Debates
The following opinions do not necessarily reflect those of the Business Health Forum.
Editorial, Denver Post (Dec. 2007)
Editorial, Craig Daily Press (Oct. 2007)
Editorial, Denver Post (Sept. 2007)
Mark Hillman, Republican, former Senate Majority leader
Reeves Brown, executive director, Club 20
Editorial, Denver Post (Dec. 2007)
More than a month before the Colorado legislature opens its 2008 session, Republican and Democratic lawmakers are already trading health care proposals. It's a welcome dialogue and we were particularly happy to see the open spirit in which the GOP initiatives were greeted by House Speaker Andrew Romanoff, D-Denver.
We're tempted to label the Republican plans "208 light" because they emphasize modest and relatively low-cost ways to plug some of the gaps in Colorado's health care network — where an estimated 790,000 people lack health insurance. In contrast, a 27-member committee known as the 208 Commission that was created by the state legislature last year has outlined five different concepts for expanding health care in Colorado.
One plan promoted by commission members would expand public programs such as Medicaid and require individuals to purchase health care coverage or face a tax penalty. The state would subsidize insurance for low-income families, at a cost of up to $1.1 billion per year.
The Republican alternatives outlined Monday focused on allowing uninsured Coloradans to buy cut-rate health care policies without the mandated coverages that now add to insurance costs in Colorado. Another GOP plan would provide additional services to Coloradans with developmental disabilities.
Romanoff said Democrats would wait until the 208 Commission's final report in January before locking in their own plans, but promised that Republican ideas would be given fair hearings. His response is both fair and wise. While the speaker has promised that health care will be the top priority in the upcoming legislature, the staggering costs of the 208 Commission proposals may rule them out.
Some health care advocates hope to ask voters for a tax increase in the 2008 election to pay for a sweeping new program. But Gov. Bill Ritter has said he wants only one tax increase plan on the 2008 ballot. If Democrats do make health care their top 2008 priority, the cost of such plans would preclude breakthroughs on either higher education or transportation — both of which are more pressing priorities for immediate state action in our view.
Ultimately, the U.S. health care system needs a top-to-bottom overhaul on a nationwide basis, with the federal and state governments working in close partnership. It would be foolish to spend billions re-inventing Colorado's health care system root and branch next year without knowing what the next president may propose in 2009.
Thus, the stop-gap health care solutions now proposed by Republicans may be the beginnings of something that could help buy time for Colorado to address our urgent needs in education and transportation while preparing to join in a new federal-state partnership to reform America's health care system as early as 2010.
Editorial, Craig Daily Press (Oct. 2007)
The American health care system is a joke. It is an expansive, expensive, bureaucratic and ineffective mongrel that tramples, or avoids, as many people as it helps. It boasts of cutting edge technology, the finest doctors anywhere and world-class hospitals. And yet it fails to serve all those who need treatment. It confuses, refuses, and, at times, arbitrarily chooses, if and how someone in dire need will receive the help required to either sustain life, or improve the quality of it.
This is the opinion of the editorial board, and it is mild compared to the stinging criticisms heard across the country every day from an increasing number of people dissatisfied with the big business of health care. There is good news and bad news regarding the health care situation.
First, the bad.
As Susan Birch, executive director of the Northwest Colorado Visiting Nurse Association, said in Friday’s Daily Press, the solution to the living nightmare that is the health care system is neither easy nor quick. It’s going to take thorough discussion and debate; it’s going to take the commitment of lawmakers and the allocation of resources.
Mainly, it’s going to take a lot of time and effort.
The good news, at least in Colorado, is our state government seems to understand the severity of the system failures — having about 800,000 uninsured state residents chief among them — and has implemented steps to begin plugging the gaping health care holes. As a side note, the Colorado Bureau of Labor reports that 24.5 percent of Moffat County residents are uninsured. That figure includes an estimated 1,600 undocumented workers.
The state Legislature created the Blue Ribbon Commission for Health Care Reform to study and diagnose the ills of the state’s health care system. To do so, the commission has hosted meetings around the state to solicit the opinions of local residents. Several commission members will be in Craig today, from 1 to 4 p.m. at the Holiday Inn, for a public meeting.
Commissioners are asking for public feedback about the health care system and how it can be improved. The feedback, commission members say, is critical in crafting recommendations the commission will make to the Legislature next year. Those recommendations could lead to wide-scale reform.
The editorial board encourages as many people in the community as possible attend this meeting. Go, the board says, and express your thoughts, frustrations and, most importantly, your opinion on how things can be changed for the better. The board believes that public debate is good and fair criticisms can lead to change. The board also believes that health care critics, of which there are many, cannot live in a vacuum.
