Don't mandate insurance

I want to thank The Pueblo Chieftain for its strong editorial against the ill-considered plan by the Colorado Blue Ribbon Commission for Health Care Reform ("Mantra of a crisis").

Their proposed system of mandatory health insurance already has been tried in Massachusetts and is failing. Costs there are already more than three times what was originally predicted, and the Boston Globe reports that it is expected to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

Nor did the program produce the promised savings. Instead, the state is asking the federal government to help with the shortfall.

These government-imposed plans violate the rights of individuals to freely choose what health insurance plans are best for them, and, as a result, lead only to rising costs and rationing. If Coloradans value their lives and their health, they will also reject this deadly proposal.

For more information on genuine free-market health care reform for Colorado, please see www.WeStandFIRM.org .

Paul Hsieh, MD
Sedalia

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Panel's report on healthcare is poor model for U.S. policy

By Linda Gorman, Health Care Policy Center director, Independence Institute

Judging from the contents of his op-ed "Congress could learn from Colorado’s 208 Commission" (Feb. 5), Sen. Ken Salazar (D-Colo.) has been misinformed about Colorado’s 208 Commission.

Sen. Salazar implies that commission members found common ground on the "complex and contentious issue" of healthcare reform. They did not. I coauthored one of the two minority reports...

Medicaid and Medicare are the largest generators of uncompensated care in the United States. They are fiscally unsustainable, yet the commission recommended a vast expansion of Medicaid/SCHIP. The recommendations accompanying that expansion would give state government almost complete control over the vast funds in the private markets for health insurance and medical care.

Sen. Salazar talks about partnership and collaboration. He repeats the fashionable assertion that healthcare is "broken."

He does not bother to distinguish between relatively efficient private arrangements and the mess that Medicare and Medicaid have created.

Steven S. Schroeder, former head of the Robert Wood Johnson Foundation, the group that almost bankrupted Tennessee with TennCare and created model legislation that destroyed health insurance markets in Massachusetts, New Jersey and New York, once explained how to run partnerships: "[t]he key to public/private partnerships is to induce the private sector to 'play' on terms that are acceptable to the public sector." Otherwise, "strong incentives -- financial or political -- [are] needed to 'force' cooperation on what were otherwise competing and successful institutions."

Healthcare is too important to be left to public officials interested in forcing cooperation, and a fabricated consensus supported by manufactured factoids is not a good reason to give government virtual control of private healthcare. Real reform means deregulation to reduce costs, and flexible programs enabling people to save so that they can spend their own money on healthcare of their own choice. ...

Golden, Colo.

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Mantra of a crisis
THE PUEBLO CHIEFTAIN

A CLASSIC way to get controversial legislation passed is to declare a "crisis."

That's why a number of politicians and activists have been crying about a "health care crisis" in recent years. After the mantra is repeated in the media long enough, some of the citizenry begin to believe it.

So it's not surprising that Colorado’s Blue Ribbon Commission for Health Care Reform reported last week it will recommend that the Legislature require all state residents to have at least a basic health insurance policy. This is the approach tried in Massachusetts and California and one which is advocated in one form or another by both Democratic presidential candidates, Hillary Clinton and Barack Obama.

Spokesmen for the Blue Ribbon group deny their approach is socialized medicine, but it's clearly a step toward that.

For one thing, their approach would provide a state subsidy on a sliding scale for lower-income Coloradans. Whenever government controls the purse strings, government dictates policy, whether for highways or health care.

The commission doesn't know how this new entitlement would be paid for, saying it was directed by the Legislature not to look at that side of the equation. However, Blue Ribbon members admit it would be expensive - billions in new expenditures, we'd guess.

While a certain percentage of people do not have health insurance, that doesn’t mean they don't get health care. All they have to do is show up at an emergency room and care will be provided.

While that's not the most efficient use of health care resources, it surely doesn't rise to the "crisis" threshold.

How about Massachusetts and California? In the Bay State, officials found out that about one-fifth of the population simply couldn't afford the mandated insurance, so those people were allowed to opt out of the program. As a result, the number of insured increased only marginally.

In California, someone was paying attention to the costs of Gov. Arnold Schwarzenegger's universal care proposal, one which was a near carbon copy of the Massachusetts scheme. California Senate President Pro Tem Don Perata raised the issue of cost to a state government already running a $14.5 billion deficit.

An independent analysis found the plan would cost much more than proponents claimed. (We haven't seen a similar analysis in Colorado yet.)

When the California Senate Health Committee took a vote on ArnoldCare, the plan died when only one senator voted to send it to the floor. Call it a mercy killing.

It's axiomatic that people want three things out of health care: availability to all, high quality, and low cost. You can have any combination of two of those, but all three are simply impossible, despite what the advocates of a single payer system claim.

One only need to look north of the 49th Parallel to our neighbors in Canada to see the truth of that.

There will be much debate in the Legislature this year over the Blue Ribbon Commission's proposed health-care fixes. While that's going on, we advise readers to keep a tight grip on their wallets.

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Health care commission wants to punish you

Remember grade school, when teachers would punish the whole class for the actions of just a few troublemakers? This is collective punishment, which is typically practiced during wartime or under martial law.

Collective punishment has now arrived with compulsory medical insurance. Known as an "individual mandate," it's the law in Massachusetts, and California's State Assembly has approved it. In Colorado, it is central to the "Blue Ribbon" Commission's recommendations, which commissioners [presented] to the General Assembly on January 31.

Politicians peddle compulsory insurance under the guise of eliminating the "cost shift from the uninsured" by making people "responsible." The story is that the uninsured get medical care without paying, which increases premium costs for the insured. So why not simply force everyone to buy insurance? Because it scapegoats the victim and empowers the true perpetrators of our insurance mess: politicians.

According to the Commission's "Baseline Coverage and Spending" report, the cost shift attributable to increased premiums is around $200 million annually. This "free from provider" cost is just $85 per privately-insured resident, or one percent of an average premium.

But the Commission's proposed billion-dollar "cure" is itself a huge cost shift. To encourage compliance with mandated insurance, the Commission's plan includes tax-subsidized premiums and Medicaid expansion. Per privately-insured Colorado resident, the tax increase would cost about $400. Worse yet, Medicaid itself increases insurance premiums by short-changing doctors.

And why expect *this* government bureaucracy to stay within budget? The Boston Globe reports that to contain costs, Massachusetts medical authorities will "probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay."

Second, holding people "responsible" would mean punishing freeloaders themselves and allowing providers to prevent freeloading. Compulsory insurance is the opposite: it forces the innocent to buy insurance determined by political interests, rather than their own needs. That’s collective punishment.

What if we applied the Commission's rationale to freeloaders who leave restaurants without paying the bill? This certainly increases prices, but forcing all citizens to buy "diner's insurance" punishes the innocent.

Third, government controls already punish the innocent – insured and uninsured alike – by making medical care and insurance prohibitively expensive.

