Colorado Care May Soon Rise On Its 2016 "Ashes"

Comparison of Colorado Care provisions with those of the failed plan in Vermont. This post deals with a number of reasons why the former "went down in flames".

My wife, Janice - with dozens of others - had worked ferociously to get the Colorado Care health plan passed in the state in the 2016 election cycle. Alas, there was simply too much opposition arrayed against, especially the sheer volume of "free speech"...errr,  the money.  The Colorado Care team and activists had amassed some  $800,000 to support their campaign but were confronting the Koch brothers' deep pockets which easily had ten times more to spend.  No surprise the Kochs' ads- seen much more frequently (and laden with propaganda) won out.

But according to T.R. Reid - one of he spokespersons and lead voices for the bill, there is no reason that it can't come back on the ballot in 2020, provided some tweaks are made.


T.R. Reid - a long time advocate for a universal health care bill believes Colorado Care can be resurrected with the right tweaks.

In a recent interview with The Colorado Springs Independent, Reid made it clear what went wrong and now the next iteration of the bill could be improved. This is essential also in a hostile environment to any kind of social safety nets and with the Republicans on the warpath to tear down Obamacare by detaching its mandate. This despite a remarkable 55 percent approval rating in an April Gallup poll, and currently with a historically impressive 50 percent approval rating according to Gallup.

What happened? Millions of people - including Trump voters- realized they could finally obtain the affordable care they need, even with preexisting conditions. 

This elicits the question of why Americans have been chronically leery of enabling or allowing the government to run a health care system?  In fact, the reasoning is inchoate and absurd. As Reid put it in his interview:

"If government doesn't get between you and your doctor, then United Health Care in Minnetonka, Minnesota, gets between you and your doctor and dictates which doctor you can see, Public health payment plans are just more efficient and work better."

Adding:

"Just about everybody on it will tell you Medicare is the best insurance they ever had,  You know, I worked for the Washington Post company, and it's a very generous company, very generous, and it took really good care of us in terms of health insurance and Medicare's better than the insurance I had with the Washington Post."

I can vouch for that, completely. As I already noted in a post last month,  the CMS Summary sheets for the procedures carried out this past year totaled more than $60,000. This was for the 3D staging biopsy and cryotherapy cancer treatment at UCHealth.  The ultrasound guidance part of the cryo treatment alone came in at $16,000 and the anesthesia just for that treatment, not including the 3D biopsy anesthesia, was $3,149..

If I'd  had to operate under a $20,000 per annum GOP voucher plan, I'd have ended up shelling out nearly $40,000 out of pocket for the uncovered procedures.  None of that even would even had included the cost for wife's hip replacement surgery, including 7 days in rehab.

So, as T.R. pointed out in his Indy interview it is "silly" for people to bitch about government health care when one of the most successful ever designed has prevented more seniors from impoverishment than in the nasty early days.  That was pre-1966 when oldsters had to either hope a son or daughter would take care of them, or they had to beg on the streets for help.

But, of course, viewed as (GASP!) "socialized medicine"  that's why the Repukes are determined to destroy it now - when their tax plan comes a cropper with exploding deficits, as it surely will.

So what went wrong with Colorado Care, apart from the fact supporters lost the money as speech game to the Kochs?  T.R. Reid provided several plausible reasons:

-  People were quite willing to help a sick kid or neighbor, so hypothetically backed the plan However, the rubber hit the road when they read the fine print and grasped they'd have to help pay for it

- Seniors especially were against it as even though they'd have to pay there was no benefit at all for them. So why support it when they already had Medicare?

Janice and I discussed this very issue last year when we both attended a meeting downtown and after a presentation, one older lady on Medicare Advantage insisted there was no reason at all for her to vote for such a bill Not one which dinged her while providing  no further benefit.

But as we noted, it was precisely this "what's in it for me" mindset that's preventing the country from moving forward on a universal health plan.  By contrast, Europeans  - like our Czech friends Martin and Gabby, e.g.

are quite happy to pay higher taxes because they understand "we are all in this together".  As Gabriella told us while we dined out in Prague in 2015,: "You can't take the money with you, so why not spend it on better health for you and your fellow citizens. It is win-win."  This sensible philosophy also carried over into their daily lives, in which they valued time much more than extra money to work more hours. 

