[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:

>It’s 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
>To: Rushtalk
>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 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 
>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 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 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 what­she 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 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. 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 
>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 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 
>tax­a 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 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. 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 systems­maybe 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 
>payment­it 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 pass?
>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.
>Pushes for Universal Health Care That’s Governed by the People
>Rushtalk mailing list
>Rushtalk at csdco.com
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