Federal tax policy deeply discounts employer-provided insurance. This chains us to our jobs and employer insurance options. Insurance companies need not please us — they know we must change jobs to buy a competitor’s product. Shall we further pamper insurance companies by forcing everyone to buy their products?

Since income is taxed but premiums are not, consumers end up buying "insurance" that is really prepaid medical care. Insulated from medical costs, patients spend like business travelers on a company expense account, so medical providers need not compete on price.

On the state level, medical providers and disease constituencies lobby to force insurance to include benefits that many customers do not need. For example, Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. How’s that for a cost shift?

These and other mandates increase Colorado premiums by 21 to 54 percent. This dwarfs the one-percent increase attributable to the uninsured. Colorado's Chief Medical Officer told the Washington Post that 2,500 Coloradans lose insurance for every one percent increase in premiums.

When government controls increase insurance costs, the young and healthy drop coverage first. Those remaining have a higher medical risk, so premiums rise again, which again drives out the healthiest remaining customers.

Reformers have some nerve to support policies that make insurance prohibitively expensive, and then make criminals of those who do not buy it.

Compulsory insurance is based on collective punishment, a perverted form of justice found where troops patrol streets and spitballs go splat. It punishes both the insured and uninsured for the misdeeds of politicians. Colorado legislators should not scapegoat the uninsured for the mess they've perpetuated. They should repeal legislation that inhibits the free market from delivering affordable high-quality
medical care.

Brian Schwartz is a resident of Boulder. The author's free-market proposal to the Blue Ribbon Commission is at WhoOwnsYou.org.

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Gina Liggett: Health care is not an entitlement

The 208 Commission has come up with a dressing for Colorado health care with its bandaids and gauze so wadded up into a big mess that it won't begin to staunch the hemorrhage. The criteria the Commission used to evaluate the proposals for reform only considered government-oriented solutions -- eliminating the only proven economic model for efficiency, fairness and innovation: the free market.

What does it take for the Commission and many citizens to see that the central-planning Emperor has no clothes? We are in this health care crisis because of a decades-long meddling by the government, beginning with the 1940s tax preferences given to Blue Cross/Blue Shield. Add in the monstrosities of Medicare and Medicaid and programs like Bush's Prescription Drug Benefit, and you have a health care market that has become so bloated, distorted and inefficient that it's amazing it runs at all.

But it won't for long. The government will not solve our health care problems by continuing to violate individual rights with forced mandates and the expropriated earnings of some to pay for the health care of others.

As a society, we must wean ourselves off this false sense of entitlement that health care is a right. It is a need that should be obtained like any other requirement of life: by paying for it according to your own choice from someone who is willing to provide it.

All government programs must be "grandfathered" out over a period of time, allowing the free market to do what it does best: innovate, provide better choice, and let the consumer and provider decide what they want--not what some bureaucrat's rules allow.

After fifty years, it's time for a new change of clothes.

Gina Liggett, RN, MPH
Denver

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BAD MEDICINE
Health care proposals will backfire on state

I want to thank The Gazette for its strong editorial against the ill-considered plan by the Colorado Blue Ribbon Commission on Health Care Reform ("Health care reform: It's a joke," Jan. 31). Their proposed system of mandatory health insurance already has been tried in Massachusetts and is failing. Costs there are already more than three times what was originally predicted, and the Boston Globe reports that it is expected to "cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay." The California state legislature has also just rejected a similar plan because it will cost too much.

These government-imposed plans violate the rights of individuals to freely choose what health insurance plans are best for them, and, as a result, lead only to rising costs and rationing. If Coloradans value their lives and their health, they will also reject this deadly proposal.

For more information on genuine free market health care reform for Colorado, please see www.WeStandFIRM.org.

Paul Hsieh, M.D.
Sedalia

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MINORITY REPORTS FAULT HEALTH CARE REFORM COMMISSION PROCESS, RECOMMENDATIONS
Contacts: Linda Gorman, (303.279.6536); R Allan Jensen (303.912.5490)

The final report of the Colorado Blue Ribbon Committee for Health Care Reform, presented to the Colorado Legislature on January 31, 2008, includes two minority reports, one written by Commissioner Mark Simon and one written by Commissioners Linda Gorman and R. Allan Jensen. In their report, Gorman and Jensen explain why the Commission has produced inadequate policy recommendations, offer alternative suggestions for real reform, and make three major points:

The Commission did not adopt any of the standard legal or academic methods for uncovering and agreeing on basic facts. As a result, many Commission policy recommendations rest on demonstrably incorrect or unprovable propositions. The lack of fact finding severely hampered the Commission’s ability to discover workable recommendations, for instance;

The Commission asserts that coverage for all will assure medical care for all. Unlike in the U.S., in virtually all health systems that have government imposed coverage for all, shortages of care deny access to basic and advanced medical treatment. The Commission cannot even guarantee that its recommendation for an individual mandate will substantially reduce the number of uninsured. The Commission recommendation for required individual coverage applies only to legal residents of Colorado. A substantial portion of Colorado’s uninsured are illegal aliens;

The Commission states that an individual mandate is enforceable and will eliminate free care to the uninsured. In the only state with an individual mandate, 20 percent of the uninsured were exempted after less than 18 months of operation, and fewer people are voluntarily enrolling than predicted;

The Commission says that health care providers gave $777 million in uncompensated care in 2007. It implies that this is paid for by the privately insured and that spending $1.5 billion on a Medicaid expansion and $550 on insurance subsidies will make people better off by obviating the need for the $777 million in free care. In fact, the largest fraction of that uncompensated care is generated by Medicaid and Medicare.

Many of the most important Commission recommendations have either had no real world tests or have already failed in the real world; The public program expansions recommended by the Commission have not operated as advertised in Massachusetts, the state plan which the Commission recommendations mimic. After roughly 18 months of operation, the Massachusetts health reform is $245 million over its $470 million budget. About 20 percent of people signing up for free care are new, the rest were previously in public assistance programs. There is no way to know how many people are dropping private coverage to participate in the state plan.

The extension of community rating and guaranteed issue to Colorado’s individual insurance market is billed as a way to keep costs lower for those who have chronic conditions, and to make health insurance more widely available. This has not worked in New York, New Jersey, Massachusetts, and other states in which it has been tried. Instead, health insurance has become more expensive and more difficult to get. Private experimentation with new and innovative ways to provide health insurance and health care has been stopped. Colorado already guarantees health insurance to everyone, regardless of medical condition, via a state plan called Cover Colorado.

The Commission majority repeated voted against analyzing reform options that increase consumer choice and accountability in favor of plans that rely on government control As a result, it turned away from considering any of the consumer-directed options known to have improved quality and to have reduced health care costs.

The Colorado Consumer Directed Attendant Support program for Medicaid patients is an example of a Medicaid reform that has both reduced spending on attendants by 20 percent and improved patient care.

Innovative health insurance policies are showing that changes in policy structure can reduce spending and improve care. At Wendy’s International, shifting to a health savings account based consumer-directed plan decreased claims by 14 percent and overall costs, including deposits to employee HSA accounts, by 1 percent in 2005.