That is, they have an obligation to be part of the solution when such an opportunity presents itself. It’s like jury duty, folks.You can’t complain about unjust verdicts while simultaneously trying to avoid your civic responsibility. The same line of thinking applies to today’s meeting: you have the right to gripe; you also have an obligation to gripe to the people who can make a difference.
Please do not confuse the editorial board’s overall opinion on health care. Our complaints are not against the fine doctors, nurses, hospitals and health care professionals in our country, county and city. We support these people and trust their intentions are to help. No, we believe the failure to be systematic.
Like school teachers, health professionals are trapped in a failing system that severely handicaps their ability to stay true to those good intentions. Only when a health care system is implemented in our state and country that works to complement these professionals rather than hinder them, will health care become more than the punch-line it is today.
Editorial, Denver Post (Sept. 2007)
If the state of Colorado is going to reform health care, it will take a massive commitment by lawmakers, the trust and faith of voters and a vast amount of money. That's a lot to ask in a contentious political year with a presidential election looming and Republicans trying to regain their footing in the state legislature. Still, it's a worthy and necessary task.
The reforms now under discussion by a blue ribbon panel likely would require voter approval because of possible tax hikes to pay for the reforms and also changes to state law. But first they must survive legislative review, which will be intense. The 27-member 208 Commission (nicknamed for Senate Bill 208, which created it) has two key goals: cover more of the 780,000 uninsured and underinsured Coloradans and reduce costs to the state. They're lofty but attainable goals. And with health care reform a top priority for many Americans, the proposals under discussion are worthy of robust legislative debate.
Formed under former Gov. Bill Owens and expanded under Gov. Bill Ritter, the panel has whittled a stack of 31 proposals to four for possible legislative review. A fifth plan, which takes the best features from several proposals, is in the works. The plans range from mandating employers to offer, or individuals to buy, coverage to expanding Medicaid to covering all Coloradans under a single government program.
At this early stage, there's no consensus among lawmakers who have reviewed the plans. The chairs of the Senate and House committees which will hold hearings on proposed legislation have their own ideas for reform. As of last week, their plans didn't necessarily match what the commission has proposed. Moreover, people who attended a commission briefing at the state Capitol last week said that opposition groups are forming to fight the proposals in the legislature.
That's fine. If anything needs open, honest and in-depth debate, it's health care reform. We're glad that, so far, it doesn't appear one plan will be ramrodded through the legislature.
Rep. Anne McGihon, chair of the House health committee, said the commission's work is meant to educate lawmakers about the costs. Actual legislation "may or may not look like a 208 Commission proposal," she said. Sen. Bob Hagedorn, chair of the Senate health committee, said reform legislation in the Senate could range from a Kaiser-Permanente-like plan paid for by the government to a basic primary care plan that would cover only the uninsured in the beginning. There is a vast difference in cost among the proposals. Hagedorn predicted that any proposal will be a tough sell to voters who are insured and will be asking, "What's in it for me?"
Lawmakers who attended last week's briefing had other concerns. Rep. Debbie Stafford fears that mental health coverage is being left out. Like many other Republican lawmakers, she opposes tax increases to pay for reform and any plan that penalizes businesses.
House Speaker Andrew Romanoff and 2008 Joint Budget Committee Chairman Bernie Buescher remain optimistic. Both must play major roles in helping find a solution that, as Ritter says, is "balanced, carefully analyzed and the consequences well thought through."
It's possible the 2008 legislature will simply lay the groundwork for later reform, given the complexities of the issue. "The question is whether a state can really resolve it," Romanoff said.
Considering the federal government hasn't, we're pleased the state is trying.
Mark Hillman, Republican, former Senate Majority leader
If you’re unhappy with health care, you’re obviously not alone. For most people, the problem isn’t availability. The problem is cost – cost of treatment, cost of prescriptions, cost of insurance, or cost of paying for the uninsured.
For more than 60 years, government has tinkered with the way we pay for health care. Unfortunately, when government "solutions" fail, lawmakers rarely admit their mistakes and go back to square one. Instead, they layer more dubious solutions on top of those that failed until the problem becomes so intractable that far more people suffer from the solution than from the original problem.
Last year, the state legislature created the Blue Ribbon Commission (BRC) on Health Care Reform and charged it with divining a proposal to expand coverage, reduce the number of uninsured and decrease costs. (After that, curing cancer should be a snap.)
A final recommendation is due this November, but the BRC now appears headed toward a nightmare "solution" consisting of higher taxes, lower wages and fewer choices.
