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Single payer cost-effective, viable
Saturday, August 18 at 6:00 AM

By Fran Ricker and Kristen Hannum

It was hot outside and the air conditioning system was acting up when The Lewin Group, a company doing independent analysis for Colorado’s Blue Ribbon Commission for Health Care Reform, gave its preliminary report on the reform proposals submitted to the commission.

The commission’s chair, Bill Lindsay, interrupted the consultants to question their findings.
Lindsay said it surprised him that the Colorado Health Services Program would give Coloradans better coverage than they now have — and at the same time save more than $1.6 billion.
It is counterintuitive that covering everyone would cost less.

That proposal was submitted by Health Care for All Colorado and endorsed by the Colorado Nurses Association. It’s one of four proposals out of 31 submitted that the commission chose for outside, independent analysis. It proposes private health care through a publicly funded system. A single risk pool keeps costs low and guarantees comprehensive coverage.

The other three proposals keep in place our current system’s private insurance companies. Two include mandates that every Coloradan buy private insurance. They also seek to shore up our tattered safety nets for the increasing number of Americans who are uninsured (16 percent) and underinsured (29 percent). The other proposals add cost and give less coverage.

Lewin Group’s lead analyst explained to the commissioners that single-payer systems enjoy significant savings, beginning with lower administrative costs. That’s not just hoping or theoretical. Every other industrialized nation on Earth has guaranteed universal health care for their citizens. They have equal or better outcomes overall and save money, spending a smaller percentage of their GDP and family budgets on health care. They have found that universal health care is good for families and businesses.

True, those systems are human and imperfect. But there are now enough rigorous international studies that we Americans cannot fool ourselves any longer. Our system is broken. Although we have pockets of medical greatness, comparative studies show that ours is not the best health care in the world.

Would such a single-payer system be workable in a single state? If history is a guide, yes. Single payer worked in a single province, Saskatchewan, where Canadian Medicare began.

The fear that a single-payer system would attract sick people from all over the country is far more an indictment of the current U.S. system than of our proposal. It’s just as likely that such a proposal would attract progressive corporations, who currently pay an average of 8 percent to 10 percent to cover their employees’ health care. That’s double the proposed 4 percent payroll tax for the Colorado Health Services Program, which would bill out-of-staters.

Although the Colorado Health Services Plan calls for a 6 percent income tax to pay for health care for all, most Coloradans would pay less because they would trade paying premiums and high deductibles for a lower health-care tax.

Would Coloradans vote for such a tax? That depends partly upon what they now spend on health care. We believe that Coloradans would choose to pay 6 percent of their salary for better coverage for all and never again having to worry about a medically caused bankruptcy.

How about rationing? American insurance companies ration care. Prior authorizations, limiting benefits and denials are examples of rationing under our current system. Europeans don’t have to worry about this. In fact, Europeans don’t worry about health care in general. A Belgian woman recently admitted to us that she had not realized that her country had public, universal health coverage. She just knew that if she ever got sick she’d be cared for.

We hope that Rocky Mountain News readers will take the time to learn more about this issue, and join in the conversation.

All the Blue Ribbon Commission’s meetings are public. Check their schedules at www.colorado.gov/208commission.

Fran Ricker is executive director of the Colorado Nurses Association. Kristen Hannum is program administrator for Health Care for All Colorado.


READER COMMENTS

Here is a hint.... if the public is all paying into one big pot and I am paying for more than my fair share so that Stephen can save on his end, then yeppers, it is socialized medicine.

How about this... take the .gov out of it, let users get their health care in groups or singly... however they like. and if you don't have insurance and cannot get it then we will provide for basic care for you, but don't ask for a sex change, etc on my dime.

And those who think it will be a 6% increase in your taxes, and if milk isn't snorting out your nose, you actually believe that a now "free" health care system won't be taken advantage. of and the costs to skyrocket..... well, what .gov are you watching? What entitlement program yet has come in under expectations?

Stephen. I don't want to pay for your health care any more than you want to pay for mine.

Posted by Dravur on August 27, 2007 04:34 PM

For a brief article on rationing in countries with government controlled health care, see David Hogberg's "Health Care vs. Health Insurance" at

tinyurl.com/2tw7qm .

An excerpt: "An article in the Canadian Medical Association Journal found that, over a two-year period in Ontario, 109 people suffered a heart attack (50 of them fatal) while on the waiting list for a cardiac catheterization."

His site, Health Hog (Google it) is also a good resource.