The Commission did not discuss reducing state regulations on insurers and health care providers. Professor Christopher Conover of Duke University estimates that excess regulation adds 10 percent to annual health care costs. Dr. Gorman and Mr. Jensen invite the public to closely examine the minority report they authored for further details, and for expanded information.

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Health care reform: It's a joke

One of the worst ideas ever proposed with a straight face will come before the Colorado Legislature today. The state's Blue Ribbon Commission on Health Care Reform wants a law to force every Coloradan to buy health insurance. It’s like solving homelessness with a law that says every person must buy a house.

Subsidies to the poor and other costs would amount to $1.1 billion out of the gate, and the commission has no plan to pay for it. The law would extend insurance coverage to nearly 800,000 people who don't have it now. Yet commission members, in a meeting with The Gazette's editorial board, said the state already faces a worsening doctor shortage, even without a mandated increase in demand for services. Creating more demand, without a means to increase services, can mean only two things: soaring costs and rationing.

Based on the commission's own findings, 25 percent of the state's uninsured have incomes of $50,000 or more, 13 percent earn $75,000 or more, and 6.4 percent earn six figures and up. That means thousands have simply chosen pay-as-you-go health care, or have decided to avoid plans that cost more than they're worth. They've exercised their rights as American consumers to not buy something.

The commission claims that insured families pay a "hidden tax" of $934 to cover the uninsured. An economist on the health care commission, however, says the figure is grossly inflated from about $84 because it doesn't account for care that's paid out of pocket, through private philanthropy, or with Veterans Administration or workers compensation payments.

But here's the most troubling part. Commissioners can't say their program would reduce the fictional $934 burden, and admit that it could actually increase under their plan. No thanks. It makes the current system — in which the uninsured are at no loss for care — look pretty darn good.

The proposal, which commissioners refer to as an untried "pioneer" idea, can't possibly work. It makes no sense, to commission members or anyone else. We hope it's DOA in the Legislature today. May it rest in peace.

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A very costly health-care solution
By Linda Gorman and Ari Armstrong

As the health-care debate unfolds, we hear a lot about cost-shifting, the idea that some people are charged more for health care to make up for the fact that others do not pay. Various legislators, journalists and activists tell us that the state should adopt the Blue Ribbon Commission on Health Care Reform's recommendation to impose an individual mandate and force everyone to buy health insurance in order to end the unfairness of cost-shifting.

In fact, the commission's recommendations likely will shift more costs onto those who already have insurance. Along with the individual mandate, the commission recommends large subsidies for those whom the commission considers too poor to purchase the insurance it says they should have.

Under the commission's plan, people with health insurance would be taxed to subsidize health insurance for single people making as much as $40,000 a year, and families of four making as much as $82,600 a year. Many of these people pay for their own health care now, or have the assets to do so in an emergency.

The commission would also increase cost-shifting by forcing many more people into Medicaid.

Because Medicaid pays so little to providers, Medicaid as a whole generates far more uncompensated care and cost-shifting than the uninsured.

Those who advocate an individual mandate throw up all kinds of numbers to support the wild claims that the proposal would save everyone money. A Jan. 8 article from The Denver Post claims that "Coloradans who have insurance spend an extra $950 each year to cover the costs of those who show up at the hospital without insurance."

The article attributes the number to state Rep. Anne McGihon, who said that the figure comes from Partnership for a Healthy Colorado. Partnership for a Healthy Colorado, in turn, says it got the figure from Families USA, which published a paper in 2005. That paper's estimates were unable to accurately predict the percentage of uninsured residents in Colorado. The paper also grossly overestimated at least some costs of uncompensated care.

The Lewin Group, the modeling firm hired by the commission to collect information about Colorado, reported total Colorado expenses for the uninsured of about $1.4 billion. Of that amount, around 45 percent, or $627 million, was paid out-of-pocket by the uninsured themselves.

Private philanthropy covered $197 million. Another $341 million was paid by the Veterans Administration, workers compensation and various public programs.

The leftover uncompensated costs, the ones that are not paid by any identifiable source, total $239 million. Divide $239 million by Colorado's 2.8 million insured residents, and the result is a maximum likely cost-shift of about $85 per insured individual per year.

To "fix" the problem of $239 million in cost-shifting, the commission proposes to increase health spending in Colorado by more than $3 billion, funded with an income tax increase of $800 million to $1.8 billion, new taxes on various politically incorrect types of food and drink, and an increase in the cigarette tax.

The sensible way to solve cost-shifting is to reduce health-care costs so that people fund their own health care, not to force people to buy insurance created by special-interest groups or to expand Medicaid. Professor Christopher Conover of Duke University estimates that 10 percent of annual health costs are caused by inefficient regulation. Results from experiments in consumer-directed health-care plans suggest that freeing consumers, providers and insurers can reduce costs by up to 30 percent.

The hostility of the commission to any plans like this was summed up in two votes that took place one after another on the same day. First the commission voted to recommend that the state legislature study single-payer health reform plans. Then it voted not to recommend that the legislature study consumer-directed reforms. While single-payer plans have failed around the world, consumer-directed reforms are succeeding wherever they're given the chance.

Linda Gorman, a senior fellow with the Independence Institute, serves on the Blue Ribbon Commission for Health Care Reform. Ari Armstrong writes for FreeColorado.com.

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Health care reform not likely, says Gov. Ritter

State policymakers probably are not going to bankroll any sweeping health care reforms through a tax increase, Gov. Bill Ritter told a group of supporters Saturday morning.

"The voters of this state are not ready for that conversation, because they think health care costs too much," Ritter told nearly 50 people at Traders Coffee and Tea near St. Mary's Hospital.

The governor said before the state can begin to think about sweeping health care reform, it has to show taxpayers it can more efficiently administer its existing programs.

...He said the state could adopt several smaller reforms suggested by a statewide health care advisory committee, set up by Gov. Bill Owens in 2006. The 208 Commission, named after the Senate bill that established it, will report its findings to the Legislature in late January.

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More political control of medicine comes with higher costs

The left packages its programs in terms that sound good, even if the claims have little to do with the program itself. Recently some health "reformers" have loudly declared that more political control of medicine will supposedly save you money. Why? The Denver Post claimed on Jan. 8: "Coloradans who have insurance spend an extra $950 each year to cover the costs of those who show up at the hospital without insurance." The figure itself is fishy, but the broader claim that it allegedly supports is ridiculous.

While details differ, most plans — including several to be touted by Colorado’s "208" Healthcare Commission next week — would force everyone to purchase politically approved health insurance and impose massive new taxes to expand medical welfare. The proposed tax hike for Colorado starts at over a billion dollars per year and likely would grow to several billion."

The current jargon for skipping out on a hospital bill is "cost shifting." That is, people who don't pay their bills shift those costs onto the rest of us. That's bad, but what is the left-wing "solution" for such cost-shifting? It is to force you to pay more in taxes than you now pay for the cost-shifting. In other words, we are to believe that the way to reduce cost-shifting is to expand it.