As Gabby put it: "Here in Europe the companies cannot work us to death or to the point of insanity like they do people in your country. That's why we can travel our continent for weeks at a time. Your countrymen would probably feel they have to check their cell phones or emails every day or twice or more a day!"

Back to the reasons for Colorado Care's downfall, T.R. also pointed to the wording on the ballot. The resolution began as follows: "Shall we raise taxes $25 billion in order to ..."   In he words of Reid:

"A lot of people thought we lost the minute that became the language of the ballot. You know, people were just not going to spend $25 billion. And the answer to that was, well we're spending over $30 billion on health insurance now to out-of-state insurance companies. But we never had the money to make that point."

Which is why a much more extensive grassroots education effort is needed.

What about future strategies for  resurrection? Reid's ideas are as follows, in his own words:

"I think there are two possible routes. One is put in legislation to the [state] Legislature to try to advance the cause. And, in that regard, we have written what's called the Colorado Patient's Bill of Rights. I think it's nine proposed bills. And they are bills like the Choose Your Doctor Act, and that says any health care plan sold in Colorado has to let the patient choose the doctor. As you know, currently, insurance companies have these narrow networks where they dictate the hospital and the doctor you can go to. So we're going to put in legislation that says they all have to do what Medicare does, which is cover all doctors, any licensed practitioner. That's one bill. Another is the Why Pay More Act, and that says whenever a hospital or a doctor bills you for a procedure, the bill has to show you what Medicare would have paid for the same procedure. And presumably then people will respond and say, "Why am I paying $36,000 for a hip [replacement] when Medicare pays $1,900 for the same procedure?"

... Different legislators have offered to put in those bills, and here's the thing: They're all gonna lose. Because the hospitals or the doctors will fight them and they'll lose. But that kind of makes our point, that the Legislature is not the place to get this done because it's owned by insurance companies and for-profit hospital companies and drug companies.

... The second plan is to come back on the ballot in 2020. And if we did that there's two crucial points about that idea [usually called the 2020 plan]. One is that the plan would be vastly simpler. Our last plan was quite complicated, we had a 35-page booklet explaining it, you know just about everybody could find something in it they didn't like, so I think next time we will make it much, much simpler. Maybe, for example, one proposal is for a two-sentence ballot initiative. First sentence is: Anyone who needs medical care in Colorado shall have access to a doctor. And the second one is: The Legislature is mandated to effectuate this guarantee by Jan. 1 of, you know, whenever."

The Indy: Where would the funding come from in this scenario?

T.R. again:

'That would be up to the Legislature, but presumably, it would come from a tax just like ours.But if the people vote for this concept, then everybody should have health insurance. The Legislature has to enact it. I mean, it doesn't solve all the problems — then the Legislature has to go back to the voters and say, "Will you pay for this?" But at least then we have the opportunity to say um, a) the people want this, they voted for it, and b) it's cheaper ..."

Indy: What year?

"In 2020, and the plan is, 10 states put the same measure on the ballot in the same year, and they would be Oregon, Washington, Colorado, New York wants to do it, Ohio and Michigan have talked about it, maybe California. And the theory is then, if it's on in 10 states, this will dissipate the insurance companies' money. You know, they'll fight it in New York and California at great expense, and maybe that would let Colorado or Oregon or Washington slip past, because they wouldn't be able to fight it everywhere ... Almost every state has a group of people who are working for universal health care ... and they've decided the way we're going to get there is state by state. Washington, D.C., can't do it."

One point of Reid's needs to be underscored: Don't look to the gridlocked Beltway for any help on affordable health care. It may well be up to state versions of universal or single payer health care to win the day. Provided the respective citizens agree with Gabby's take that "we're all in this together" as opposed to the individualist path of "every one for him or herself".

Will Reeps Use Nate Silver's Health Stats to Try To Gut Medicare?

The ominous notes sounded yesterday, from Mitch McConnell and other Reeps, signals they are determined to carve out as much as they can from Medicare - either forcing the program to delay enrollment of seniors until 67, or imposing steep cuts and premium hikes.

After seeing all my recent copies of paid for Medicare bills, the very thought gives me nightmares as it should anyone approaching Medicare enrollment age.

No one certainly wants to go back to the pre-Medicare era, as depicted in the accompanying image- when oldsters had to sign away their homes, to get medical help or to depend on their grown children to co-sign loans or take 2nd mortgages.

