[Rushtalk] Colorado Pushes for Universal Health Care That?s Governed by the People
John A. Quayle
blueoval57 at verizon.net
Sun Nov 15 23:44:11 MST 2015
At 05:18 PM 11/15/2015, Stephen A. Frye wrote:
>Its November 15. This is over 3 weeks old.
>At least try to be current.
But, Stephen........this is the closest
Carl's been to current in YEARS! Usually, stuff
he posts in months behind! - jaq =-O
> There are major happenings n the news.
>Two days ago, Felix Unger was asked to remove
>himself from his place of residence!
>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
>Subject: [Rushtalk] Colorado Pushes for
>Universal Health Care That¢s Governed by the People
> Colorado Pushes for Universal Health Care Thats Governed by the People
>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 againthis 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 constitution.
>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
>states 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 states libertarian streak.
>Irene Aguilar, a physician and state senator, is
>the chief architect of ColoradoCares 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 legislature?
>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 Id drag her in to write her
>prescriptions, and shed say, I cant 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
>couldnt 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 whatshe couldnt 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 system.
>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. Its 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
>oneand 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 patients
>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 governmentdeath
>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, were all putting our money in, so
>in some ways its a cooperative. But its
>different from a cooperative because you dont
>have to put money in if you dont have a lot of
>money. The pure cooperative people tell us to
>stop calling it a cooperative, both because its
>mandatory and everybody doesnt 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
>taxa 6.6 percent employer tax across the board
>and a 3.3 percent individual tax. If youre
>self-employed, its the whole 10 percent, but
>because its tax deductible it ends up being
>less than that. The funds are collected through
>our taxes, but theyre 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 topPlatinum Pluscovering 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. Vermonts
>single-payer policy imploded because it was way
>too expensive for them. Its a small state. But we have the numbers.
>Schneider: Do you think Colorados 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 governments responsibility. They
>really dont want health care to be governments
>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 cant get the care they
>need, its somebody people know. They asked me a
>lot of questions, and they seemed to like my
>answers. I didnt 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 dont. I would expect Big Pharma and
>for-profit hospital systemsmaybe all hospital
>systems. Its 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
>paymentit just wouldnt 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 dont think that
>insurers would go away, but theyll 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
>its a shift in what kind of jobs provided. The
>overall savings also means a certain amount of
>extra income thats available in the economy to
>do things other than health care.
>Schneider: What do you think the chances are
>that this plan will actually pass?
>Aguilar: Colorado is usually seen as a leader,
>as a state that is trying to do the right thing.
>I think theres sort of a sense that it wouldnt
>be unusual for a state like Colorado to try and
>do something new, since weve been so proactive
>in other ways. I give it at least 50-50, and the optimist in me gives it 52-48.
>Theres 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, hes
>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 cant 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
>theyll be furious. But in 10 years well 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.
>Pushes for Universal Health Care Thats Governed by the People
>Rushtalk mailing list
>Rushtalk at csdco.com
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