On top of that, the figure of $950 of cost-shifting to each insured family is not very credible. The 208 Commission funded a study by the Lewin Group that suggests a much lower figure. The study claims that $239 million will be spent on the uninsured this year that is "free from provider" — much less than proposed tax hikes. (An additional $211 million comes from "public programs," but this is funded through taxes, not insurance premiums. The rest of the $1.4 billion is covered through out-of-pocket payments, private philanthropy, workers' compensation and funds for veterans.) Around 2.8 million Coloradans have private insurance. The first figure divided by the second suggests a cost of around $85 per insured individual. (Brian Schwartz, Ph.D., whose free-market proposal is available at WhoOwnsYou.org, pointed us to these figures.)

Yet, regardless of the exact figure, the expansion of tax-funded medicine would not address "cost shifting" nearly as well as its supporters pretend. As the health care experiment in Massachusetts proves, even the most ambitious program cannot force everyone to obtain insurance. Transients, illegal immigrants and many among the chronically poor would continue to forgo insurance and seek "free" care. Moreover, the expanded tax-funded programs would encourage more use without regard for costs. The left claims that more tax funding would promote primary-care visits and thus reduce long-term costs, but the reality is that many of the highest-cost freeloaders neglect their health (such as by abusing drugs and alcohol) and would continue to do so.

That said, we ought not scapegoat the uninsured as a group. Many among the uninsured maintain their health, and they pay for their health care themselves. According to Lewin's figures, the uninsured as a group pay 45 percent of their costs, while private charity pays another 14 percent. Yet most of the uninsured pay all of their bills themselves.

Why is health insurance too expensive for some people? Medicare and Medicaid notoriously underpay their health bills, forcing those with private insurance to pick up part of the tab. Health costs in general have skyrocketed because of the tax distortion that promotes employer-paid insurance that encourages use without regard for cost. And a variety of mandated benefits dramatically increase the costs of insurance premiums. The way to expand health insurance is to repeal the political controls that have made it so expensive.

While we're on the topic of controls, why is it that some people can demand "free" care from hospitals in the first place? After all, people can’t force businesses to give them "free" food or clothing.

The reason is that the "Emergency Medical Treatment and Labor Act of 1985 ... requires that hospitals that accept Medicare patients diagnose and treat anyone who comes within two hundred feet of an emergency room, regardless of whether the person can pay for the treatment" (see the article by Lin Zinser and Paul Hsieh, M.D., at TheObjectiveStandard.com). We should repeal that unjust law and return to a system of voluntary charity.

Over the coming months, you may often hear claims that massive tax hikes and expanded political control of medicine will save you money. If you value your health and your money, you will recognize such claims for what they are — dishonest spin. Don't be fooled: Expanded medical welfare will cost you plenty, and ever more as the programs grow. In the long term, the only way that politicians can control costs is to impose rationing. The alternative is to repeal the political controls that have created the problems and turn to liberty in medicine.

Linn is a local political activist and firearms instructor with the Grand Valley Training Club. His son Ari edits FreeColorado.com from the Denver area.

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Politically controlled insurance is a disease
Brian Schwartz, Boulder
Thursday, January 17, 2008

Health care reform commission Chair Bill Lindsey's recent comments show that he either misunderstands why insurance is so expensive or deliberately misrepresents fundamental issues ("Mandatory health plan participation opposed," Jan. 10).

He wants to force Coloradans to buy politically defined insurance because "the market for health insurance isn't working." But as my free-market proposal to the commission explains, it's not working because government controls have crippled it.

Federal tax policy deeply discounts employer-provided insurance. This locks us to our employer and the costly insurance plans they offer. Hence, insurance companies need not please us, as they know we must change jobs to buy a competitor's product.

Likewise, mandated benefits laws force us to buy expensive policies with benefits we may not need. For example, a widowed wife must buy a policy that covers marital therapy, prostate cancer and maternity. In Colorado, these and other controls add between 20 percent to 50 percent or more to premium costs.

Politically controlled medical insurance is a disease masquerading as its own cure.

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Mandatory health plan participation opposed

By David Montero, Rocky Mountain News, January 10, 2008

No one would be required to participate in a public or private health care plan under a proposed amendment to the Colorado Constitution.

Jon Caldara and Linda Gorman of the conservative-leaning Independence Institute are proposing the amendment and will meet with the Colorado Legislative Council staff later this month to discuss it.

The amendment, which Caldara wants on the November ballot, would not allow the state to mandate coverage for all its residents.

Coloradans would also not be denied the right to purchase private health insurance in any other state, and the proposal would allow people the option to purchase health coverage from out-of-state providers.

More than 790,000 people in Colorado are living without health insurance.

Gov. Bill Ritter has said it is one of his top priorities to find a way to reduce the number of uninsured, and a Blue Ribbon panel will make recommendations on how to do that to the General Assembly at the end of the month.

One of the recommendations from the panel is to mandate that every legal resident of Colorado have at least minimum health coverage - with an enforceable penalty if residents try to drop out.

The state currently spends more than $30 billion on health care, and the commission studied four plans and crafted a fifth in an attempt to reform some of the system's shortcomings.

Mandating coverage is not needed, according to Gorman, who sat on the Blue Ribbon panel, was one of three members who voted against its recommendations and who wrote a dissenting report.

There were 27 commissioners and 24 voted to approve the recommendations.

"We have a lot of experiments going on that are sort of intellectual fads, and one of those is requiring everyone to purchase health insurance," she said.

"We think that's wrong. There are more important things than health insurance - a car, a job - and some people are responsible enough to pay cash for their health insurance, and they have a right to do that. But the government should not require it."

But Bill Lindsay, the chairman of the panel, said there was a simple reason that the politically disparate body agreed to make mandated coverage a recommendation.

"The reason is what we see in the marketplace is that the market for health insurance isn't working," Lindsay said.

He also found the idea that people would pay cash for services to be unrealistic.

"The notion that people would pay cash for services is ludicrous because of the cost of health care," he said.

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A warning for Colorado: Court ruling suggests several health-care plans violate federal law

The prospects for dramatic changes in Colorado's health-care delivery system got a little more murky last week, thanks to a court order issued by a federal judge in San Francisco.

That's a positive development, in our view. As we said two months ago, presidential candidates are giving medical reform a prominent role in the campaign. So any state legislation enacted in 2008 may well be pre-empted by federal action in 2009.

Next month, lawmakers are expected to begin reviewing five proposals that were selected this year by the Colorado Blue Ribbon Commission for Health Care Reform. As they do, they should keep in mind Wednesday's ruling by U.S. District Court Judge Jeffrey White.

The decision suggests that any state-based measures that affect workplace benefits could violate federal law. And this ruling is no outlier; federal courts in Maryland and New York have recently come to similar conclusions.

The implication for Colorado is that our lawmakers might be wasting their time if they craft reforms that affect employer medical plans.

