope that it will be
the same in Colorado. There will be people who put up a big fight, and when
we beat them by the hair on our chinney chin chin they'll be furious. But in
10 years we'll all be grateful we took that step.

Editor's note: A previous version of this article referred to ColoradoCare
as "single-payer." While in some respects it is, in others it is a hybrid
that deviates from the standards many people associate with single-payer.
The phrase was removed to prevent confusion.

Colorado Pushes for Universal Health Care That
-health-care-governed-by-the-people-20151023> 's Governed by the People

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