Re. advocates of "single payer," I wonder what else they want to be "single payer," where instead of dealing directly with people selling what we want, we hand over our money to the government as a monopolistic middle man. The want government to be the only insurance company in town - a monopoly.

For example, should we have "single payer" cars, where government is the single provider of cars? Or "single payer" barber shops?

People generally think monopolies have little incentive to provide a good product or service...unless it's a virtual government monopoly - like government-run schools. But are government run schools a model of quality and efficiency?

Sadly, most people do not understand that we do not have a free-market in health care, and government can't rescue us. As I described in my proposal to the 208 Commission (at WhoOwnsYou.org), government meddling is largly responsible for expensive insurance plans and our being stuck with our employer's insurance offerings.

"Liberals" should hate the employer-based system, created by a tax exemption for employer-paid insurance premiums. It gives insurance companies little incentive to compete, so it's in a sense a favor to big business.

Posted by Brian T. Schwartz on August 21, 2007 11:52 PM

Brooks Imperial,

Simple suggestion would be to ask the insurance company that can't talk to you, or anyone besides your father, who the heck they DID talk to the change that insurance. Then announce you will be contacting the State Attorney General about insurance fraud...Also tell the nursing home...They will clear their throats fumble around for a bit then decide it was a mistake in the paperwork or communications with the nursing facility. Let them have it.

Tree Hugger

Guess you never really had anything to do with the VA. They invented delays, bad advice and downright denial of care. My husband is a disabled vet who gets care through VA. You are right in one thing. The VA is what government health care would be for. What is the problem here with those who want single payer? Let's make it easy. Let the single payer people have a buy in for Medicaid and VA and leave those of us who are believers in personal responsibility alone. Maybe it would be easier to think of it as letting the single payer promoters eat in a soup kitchen while the rest of us can either cook for ourselves or go to a good restaurant. Futile hope that reason will win out but I was born to be an optimist, and a pain in insurance companies sides.

Posted by momma y on August 20, 2007 08:22 PM

I would enter this conversation, but like so many others I am overwhelmed by the assertions from people that want "universal healthcare".

If you think health care costs are high now, just wait until it is 'FREE'....

I love it when logic and facts are referred to as "scare tactics" and "strawman" points....

Never any quotes about the problems that have been shown for over 40 years in Europe and Canada... facts again....


To the poster that says he or she is paying 10,000 a year for health care and would want that 'coverage' through taxes, it would be great if you were covered. But as shown in Europe and Canada, waiting six to nine months for by-pass surgery is NOT the type of coverage I want. you can have it..but not me....

Cancer treatments anyone? "Not now, later dude.. we don't have room"

But I digress, I can't join in and respond to all of the lack of facts...

Anyone ever look into what individual states have saddled the health care industry with regarding minimum catastrophic coverage?

Health care providers can't.. that's the point. ... shackle private industry to the point it can't offer a viable cost effective product, then socialize it because that is the only way to "lower the cost". It doesn't and it won't.....

I've written too much already, I apologize...

May God Bless,
Father O'Malley


Posted by Father OMalley on August 20, 2007 01:30 PM

So, what illnesses were covered by this plan? What conditions? Did they model covering abortions as well as other socially controversial procedures such as gender-reassignment surgery? Did they model psychiatric care? Which psychiatric conditions would be worthy of state-funded treatment, and which would be excluded?

I have a hard time believing that a government-managed system of health care would pick up the tab, were I to have an abortion or require psychiatric care. How would I be better off paying higher taxes when, in fact, these services were the only health care providers I visited this past year? I paid out of pocket for these services, but I doubt the government would have pitched in under a "universal coverage" program since some voters might consider my medical problems signs of moral degeneracy.

Posted by Katherine on August 19, 2007 09:31 PM

Good point, Chuck.

I would much rather have a huge health management organization telling me what tests and treatments my family members need than have the evil government doing it.

After all, the HMOs are focused on making the maximum amount of money, whereas the government is merely concerned about making the maximum amount of money.

Don't you get it? It doesn't matter if it's the government or the health insurance companies calling the shots. Either way, our best interests are not even a consideration.

My family has low-cost health insurance because I am retired from the US Air Force. So far, it has been a bargain. We get to pick our own doctors, and our co-pays for doctor visits and prescriptions are $12 and $9 respectively.

Contrary to the real "fear mongerers," the government can in fact deliver quality medical care at affordable prices. And aspirins don't cost $50 each at the VA hospital like they do at the University of Denver Health Sciences Center.