White struck down a universal health-care program that was to take effect Jan. 1 because the measure violated the Employee Retirement Income Security Act, or ERISA. That's the federal law that gives Washington rather than states the right to regulate workplace benefit plans. ERISA was designed to prevent companies from having to satisfy a hodgepodge of state regulations when they set up pensions and other benefit packages.

The San Francisco system would have required employers to either provide comprehensive medical benefits to workers or pay taxes to subsidize the uninsured.

The court cited several ways the employer mandate ran afoul of ERISA: The benefit package would force some businesses to pay for medical coverage they haven't previously offered; the ordinance's record-keeping mandates would affect how employers managed their medical benefits; and the ordinance would require national employers to offer unique benefits to their workers in San Francisco.

If White is correct, then at least three of the five reform plans from Colorado's commission look suspect.

The single-payer proposal would establish a uniform package of medical benefits for every Coloradan and outlaw nearly all private insurance, invalidating health benefits offered by employers.

The "Plan for Covering Coloradans" has a "play or pay" employer mandate along the lines of the San Francisco system.

And even the fifth or hybrid proposal crafted by the commission might have ERISA issues because of how it lets workers deduct pre-tax money from their paychecks.

Several legal blogs have speculated that the only reason the medical plan in Massachusetts, which has an employer mandate, is still functioning is because it hasn't faced an ERISA challenge.

The lesson: Major policy fixes to the health care system will have to originate in Washington. And if Judge White's ruling stands, even small fixes that affect employers may need congressional approval.

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Health care, ho!
State should avoid repeat of Massachusetts
THE GAZETTE January 3, 2008

For Colorado Democrats, a regulatory fix of the state's ailing health care system may seem irresistible during the upcoming 2008 legislative session. Imagine the attention major health care reform, or statewide "universal health care," would garner from the media in August, when the country's Democrats converge in Denver for the Democratic National Convention. Colorado could be held up as the example of how it can and should be done. Democratic leaders could be lauded for aiding 792,000 uninsured men, women and children.

House Speaker Andrew Romanoff, as quoted in The Gazette, says Coloradans are tired of waiting on a federal government that "cannot or won't fix" the health care crisis. The Blue-Ribbon Commission on Health Care Reform, appointed by legislative leaders and the governor, will present its recommendations to the Legislature on Jan. 31. The commission plans to recommend that all Colorado residents be mandated to buy insurance that meets minimum standards, and state subsidies would be extended to more of the state's poor.

Before politicians get too ambitious, however, they should take a closer look at the health care reform led by a leading Republican: Mitt Romney, the former governor of Massachusetts.

"The majority of the commission favors a government-heavy proposal," says Dr. Paul Hsieh, a Denver physician who has studied the new Massachusetts system. "They're crafting it similar to the Massachusetts model."

A year old, the Massachusetts system is resulting in rationing and shortages of care, and higher costs to taxpayers than originally expected. The Patriot Ledger newspaper tells of Lee Sampson, a 47-year-old unemployed medical transcriptionist. Sampson bought into Commonwealth Care, a state-subsidized insurance cooperative. She had to buy insurance by Jan. 1 to avoid tax penalties and fines.

But Sampson, like a growing number of other Massachusetts residents, is learning that mandatory insurance doesn't mean doctors will treat her. To receive benefits from the plan, Sampson must find a primary care physician. She reported calling 50 doctors' offices within a half-hour drive of her home. All rejected her. Most explained they were overwhelmed and accepting no new patients.

Massachusetts, like Canada, will learn that mandating health care as a universal right results in a demand for services that exceeds the supply. The demand for medical services under the new Massachusetts system has become so great, and so expensive, that state officials are cutting back on the compensation doctors receive for services, while raising patient co-pays. The medical community, struggling with high demand and inadequate reimbursement, is cutting costs by rationing services for patients like Sampson.

Ask Americans if they would enjoy free universal health care, like the Canadians have, and many will say yes. Ask the same folks if they'd like to wait several months for an MRI, a heart scan or chemotherapy -- as Canadians often do -- and they'll give a resounding "no way."

Yet one can't argue that our nation's health care system is well. As reported by The New York Times, health care costs are going up at twice the rate of inflation. With soaring costs come rising insurance rates, which fewer employers and individuals are willing or able to pay. Based on U.S. Census data, 10 million Americans were uninsured 15 years ago. Today, more than 46 million live uninsured.

While it's expedient for politicians to promise a solution in the form of a program, Massachusetts will continue showing us why it doesn't work. Government intervention, in fact, explains the failures of our current system. The IRS code drives most Americans to buy health insurance through employers. That means insurers don't have to compete for consumers, because for most Americans, shopping around for a better deal involves a career change. And because health insurance has been packaged as a "free" benefit from employers, patients have spent the past half-century consuming health care without challenging the price. For those with health plans, "insurance" has morphed into pre-paid service, seemingly paid for by someone else. Imagine a system in which large employers provided auto insurance. Would employees balk at the cost of this "free" benefit, demanding a better price? If the insurance covered routine oil and lube jobs, the way health insurance covers physicals, would consumers demand lower prices from Grease Monkey? Doubtful.

State legislators can't change the morass of federal regulation that has led to a health care system unrestrained by the conventional market forces that control other services and goods. But legislators can improve access to health care by eliminating most of the state controls that prohibit affordable coverage. State law, for example, requires that health insurance plans include coverage for childhood autism -- even for consumers with no prospect of children. Regardless of a consumer's personal needs, any policy he or she buys in Colorado must cover alcohol rehab, mental health and maternity treatments -- to name a few. Why not a law that says all cell phone plans must come with 80-channel cable TV?

Brian Schwartz, an Arvada-based optical engineer, proposed to the Blue Ribbon Commission a market-based health care reform package that mostly involved deregulation. Commission member Linda Gorman fought for it, but others scoffed.

"One commissioner said we already have a free market in health care, and it has failed," Schwartz told The Gazette. "But we don't have a free market. If you're a widow, you have to buy a policy that covers marital therapy, maternity and prostate cancer. You have no need for this, but if you want insurance you're required to buy it. Mandates raise your premium by 20 to 50 percent."

Government, as we're seeing in Massachusetts, can't make health care affordable and abundant. Market forces can and will -- if politicians ever allow them to.

Labels: 208, Canada, CO, Countries, Insurance, MA, OpEd, States

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Free-market health insurance needed

"The goals of free market barons differ considerably (and obviously) from those of physicians. ...But given the powerful and wealthy forces arrayed against meaningful change, don't bet the farm on reform," writes Clint Talbott on health care (Editorial, Dec. 30). Mr. Talbott's second point is correct, but not in the way he intends.

Mr. Talbott tries to defile free markets by associating them with "barons," rich fat cats who care about profits -- to the exclusion of the general public. In a free market, greedy capitalists must satisfy customers, or else they go out of business. Customers could be physicians, or they could be patients, whom physicians serve.

But we don't have a free market in medical care or insurance. This explains common views of insurance companies as villainous "barons" unconcerned with patient welfare. Tax-exempt employer-provided insurance coddles insurers by tying us to our employer's plans. Insurers are committed to satisfying customers, which are employers, not you. Hence, they can afford to be stingy and deceptive: they know that losing your premium dollars requires that you change jobs.