The commission chairman says the state may have to resort to a tax increase. Meanwhile, three of the four proposals still under final consideration include mandates to require all Colorado residents to purchase health insurance or all employers to buy insurance for their employees.
While the BRC could do many things to modestly improve Colorado’s health care climate, coercing everyone to purchase a government-approved health plan isn’t one of them. Such a mandate takes away from consumers the power to select the coverage that best fits their unique needs and budget.
Employers don’t mind helping their employees pay for insurance, but they don’t want to pick their policy for them. You wouldn’t want your employer to buy groceries for everyone at work from a one-size-fits-all shopping list — and deduct the cost from your paycheck. So why do we accept the notion that employers should pick our health insurance coverage using that very model?
The only reason employers provide health insurance, rather than simply giving you the money to buy it yourself, is the federal tax code. Purchasing health insurance is tax deductible for employers; for employees, it’s not. If your employer simply reimbursed your for your premiums, the IRS would tax the reimbursement.
Although state lawmakers cannot change the federal tax code, they can certainly tell our congressional delegation that equal tax treatment of health insurance premiums is imperative.
Another practical reason to resist an employer-purchase mandate is job creation and competition.
Most employers recognize that providing health insurance is crucial to attracting and retaining qualified workers. However, every job has a value based on the goods and services that a worker produces. If a worker’s production is worth $10 an hour and the job currently pays $9.00 an hour, even a bare bones health insurance plan will drive up the cost of employment by at least $1 an hour.
When low-skill, low-wage jobs no longer pay their own way, businesses have no choice but to consider eliminating, automating or relocating them out-of-state or overseas.
On the other hand, a mandate requiring all individuals to purchase health insurance initially sounds like a reasonable step toward personal responsibility.
However, such a mandate takes the power to shape the marketplace away from Colorado families and gives it instead to politicians and bureaucrats. Rather than tailor policies to please customers, insurance companies and special interests will lobby lawmakers to force you to buy the products they prefer.
Moreover, government notoriously underestimates the cost when you and I are paying the bill. In Massachusetts, officials predicted that mandatory coverage could be purchased for $200 a month; now, it’s closer to $400. Worse still, many residents who were already covered by insurance now must buy a more expensive policy to satisfy the state’s expensive standard.
Colorado’s health care climate didn’t get into this mess overnight. Lawmakers and the Blue Ribbon Commission should view reform as a long-term commitment, set modest expectations, and proceed carefully.
If, instead, they are bound and determined to hold a press conference to declare the problem solved, the rest of us will be paying the bill until the next commission comes along.
Reeves Brown, executive director, Club 20
Club 20's health-care reform proposal was developed through the collaborative efforts of a diverse group of individuals representing doctors, nurses, hospital administrators, health insurers, the business community and individual consumers - each representing a critical component in the delivery of health care.
We believe that a great deal of the solution to Colorado's health-care challenge has less to do with new ideas, and more to do with the need for policy-makers (and the broader public) to accept the reality of our current health-care situation. Once one understands and accepts the indisputable reality within which we must operate, it's not that difficult to connect the dots to determine the necessary changes that must be made.
Our proposal is based on several acknowledged realities:
- On a macro scale, the cost of health care is simply a function of the overall cost of the health-care system divided by the number of participants who pay into that system.
- The question our society needs to answer is not "Should we provide health care to everyone?" because we already do that through access to emergency care. Rather, the appropriate question that we answer in this proposal is "How should we provide health care to everyone in the most efficient and equitable way?"
- There is a finite amount of money in the system. We cannot afford to provide unlimited care to everyone.
- To the extent that some people do not have health-care coverage, they will avoid preventive care measures in favor of crisis-driven health emergencies and continue to seek the most expensive treatment at the emergency room when needed. The result will continue to be an irrational and inequitable cost-shift to those who are paying for coverage.
- More health care does not necessarily result in better outcomes. Quality health care is a function of provider-patient relationships, timely care, and good standards of practice . . . not quantity of care.
- Our current health-care "system" is plagued by tremendous inefficiencies at all levels, and built around fractured and adversarial relationships rather than a coordinated effort to deliver seamless care.
With these realities in mind, and with a combination of health coverage mandates, benefit limitations and a simplified delivery system, we believe our plan for comprehensive reform will sustain a health-care system that will efficiently and equitably deliver quality care for all.
Ultimately, the merits of any health-care reform proposal should be evaluated not against what we want as a society, but rather what we need.
We all want unlimited access to health care, no cost-shifting, no mandates, benevolent care for everyone who really needs it, and reduced cost. But these objectives are simply contradictory and unrealistic.
What we need is a quality health-care system that is equitable and sustainable.