Thus, it has to disturb many true liberals to know that just 4 days ago, Nate Silver- in a much-discussed post in The New York Times  “What Is Driving Growth in Government Spending?”   -  made a statistical case that can easily be appropriated and exploited by the Republican House and its Tea Party Cabal. After going through assorted healthcare numbers, Silver wrote:

"All of the major categories of government spending have been increasing relative to inflation. But essentially all of the increase in spending relative to economic growth, and the potential tax base, has come from entitlement programs, and about half of that has come from health care entitlements specifically.


The growth in health care expenditures, for better or worse, is not just a government problem: private spending on health care is increasing at broadly the same rates and is eating up a larger and larger share of economic activity. It’s an immensely complicated problem, but the arithmetic is simple: if we can’t slow the rate of growth in health care expenditures, we’ll either have to raise taxes, cut other government spending or continue to run huge deficits. Or we could hope to grow our way out of the problem, but health care expenditures may be impeding private-sector growth as well."

For sure, Silver in exclusively looking at the hard numbers is quite correct, and health care is driving inflation. It is also a no-brainer that as a country we have to get health care costs under control. But that doesn’t necessarily mean what diehard Tea Party folks or Paul Ryan types might think it means, i.e. massive spending cuts.  The reason is that to impose austerity-based medical spending cuts would be to treat the symptom, not the cause. We need to fix the cause.

If we instead are driven like lemmings to cut, then providing less health care only means people have to go elsewhere (or nowhere), which has terrible effects on the people — and ultimately on the economy.   How can sick people, impoverished people, be free people or contributors? They can't!

What is the solution? As I noted in an earlier blog, e.g. http://brane-space.blogspot.com/2012/02/why-cant-colorado-follow-grand-junction.html

It is to adopt the same model used in Grand Junction, CO for the whole nation. To summarize: The template provides the basis for a standard set of costs-prices for all procedures, whether appendectomies, gall bladder removal, or open heart surgery. Thus, according to a standard cost set, each procedure will have its assigned, designated prices- say $11,000 for an appy, $35,000 for open heart surgery...whatever. No more charging one guy $60 grand and another $30 grand for the same surgery. Also no more charging $34,000 in Miami for a cardiac procedure, and only $14,000 in Fairbanks, AK. ALL procedures are set with the same prices!

The model was popularized in T.R. Reid's  PBS effort,  "U.S. Health Care: The Good News" . Reid traveled to three distinct U.S. municipalities - not Communist Cuba or anywhere "socialist" - where every person including the uninsured received medical care, and no one was turned away....not even Medicaid patients! The places included Seattle, and Evergreen, Washington, and Grand Junction, Colorado. In the last, Reid found an eminently rational model in which all patients are pooled together in one risk pool to lower the cost for all. All physicians in Grand Junction sign on to take any and all comers, no one indiscriminately turned away for whatever reason....whether Medicaid (low rates of pay, paperwork) or the uninsured. Any physician who doesn't agree is excluded from the Main physician network. He can go it alone and catch as catch can. Readers can watch its implementation as portrayed on PBS:


http://video.pbs.org/video/2198039605/

Note also, that instead of separating all medical procedures and costs they'd be unified as one single cost - say for a prostate cancer HDR treatment. Thus, instead of a medical center or hospital expensing multiple items for a prostate cancer procedure, e.g., from anesthesia ($4,124), to radiology services ($16,768), to recovery room ($2, 090), to operating room services ($14,994) with the bill totalling $42, 776  for all added up, we see just one bill for all integrated services directed at the ONE primary procedure..   In effect, perhaps a bill for $28,000 instead.

Is this do-able?  Of course! If Grand Junction and the other towns -cities Reid visited could do it, so could the nation! One more thing, we can also help lower medical drug costs by allowing the government to bargain for prescriptions like the VA. No, those of us no Medicare didn't fight in any bogus "wars" - but that should not matter. We are all citizens and as citizens we certainly deserve the same standards of care as anyone who by choice served in the military! To separate citizens out on the merits of 'military' service is a fool's errand.

The final goal: "Medicare for all", as opposed to a private insurance company based plan where people who may not be able to afford it have to cough up for private insurance policies. Then halfwits saying this is "universal healthcare'.  No it is not, it is a weak semblance of universal private insurance coverage paid by citizens themselves!

