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

Tom Matiska tom.matiska at att.net
Mon Nov 16 09:03:48 MST 2015

Colorado simply needs to put state run universal health care on the ballot, to be paid for by taxes on marijuana.    Lefties would then get to vote for health care, pot, and taxes all in one..... what's not for them to like??  Tom
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"John A. Quayle" <blueoval57 at verizon.net> wrote:

>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
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