Posted by Tree Hugger on August 19, 2007 06:10 PM

Corey you are a complete moron. You have no idea what true social medicine is do you. You just to lazy to work for and pay for your healthcare. You would rather other people pay for you. You must learn to priortize what is truely important to you.

Posted by Travis on August 19, 2007 04:47 PM

Mr. Swan you should not enter into a debate before you know your facts. First the U.S. Constitution states to promote the COMMON WELFARE. The Declaration of Independance speaks of "Inalienable Rights". Second read the Federalist papers to get a very insightful look of what our founding fathers wanted out of government and the responsibilities of the government vs. the individual. Finally when you miss qoute, or site wrong information you weaken the arguement and show your lack of understanding.

Posted by Mike on August 19, 2007 04:42 PM

Blue Ribbon my butt. Blue Ribbon is Ritter code for taxes, taxes and more taxes. Higher costs and lower quallity are always the result of a monopolies; they never serve the best interest of the consumer. The only thing that serves our interests are more choices and our ability to shop the system with our own best interests being our primary objective.

Otherwise we will be forced to rely on the very same crowd that runs the post office, repairs our bridges and secures our borders for our health care. The very thought of that gets me very sick.

Posted by Hank on August 19, 2007 02:05 PM

When you decide to let the government pay for something you always get two results.

First: It will cost more than the estimates and the costs will continue to increase until the program is discontinued.

Second: There will be massive inefficiency, waste and delays. These will be denied and when confirmed there will be investigations and finger pointing which will solve no problems but will give those in charge the ability to claim they are improving things.

Socialized medicine, sorry but that is what is promoted here, doesn't work. Because of the increase in demand and the limited supply you end up with denials of care. Because of the inflexibility of government, there will be delays for the higher levels of care. People will die from both of these things. Our present system will work. We just have to get the government OUT of health care in order to give people a free market.
Give individuals the same tax breaks as businesses now receive. Allow all health care expenses to be deductible. Create a medical tax credit to allow the working poor to buy into Medicaid and receive care from this government agency.
HSAs do work. Problem is the silly restrictions and limitations placed on them by a minority in Congress who failed to socialize health care and were determined to block any plan capable of creating individual responsibility and understanding of health care.
Let's stop trying to wave the poor in the faces of others and claim they need the government to intervene. We are a family living at the poverty level. Our three person family consists of a 63 year old disabled veteran (Now you know why I know the government can't do health care right) an 8 year old granddaughter who is physically and emotionally disabled due to severe neglect and malnutrition for the first four years of her life and me, a 56 year old diabetic who has had 5 heart attacks, 7 hospitalizations for infections in the past 10 months and an amputation of all the toes on my left foot. (Now I am not qualified to teach math in Arkansas). Our total income is less than 30K a year. Our present deductibles for our health care, including those to VA are 23K. The only thing worse than that would be if we allow the government to interfere in health care any more than it already has. Next January we will exchange our present insurance for a Medical Savings Account. We calculate it will cost us about half as much as we are paying now.

Don't let the government get its flawed logic and stiff attitudes mixed up with health care. If they do we will all be as frustrated and ill treated as the veterans who try to get care through VA. End result will be a system where only the rich, who can afford to travel or build their own health care facilities , will have high quality health care. The rest of us will have to make do with bureaucracy 101 and the wonderful efficiency of the Driver's License Office. That will be the best result we can hope for.

Posted by momma y on August 19, 2007 12:37 PM

Regarding healthcare as a "right": Reading the preamble to the Consititution, it says we have "inalienable rights to life, liberty and the pursuit of happiness." Thus, we are pro-life and pro-choice at the same time! This can only occur if you live in a non-dual world (see Ken Wilber, "Integral Spirituality"). There are pathologies of both points of view, of course. Single payer would not guarantee "happiness", but it would get most of the sick and injured to the starting gate. Removing the barriers would simultaneously be a boon to the economy.

Posted by George Swan on August 19, 2007 09:45 AM

8/18/07
AN INSURANCE CASE

Two years ago in November of 2005, I signed up both my parents who live in Akron, Ohio, for Humana Prescription Drug coverage under Medicare’s new Part D program.

My dad has more extensive prescription drug requirements than my mom, so, based on his drug formulary, the Medicare website recommended the Humana Complete plan as the most cost effective.