We can do it! If we can blow $1.2 trillion a year on useless miltary BS we can help our citizens toward their own domestic security!

Why Can't Colorado Follow The Grand Junction Health Delivery Model?

At the top of the news lately in Colorado is the divergent cost of health care, as exemplified by the recent case of uninsured Justin Swanstrom (Denver Post, p. 1A, 6A) who went into more than $60,000 in debt after having a heart attack. Meanwhile, those on any kind of insurance, whether private or Medicare, are charged significantly less....WHY?

According to Serena Woods of the Colorado Consumer Health Inititiative (ibid.):

"The uninsured are charged considerably more than the insured in Colorado."

She went on to point out that a proposed new bill would "give people more chances to take responsiblity"

It would do this by peeling away the cost cloaking of most hospital bills and provide transparency. It would even go further by providing the basis for a standard set of costs-prices for all procedures, whether appendectomies, gall bladder removal, or open heart surgery. Thus, according to a standard cost set, each procedure will have its assigned, designated prices- say $11,000 for an appy, $35,000 for open heart surgery...whatever. No more charging one guy $60 grand and another $30 grand for the same surgery.

Backers of the bill cite a 2009 American Journal of Medicine study that found medical debt to the the driver for 62% of all personal bankruptcies, up from 8% in 1981. This is totally ridiculous!

And yet industry groups, like the Colorado Hospital Association, are claiming it will "increase the cost of health care and impede access".

They also add (Denver Post, Feb. 17, p. 1B):

that this amounts to "price fixing that will ruin many facilities"

Horse manure!

WHY?

Maybe these hospital hotshots ought to take a good hard look at T.R. Reid's latest PBS effort, screened two nights ago - U.S. Health Care: The Good News . Reid traveled to three distinct U.S. municipalities - not Communist Cuba or anywhere "socialist" - where every person including the uninsured received medical care, and no one was turned away....not even Medicaid patients! The places included Seattle, and Evergreen, Washington, and Grand Junction, Colorado.

That's right, Colorado Hospital Association, Grand Junction, Colorado! Reid found an eminently rational model in which all patients are pooled together in one risk pool to lower the cost for all. All physicians in Grand Junction sign on to take any and all comers, no one indiscriminately turned away for whatever reason....whether Medicaid (low rates of pay, paperwork) or the uninsured. Any physician who doesn't agree is excluded from the Main physician network. He can go it alone and catch as catch can.

Each "in house" physician treats not only the patient's physical well being but also with an eye to his or her fiscal well being. This mission and network includes FIXED pricing for each procedure irrespective of what insurance vehicle one has....or doesn't. In this way, the delivery of care is rendered uniform without wild variations in costs, and in addition, costs can be controlled - especially as unnecessary procedures (say undertaken just to stir up cash flow) are frowned upon.

The implementation as portrayed on PBS:

http://video.pbs.org/video/2198039605/

was a model of simplicity, belying Cole White's claim (D.Post, ibid.) that "it is complicated".

No it isn't! It's eminently simple...IF you're out to serve people and not merely rake in profits!

The Grand Junction model was brought to Reid's attention by Dr. Elliott Fisher, of the Dartmouth Institute for Health Policy, noting " that about 30 percent of what we spend on health care is unnecessary".

Grand Junction's success at cost-saving was highlighted in The Dartmouth Atlas of Health Care . The accumulated data - extracted from billing records compiled from hospitals across the nation, discovered variations from one town to the next in the treatment of the same ailment. This leads to massive variation in the cost of treating the same ailment. As a result, some U.S. localities (like Miami) spend $17,000 per year on the average Medicare patient, while others (in Grand Junction) spend less than $7,000 per year with results that are just as good.

This led Reid to investigate what made Grand Junction different. For this reason I commend the video link to all readers to watch, at least for the introductory Grand Junction segment - lasting maybe 15 mins.

Unlike the hospitals that gouge the uninsured patients like Justin Swanstrom, the ones Reid encountered featured communities that have several important things in common, including a clear commitment by doctors and hospitals to lower the cost of health care.

I would strongly advise the Colorado Hospital Association defenders of the status quo to watch that PBS program....then try to come up with more excuses for not doing what Grand Junction is to deliver high quality medical care at lower cost.