What "powerful and wealthy forces" oppose changing this? Labor unions. Like Mr. Talbott, the AFL-CIO supports "single payer health care": politically controlled medicine with government as a monopolistic insurer. This is even worse than buying it through your employer. If you don't like what the government "health barons" offer, it's not enough to change jobs, you must move out of state to change providers.

If you like "single payer," don't worry that the 208 Commission on Healthcare Reform has not recommended it. They recommend an "individual mandate," which makes it a crime not to purchase politician-approved "insurance." Such compulsory insurance is essentially single-payer in disguise. Strict regulations on legal insurance plans severely limit competition, so insurance companies are effectively government contractors for politically-defined insurance.

BRIAN T. SCHWARTZ
Boulder

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An Unhealthy Cure

Health-care reform proposal won't solve underlying issue of escalating costs

The Colorado Blue Ribbon Commission for Health Care Reform, after soliciting and reviewing health-care reform proposals from numerous organizations, recently approved recommendations that were reported to closely mirror its own "fifth proposal." While this proposal has a number of beneficial features, its major recommendations would do little, if anything, to contain rising health-care costs, while significantly increasing both taxes and the regulatory burden on employers, health-care providers, insurers and consumers.

A big mistake

Some people believe this proposal has a chance of winning approval. But based on my many years working in the health-care field, I think that would be a mistake. A big mistake.

The commission recommends that all legal residents of Colorado be required to have health insurance, with basic plan coverage. But that's like requiring that we all have auto insurance that pays for oil changes and dent repair, but not for a totaled car. The basic benefit plan, with its emphasis on low-cost primary care, anemic hospital coverage ($25,000 maximum) and low maximum total benefits ($50,000), is not so much an insurance product as a prepaid primary care product.

Real insurance is intended for people to pay relatively small amounts into large risk pools to fund major, unpredictable and otherwise unaffordable events. But with acute medical conditions often far exceeding $25,000, the basic plan is anything but catastrophic insurance. People needing it most will be left high and dry, with huge bills to pay.

True high-deductible, catastrophic insurance would be no more expensive than this basic plan, but offer far better, real insurance coverage for the currently uninsured. As a bonus, those so insured would be eligible for significant federal tax benefits via health savings accounts...

Continuing a flawed system

Setting minimum benefits merely continues and further complicates the current, deeply flawed defined-benefit system of health benefits.

Such approaches have utterly failed to provide consistently high quality health-care at affordable prices to all our citizens. Getting the state out of the benefit-setting business and properly enabling a more market-based solution will allow the use of a more rational defined-contribution approach. That will allow the state to apply its subsidies in a much more precise and targeted manner to aid those most in need of assistance, while relying on market solutions to make health care increasingly affordable.

No matter how low one sets the level of basic benefits, even the most inexpensive plan will eventually become unaffordable if health costs and premiums continue to rise by two to seven times the rate of wage growth. We need reform that will truly contain costs, not just pump more money into the current, dysfunctional system.

There is nothing in the Blue Ribbon Commission's plan that will result in cost containment and much that will exacerbate the problem.

Steve Hyde is the president of Hyde Rx Services Corp., and former CEO of Peak Health Care. He is the author of the book, Prescription Drugs for Half Price or Less, and the forthcoming How I Destroyed American Health Care, And Why We Need To Do It Again. Reach him online at sshyde@hyderx.com.

Labels: 208, CO, Insurance, OpEd

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Here's your prescription

By Dr. James Schroeder
Grand Junction CO, Colorado
December 26, 2007

Dr. Michael Pramenko expressed his health care views via a series of false premises in his Dec. 10 column “Play doctor, help find a cure for health care reform.” Well I don’t just play a doctor, I am one. Allow me to give your readers a healthier perspective by analyzing some of these fallacies individually.

* “Unfortunately, [taking government out of the equation] leaves a significant number of people without health care.”

There is a significant difference between health care coverage and health care delivery. Anyone (including my brother-in-law) can declare “health care coverage for all,” but if they can’t actually deliver services, it is an empty declaration. I know my brother-in-law doesn’t have the wherewithal, and I have my doubts about the government. Taking government out of the equation therefore would merely result in people not having governmental health insurance. We have yet to see in real life a government-run health care system without delays and rationing. The real question is whether more efficient use of health care dollars is achieved by government or by private entities. The other key variable is individual behaviors. How do we motivate individuals to use their primary care physician rather than the ER? Should the government try to modulate individual behavior in our best interests, or should we be responsible for making our own decisions? Dr. Pramenko seems to think that government is better suited to make those decisions by mandating individual purchase of insurance. I disagree.

* “The free market has chosen repeatedly to ignore the problem of the uninsured.”

We do not have a free-market health care system, so this premise is false from the get-go. The main causes for the expense of private insurance are unrelated to the free market. The tax code rules that originally allowed employers to provide health insurance as a tax-free benefit created a deeply entrenched connection between employment and insurance.

This led to employers controlling payroll costs by limiting the selection of plans while the employee was basically removed from the decision-making. It also meant that employees who changed jobs had a gap in coverage.

People who are temporarily between coverage account for about one-third of the total uninsured. Current government mandates force insurance companies to include services such as acupuncture, even if the policyholder has no need or desire for such coverage. Finally, individuals who buy health insurance must do so with post-tax dollars, effectively penalizing them. SOLUTION: We should reduce, not increase, government mandates. We should allow insurers to sell plans that are responsive to the needs of individuals and offer equivalent tax breaks for the individual insurance market. In other words, remove the government and employer from the market transaction between insurance provider and consumer. Wait a minute; that sounds like a free market!

* “We all pay for this unbridled use of the emergency room.”

The fallacy here is not that we all pay. The fallacy is that inappropriate use of the emergency room is because patients cannot access physician offices. The fact of the matter is that EMTALA legislation decrees that hospitals cannot deny emergency treatment on the basis of ability to pay. This has become distorted to mean that nobody can be turned away without fear of steep fines or penalties. Most Medicaid plans do not require a copayment for emergency room use. Thus, the current system actually makes it easier for patients to use the ER (convenient hours and no appointment needed!) for primary care. SOLUTION: We need to revamp EMTALA so that true medical screening can be applied and that patients without emergency conditions can be turned away. This should be a medical decision, not a financial one. Medicaid copayments should be reinstituted to serve as a deterrent for inappropriate ER use.

* “There is agreement on universal coverage, mandates on participation and … essential levels of coverage.”

“One thing is certain: More taxes will be needed ...”

These two comments are laughable. If there is already agreement and certainty in this discussion, the debate would be over. Far from any kind of consensus on health care reform there is ongoing active debate throughout Colorado. Many doctors feel, as I do, that government over-regulation has created a mess that cannot be fixed by expanding the role of government. More taxes are not the solution, but are inevitable if we continue to stumble down the path mapped out by the 208 Commission. The government’s role should be that of referee, not participant. Mandates are the problem, not the solution.

