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On the road to health-care reform

Friday, June 29 at 12:01 AM

By Elisabeth Arenales and Steve ErkenBrack

Remember the children’s game, Telephone? You’d whisper a phrase in someone’s ear, who’d whisper it to someone else and it would continue down the chain. By the time it emerged from the lips of the last person it was, invariably, wildly different from the original phrase.

As members of the Blue Ribbon Commission for Health Care Reform (the 208 Commission), we’re experiencing a similar sensation. As we begin analyzing health-care reform options, our work is attracting greater scrutiny — which we welcome — and generating some misperceptions — which concern us.

Created by the legislature in 2006, the commission was charged with providing ideas for expanding health-care coverage and controlling health-care costs in Colorado. Appointed by both Republicans and Democrats, commissioners represent a range of ideologies and viewpoints. That makes for healthy debate, and we approach our work in a spirit of problem-solving, not politics.

We began by soliciting proposals for comprehensive health-care reform — Coloradans’ best thinking about the way to address those twin problems of cost and coverage. We held two series of public meetings around the state during this stage, first to gather input on the criteria that should frame our request for proposals, and later to hear opinions about the features and principles we should honor as we reviewed the proposals we received.

The response was tremendous, with 31 proposals submitted to us and hundreds of people showing up for public meetings. We reviewed all the proposals carefully to identify a short list on which to conduct detailed technical analysis. While it would have been interesting to analyze all the proposals in this fashion, our statutory charge (not to mention our time frame and budget) required us to identify only three to five for detailed analysis.

To develop that list, we looked for a range of the most well-thought-out proposals that we believe will give legislators the best information about the impact of various approaches to health-care reform.

We selected four very different plans to analyze. One imposes no coverage requirements on businesses or individuals; one covers everyone with a government-run plan. Two would require every individual in the state to have insurance; one of those would also require employers to provide insurance or pay into a state pool. Three of the proposals expand eligibility for public programs. One emphasizes choice and the enabling of market forces.

At this stage, the commission is evaluating options and gathering data. We have made no recommendations. We have not identified a preferred approach.

Next month, we’ll see the evaluations on the four proposals. We’ll have an idea of how much they’ll cost to implement, how much money they’re likely to save, and how many people would be covered by them.

We’ll also get an idea of unintended consequences. For example, would any of these proposals actually make it harder or more expensive for any group to get the care they need? At that point, the commission might select one proposal and make adjustments, or it might take concepts from other proposals — including the 27 proposals not selected for modeling — and develop a fifth option for analysis. Our purpose in doing so will be to provide the legislature additional insights into the alternatives they might wish to consider.

By the end of the year, we’ll have thoroughly analyzed the four — possibly five — proposals and held additional meetings in every congressional district in the state to get input from the public. After considering all of that information, one proposal might rise to the top as a preferred option, but we certainly have not made that decision at this point.

We realize that this is a lengthy process, but careful analysis is essential to address a complex problem. We believe this is the best way to help legislators make informed decisions about how to increase access to health care and reduce health-care costs in Colorado. If you hear things about the commission’s work that don’t fit with the way we’ve described it — just remember that game of Telephone.

Elisabeth Arenales directs the Colorado Center on Law and Policy’s Health Care Program. Steve ErkenBrack is vice president for legal affairs of Rocky Mountain Health Plans.

READER COMMENTS

Mr. Watts, you seem seriously confused about the difference between who pays for health care and who provides it. None of the proposals move everyone into "government run" medicine. There is still choice and options for people of different circumstance - and people still got to doctors and clincs that run independently of the state.

You also seem to misunderstand why expanding Medicaid coverage to lower income people is an important part of any plan to get more people covered. For one thing, every dollar Colorado spends on Medicaid is matched by a dollar of federal funds. It's just one way of having the tax dollars we as Coloradans pay to the federal government returned to Colorado as federal spending. It's an immediate 100% return on our money...pretty good if you ask me. If someone offers to foot half the bill, I say, why not?

Finally, if a free market solution was really viable, why did the commission receive only 1 out of maybe 30 different proposals from very diverse groups - business, nonprofit, provider, etc? Let's be serious. We have a free market health care system right now. If it were working, we wouldn't need a commission or health care reform.

It would be better if we all supported the commission and started thinking of new ways to get more people the health care they need so that ultimately costs come down for us all.

Posted by Pete Lindstrom on July 2, 2007 11:40 AM

The 208 commissioners say:
"If you hear things about the commission’s work that don’t fit with the way we’ve described it -- just remember that game of Telephone."

This amounts to saying "Take our word for it, anything you hear which contradicts our claims is a rumor".
Well, let me be the first to point out that some of the commissioners' statements are misleading.
The commissioners attempt to gloss over the concerns about the commission's activities.
They state, "We selected four very different plans to analyze".

There are some differences. But what the commissioners dont mention is what all four plans have in common -- the commission chose only proposals which call for a massive increase in governmment interference. None of the four plans respect the individual's right to make his or her own health and financial decisions, despite the commissioners' ridiculous assertion that "One emphasizes choice and the enabling of market forces".

On the 208 Commission’s chosen menu of coercive measures are forcing every individual in Colorado to buy health insurance, forcing employers to buy health insurance for employees, enormously expanding Medicaid and forcing every person in Colorado into a state-run health care system. The commissioners make their selections sound less coercive than they are, stating that one plan "imposes no coverage requirements on businesses or individuals". They dont mention that this is the plan for the enormous expansion of Medicaid.

Neither do they mention that the 208 Commission has discarded the only free-market proposal, (called FAIR -- Google "Free-markets Affordability and Individual Rights").The commission has excluded that proposal from their "detailed analysis", choosing to analyze only proposals from the statist end of the spectrum. This means that they certainly do not intend to seriously consider reform toward a free-market as one of their possible recommendations to the legislature. So much for the 208 commission's claim that they are considering a broad range of proposals.

The 208 Commission thinks they know best, and they have plans for you. But they are wrong -- forcing Coloradans into a government-run medical program because some people are uninsured would be just as wrong as forcing everyone to live in a government-run housing project because some people are homeless.

Posted by Richard Watts on June 29, 2007 11:52 PM