2006 Humana Complete
Monthly Plan premium $63.91
No deductible
Tier 1 drug Co-pay $0
Tier 2 drug Co-pay $30
Tier 3 drug Co-pay $60
Tier 4 drug Co-pay 25%
Continuous coverage – no gap

In September of 2006, my dad’s monthly newsletter from Humana arrived containing “important information” about his 2007 plan. After 3 pages of detailed statistics about his 2006 year-to-date plan usage and benefits by drugs, page 4 starts in a giant sized lettering,

“RELAX… Keeping your Humana coverage for 2007 is easy
What you need to do
To remain a Humana member in 2007, you don’t have to do a thing. Humana will automatically renew your membership so coverage will be active Jan. 1.

Some details of your plan are changing, so be sure to review How your plan will work for 2007 on the following page.”

Relax, some details are changing, you don’t have to do a thing. Pretty disarming, right? My parents relaxed. They took Humana at its word.

Here’s the new Humana Complete plan.

2007 Humana Complete
Monthly Plan Premium $85.00
Stage 1, prescription costs up to $2,400
Generic drug co-pay $0
Preferred drug co-pay $30
Non-pref drug co-pay $60
Specialty drugs co-pay 25%
Stage 2, begins when prescription costs reach $2,400
ends when what you’ve paid reaches $3,850
Generic drug co-pay $5
All other drugs, pay 100% (no coverage)
Stage 3 beneficiary has paid > $3,850
All drugs co-pay 5%

At the point in time when the details of the new plan were revealed, my dad had paid a total of $1,553 for the “complete” plan. He was relaxed. He had good coverage. Why should that change?

After the details of the new “complete” plan were revealed, there followed a note:
“What this means to you
Based on your total cost of prescriptions in 2006, you are likely to reach the new stage 2 of your plan.”

These, are not reasons to RELAX. These are not a few minor details! His drug costs tripled and they, effectively, told him there was nothing to be concerned about.

This is a case of misrepresentation and inducement. The material changes in the plan were only revealed much later in the document after a crushing amount of numeric detail, confusing terms, and new stages of coverage in the plan that did not even previously exist.

For example, they laid out the two plans, 2006 and 2007 side by side in a chart. They made it look like the 2006 plan had multiple stages so the new stage in 2007 wouldn’t appear to be new. But there were no multiple stages in the 2006 plan! The 2006 complete plan had no “gap!”

How many people did Humana fraudulently induce to accept the terms of their 2007 complete plan? I bet my dad wasn’t the only one.

If this weren’t bad enough, it gets worse.

My dad’s in this expensive plan now – August of 2007 - about to reach Stage 3 when he’ll finally get some coverage out of this plan he’s stuck with until he can enroll in a new plan at the end of the year.

He’s being treated for diabetes, high cholesterol, Alzheimers. He’s in a nursing home. Most of his drugs are newer and not available in generic form. His out-of-pocket monthly drug costs have reached nearly $600, not including the plan premiums.

My mom gets a letter today from Humana saying they’ve dropped my dad’s coverage as of July 31st because Medicare told them he enrolled in another plan. Now, why on earth would he enroll in another plan when he was just getting to the point to receive some real coverage from this plan?

He of course wouldn’t, and didn’t. In fact, he couldn’t. He doesn’t even have a phone. Someone in Medicare or Humana made a mistake.

The timing of this mistake is passing strange.

So, both my mom and I call Humana right away. The notice said call right away if this is incorrect. We did.

Humana refused to talk to either one of us because we haven’t filed power of attorney documents with them.

My dad, in a home, incapacitated, can’t make a phone call let alone have a conversation, and none of us could have changed his plan because we don’t have power of attorney on file with Humana, or Medicare for that matter.

True story. Every word of it. A complete injustice. This is no way to treat our senior citizens.

There's a single payor system for you. You can have it.
Brooks Imperial

Posted by Brooks Imperial on August 18, 2007 11:49 PM

Medical insurance is already a form of socialism, you morons (Chris, Scott - I mean you). Did it not occur to you that spreading risk across a wide variety of individuals is how commercial health insurance companies operate? Does it not occur to you that by denying claims to the sickest those corporations make more money? Do you not realize that the only ethical obligation insurance companies have lies with maximizing shareholder value - often antithetical to maximizing policy-holder health? When $80/month only buys a $5000 deductible policy our system is broken. HSAs haven't worked. The free market has failed everyone except the corporations. Bring on single-payer. I'll gladly pay 6% for that, it's much much cheaper than what I'd otherwise pay for corporate health insurance.