I have dedicated my career to the provision of high-quality medical care for children and truly believe that free market solutions are more sustainable in the long-run and more likely to benefit my grandchildren and yours. This belief is based on my own first-hand experiences in the health care system and my ongoing study of the issues.

Dr. Schroeder is in private practice in Grand Junction specializing in pediatric cardiology. He is a graduate of the University of Colorado and Tulane University School of Medicine. He completed pediatric cardiology training at Denver Children’s Hospital.

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Tough sell for health-care panel

Is the Colorado Blue Ribbon Commission on Health Care Reform going to lay an egg in January, when by law it must offer its recommendations to the legislature?

It's too early to say, but prospects for the commission's success dimmed somewhat the other day when the price tag was announced for the panel's own proposal - we'll call it Plan Five because the commission will submit four others, too, written by outside groups.

Plan Five's cost: between $1.4 billion and $2.1 billion a year, according to the Virginia-based Lewin Group.

Let's put those figures into perspective.

Two years ago, after a bruising campaign in which millions were spent to promote it, Referendum C passed in a statewide vote by the relatively narrow margin of 53 to 47. Yet as most of you no doubt recall, Ref C did not raise taxes; it only asked the public to give up their tax refunds. And it was not advertised as costing $1.4 billion or more per year. The total cost for Ref C was then projected to be $3.7 billion over five years (a figure that has since gone up).

Meanwhile, Ref C enjoyed far broader support than any health-care tax hike is likely to attract. Although the Republican Party was split on Ref C, the fiscally conservative Republican governor, Bill Owens, supported it and campaigned widely on its behalf. So did Hank Brown, the former Republican U.S. senator noted for his opposition to extravagant government spending, who by then had moved to head the University of Colorado.

Much of the business and civic establishment - not to mention all of the Democratic Party, most of academia and a large majority of commentators in the press - also supported Ref C.

And one final note: Ref C was sold in an atmosphere of budgetary crisis. If they didn't pass the measure, voters were warned, they would doom higher education and virtually every other program not protected in the state constitution or by federal mandate.

Such breadth of support simply isn't in the cards for Plan Five or any other proposal needing an annual infusion of more than $1 billion, and no such sum is available without a tax hike approved by voters.

"Now it's time to see if you can drive down costs in some way," John Sheils, senior vice president of the Lewin Group, told the commission.

Yes, that would be nice, especially since the law passed last year creating the commission gave it two mandates: "To expand health-care coverage and to decrease health-care costs for Colorado residents."

So far, the focus seems mainly on the first half of that charge.

The commission did devote itself to cost-cutting at a recent meeting, but the effort basically amounted to tinkering with the plan. We'd be very surprised if the price tag declined significantly without a wholesale rethinking of how health care is delivered and paid for, and how to alter the incentives that motivate consumers and providers alike. Yet if that's not in the cards, it's hard to see how the state is going to afford such an ambitious initiative - or, perhaps to put the matter more precisely, how the state will find the will to pay for it.

Labels: 208, CO, OpEd

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It's Official: Medicaid Managed Care Does Not Save Money

The reform plan drawn up by Colorado's Blue Ribbon Commission on Health Care Reform plans to enroll 50 percent of Medicaid recipients in managed care. Given the history of Medicaid managed care in Colorado, this is an odd recommendation.

Back in the dark ages of Clinton Care 1.0, heath care policy gurus asserted that managed care would save enormous sums. State governments salivated. To sweeten the pot for switchers, the Robert Wood Johnson Foundation and other acolytes of managed care encouraged the notion that Medicaid HMOs could provide better, more coordinated care, at rates that were 95 percent of fee-for-service costs. The usual economic models predicted big savings. Projects were funded. Federal waivers were pursued. Medicaid clients were herded into capitated health plans, and all parties proclaimed the dawning of a new era in health care.

In the heady days of 2002 and 2003 Colorado Medicaid enrolled 50 percent of Medicaid clients in one of five Medicaid HMO plans. Kaiser and United Health pulled out in November 2002. In 2003, two others left. Four of the five original plans sued the state for inadequate payments. They won $77,810,395 in additional payments, along with legislation requiring actuarially sound calculations of capitation rates.

Enrollment in Medicaid HMOs fell. Even though clients in the Denver metro area were automatically enrolled in managed care unless they actively chose fee-for-service, by September 2006 fewer than 10 percent of Medicaid clients were enrolled in risk-based managed care.

In June 2007, Denver Health Medicaid Choice, the remaining Medicaid HMO, informed the state that it would withdraw unless capitation rates were increased to 100 percent of the fee-for-service rates. The state applied for the emergency supplemental appropriation required to fund the increase.

After years of testing, the state has found that Medicaid HMO plans are at least as costly as traditional fee-for-service. They may even cost more. In its December 2006 Joint Budget Committee hearings, the Colorado Department of Health Care Policy and Financing wrote that "Although managed care organizations should experience savings over fee-for-service due to their improved ability to reduce unnecessary hospitalizations, emergency room visits, and other overutilization, there are also extensive administrative costs for care management, utilization management, providing networking to ensure access, and other processes such as bill paying and risk management."

The state could elect to give taxpayers a break and simply make the same payment for the same care regardless of delivery method. People who use the care would simply pick the kind of care they like. They might prefer a private physician to an HMO. In Medicare, where people do have a choice between HMOs and fee-for-service, the data show that healthier people tend to enroll in HMOs. Those most likely to leave HMOs are those in poorer health.

The fact that managed care should cost less but doesn't poses a problem for influential people who have spent their entire professional lives being trained in the managed care creed. Many of them prefer to believe that failure results from too little money and not enough regulation. Undeterred by failure, they want to repeat the Medicaid managed care experiment with more regulation and more tax money.

To attract managed care providers, the Department proposes increasing Medicaid HMO payment rates to 100 percent of fee-for-service payments and adding a 5 percent payment for administrative costs. If these measure fail, it is even investigating the possibility of setting up and running its own Medicaid HMO. The idea is that if it runs its own HMO, it will enjoy lower costs for purchasing and administration. In some particularly florid prose, the Department says that a state run HMO would allow the state to achieve "the efficiency of centralization," a transcendental state that has eluded every other government-run, centralized health care system in the English speaking world.

Meanwhile, the Consumer Directed Attendant Support program, Colorado's innovative experiment with consumer directed care, frees clients from Medicaid centralization, giving them a budget and letting them keep 50 percent of any money they save. In turn, their ingenuity saves the state about 20 percent a year. In the private sector, innovative companies are having similar results when they reduce centralized management by marrying tax free health savings accounts with high deductible health insurance.

Unfortunately, real savings by real people cut little ice with those who think that 50 percent of all Medicaid clients should, for some unknown reason, be in Medicaid HMOs. That the state is demonstrably unfit to run an HMO doesn't matter.