Posted by Corey on August 18, 2007 02:34 PM

You trust universal healthcare. You trust UNIONS which haven't done the U.S. any good for decades and cause more problems. You trust a government employee who often has little intrest or training in medical field to make your health decisions (Who gets what, when, and how) and cannot be sued (because he/she is protected by taxpayer paid lawyers and governmental laws). You believe other people should have to pay for YOUR HEALTHCARE, through TAXES. America was not founded on Socialist principles and our founding fathers would be extremely disappointed in us.

Posted by Scott on August 18, 2007 01:36 PM

PLEASE EXPLAIN TO ME WHY I MUST PAY FOR SOMEONE ELSE'S HEALTHCARE. Show me where healthcare is a right in either the U.S. Constitution or the Colorado State Constitution. To many people feel the government should supply everything for them. We need to quit giving people things off of other peoples money (I.E. TAXPAYER MONEY). This society has this idea that other people must take care of them, guess what WE DON'T. People complain the government isn't taking care of the infrastructure (Which is a government responsibility) well that is because all the money goes into wasteful social programs. People complain the government interferes or gathers to much personal data on them., GUESS WHAT HAPPENS IF YOU LET THE GOVERNMENT CONTROL HEALTHCARE, they control your health data. Don't believe me who do you think owns the medical records of military personnel, their dependant's, and retiree's of the military. EVERY TIME the GOVERNMENT gets involved in ISSUES outside of DEFENSE, INFRASTRUCTURE, or those areas that are SPECIFIC in the CONSTITUTION to the governmentthey create greater problems. SO BEFORE DEMANDING SOMETHING FROM THE GOVERNMENT THINK OF WHO REALLY IS PAYING FOR IT, NOT THE GOVERNMENT (who dosn't generate money), BUT THE AMERICAN TAXPAYER (you and I).

Posted by CHRIS on August 18, 2007 12:45 PM

Health Care for All Colorado and the Colorado Nurses Association are "spot on" here - a single-payer health care system IS the most efficient, cost effective way to provide health care for all Americans.

Those opposed to a single-payer system typically raise two "straw man" arguments - the first being the fear of a "dreaded" tax increase; and the second being the fear of having a nameless, faceless government bureaucrat making health decisions for them - or worse, for their loved ones.

Regarding taxes, what those nay-sayers fail to acknowledge is that either they, or their employers, are already paying "through the nose" for their private health care coverage.

I, personally, am paying close to $900 per month ($10,800 per year) to buy private health insurance for my family of four. I would GLADLY pay an additional 6% in federal income taxes, because, not only would I be guaranteeing coverage for my family, but, I would also have a couple of thousand dollars extra in the bank at the end of the year, to boot.

Regard the concern that a nameless, faceless, government bureaucrat making health care decisions for them, again, the opponents of a single-payer system fail to acknowledge the obvious - there is ALREADY a nameless, faceless insurance company bureaucrat making health care decisions for most of us.

Who would you trust more to make a health care decision based on what is in the patient's best interests - a government bureaucrat who is ultimately responsible to the Public; or, an insurance company bureaucrat who's only responsibility is to the corporate "bottom line?"

For me, the answer is an easy one. I say YES to Single-payer, Universal, health care coverage!

Posted by Stephen A. Justino on August 18, 2007 09:24 AM

This discussion of a new 10% tax at the state level ignores those of us who have made a lifetime payment for healthcare and would need to be exempted from this new tax system. Who are these people? Those with military service and Service-connected disabilities. The VA provides our healthcare through federal funding; a benefit we earned through our voluntary military service and resulting disability/injury requiring a lifetime of medical care. The fact this being ignored makes it clear these alternatives have not been thoroughly examined.
Further, the issue of illegal recipients of services is again being ignored. Hospital emergency rooms are shutting down for the simple reason they are required to provide services to anyone, regardless of legality or ability to pay, but they are not required to EXIST. If they only lose money, they get closed (people working in them deserve to be paid).

Posted by RS on August 18, 2007 09:17 AM

Ah, yes, the trusty old "socialized medicine" scare words. But that's not what the single-payer system is. Here's a hint. If the health care providers are not working for the government, then it's not socialized medicine. Try arguing the merits instead of resorting to scare tactics.

Posted by Docjay on August 18, 2007 08:18 AM

Socialized Medicine-Are we ready for Government to tells us when or where we get our healthcare for our loved ones?

Posted by Chuck Mann on August 18, 2007 08:10 AM

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