The goal has been set, "the efficiency of centralization" awaits, and real costs are of little real importance when true believers spend other people's money. Look for a massive rollout of results from esoteric theoretical models. These results will prove that state run health facilities will produce big theoretical savings. In practice, the real world is unlikely to oblige.

Labels: 208, Medicaid, OpEd

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Insurance mandates threaten your health

Should politicians force you to buy health insurance? In his September 28 column, Dr. Michael Pramenko advocates an "individual mandate" for health insurance. That means that you, the individual, will be forced to buy insurance that's approved by politicians, and if you don't you will be penalized.

Insurance mandates are morally wrong because they violate the rights of individuals to control their own lives and resources. The government has no more right to force us to buy health insurance than it does to force us to buy shoes, houses, hamburgers, or Bibles.

What the government forces, the government controls. The sort of insurance that people purchase should be a matter of voluntary arrangement involving them and insurance companies. If politicians force you to buy health insurance, it will be insurance that politicians and bureaucrats design for you. Such insurance will be designed to serve special interests, not you. It comes as no surprise that unscrupulous insurance companies salivate at the thought of using politicians to force you to buy their products.

Moreover, people have the right not to buy health insurance, as they have the right not to buy home insurance and life insurance. (Drivers are required to purchase auto insurance only if they drive on government-financed roads, so the case is problematic but not comparable.) Maybe a person has saved up hundreds of thousands or millions of dollars and doesn't think insurance is necessary. Maybe an extended family or other group has agreed to fund each others' high-cost, emergency treatments. Whatever the reason, people have the right to make their own decisions and control their own lives.

It is true that on a voluntary market people don't always buy what's good for them. Some people buy fatty hamburgers instead of health food. Some people don't purchase books, which disadvantages their children. Some people don't buy a new roof before the old one starts leaking. And some people don't buy health insurance and other types of insurance even when it would be advantageous.

But do we really want to live in the sort of society in which the government forces people to buy things that politicians decide are good for them? Think about where that will lead.

Instead of trying to force people to buy health insurance, why doesn't Dr. Pramenko take a look at why health insurance is too expensive for some people to afford? We've explained the reasons previously in this column. But Dr. Pramenko has completely ignored the causes of the problem. If he tried to treat an illness without first examining the causes of the symptoms, he would be sued for malpractice. Why does he hold himself to a different standard when it comes to politics?

So we will quickly review. Through federal tax distortions, politicians have entrenched high-cost, non-portable, employer-paid insurance. Because of the tax distortion, this insurance has effectively evolved into pre-paid medical care, not true insurance to cover emergencies. Such insurance has encouraged people to consume medical care with little thought to their needs and to costs. And doctors answer to insurance companies rather than to patients. The result is that costs of medical services and insurance have skyrocketed.

Politicians also took over around half of all health-related payments, further driving up costs. Politicians forced some providers to operate even without compensation and forced insurance companies to "guarantee issue," encouraging some people to forego insurance and even care until they get sick. Politicians have further driven up costs of health insurance by mandating all sorts of benefits and subjecting medical services and insurance to a host of controls.

In short, the problem is political intervention in medicine. To "fix" this problem, Dr. Pramenko prescribes more political intervention in medicine. That's like prescribing cigarettes for lung cancer.

As Dr. Paul Hsieh writes for the blog at WeStandFirm.org, a mandate "has already been tried in Massachusetts and is generating serious problems because it does not address the fundamental cause of skyrocketing health care costs, namely the government interference in medicine."

Indeed, as Massachusetts politicians discovered, mandates generate two immediate problems. First, it's impossible to get everyone to buy insurance. The very people most likely to try to push their health costs onto others are among those least likely to follow the mandate. Second, it turns out that the poor can't afford the mandated insurance, anyway. That's why various Colorado "reformers" call for much higher taxes to further subsidize insurance and care.

Mandated insurance acts to transfer wealth away from young, healthy workers to those with higher medical costs. If Colorado imposes a mandate, that will drive away young workers and attract those with high costs. A national mandate would make it harder for younger workers to save for their own futures.

Dr. Pramenko calls for "cooperation" and "compromise." Yet a health-insurance mandate is all about political force, not cooperation. We urge Coloradans to compromise neither their health nor their liberty for this latest political scheme.

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How to Access Dental Care Without Insurance

Chris J. Wiant, M.P.H., Ph.D., wrote the following comments for the October 7 Rocky Mountain News:

While 770,000 Coloradans are without health insurance, twice that number of citizens do not have dental insurance and, therefore, lack access for preventive and restorative services. They must wait until their dental problem becomes a medical emergency before they are likely to get service. ...

Therefore, it is my hope that Colorado’s Blue Ribbon Commission on Health Care Reform takes seriously the need to include dental care as part of an overall strategy in fixing our health-care system in Colorado.

Wiant's assertion is false. It is simply not true that people who lack dental insurance therefore "lack access for preventive and restorative services." They have all kinds of access. Since Chris J. Wiant, M.P.H., Ph.D., is apparently ignorant of this fact, I'll describe how people may access dental care.

Step One: Locate a phone book.

Step Two: Look up "dentist" in the phone book. It's under "D."

Step Three: Using a telephone, call a dentist in the phone book.

Step Four: Make an appointment to see the dentist.

Step Five: Go to see the dentist at the appointed time.

Step Six: Pay the bill.

As an alternative to the first two steps, look on-line -- I found 2,080 dentists listed through DexKnows -- or ask friends for a referral (which is what my wife and I did).

My wife and I do not have dental insurance. Indeed, we have never used our high-deductible insurance to cover any medical cost. We pay all of our medical and dental costs out of pocket (or out of our Health Savings Account, which is an extension of our "pocket"). And we like it that way.

My wife and I have both been very proactive in seeking out (and purchasing) "preventive and restorative" dental services. For example, just within the last few weeks, I had my first cavity filled (which was tiny because I went in as soon as I noticed it), and my wife had a filling replaced. Months ago I had a cracked molar repaired. We both get regular check-ups and cleanings.

Our dentist does an outstanding job. He is worth every cent that we've ever paid him -- and much, much more. We get a spectacular value for our money with him, and I am proud to pay him for the services that he renders. Now that's "access."

We don't need Chris J. Wiant, M.P.H., Ph.D., to force us to purchase dental insurance that we neither want nor need. And that's really what he's saying here. It is now common knowledge that the 208 Commission has endorsed an "individual mandate" for Colorado, meaning that the Commission wants to force people to buy "insurance" that's approved by politicians and bureaucrats (as opposed to, say, removing the political impediments that make insurance too expensive for some people to purchase).

But Wiant is concerned with the fraction of people lacking dental insurance who have trouble with Step Six. But they don't need "insurance" (i.e., government-managed, pre-paid care that others are forced to fund) in order to have "access." Those without funds to pay for dental services can and should set up payment plans or turn to voluntary charity.

Wiant's article is indicative of what we can look for if the political takeover of medicine advances. Special interests will continually lobby to have their favored services included in the politically-enforced mix. As people "access" more of the "free" (or nearly free) services, the result will be price controls and rationing. Real "access" will be reduced.

By the way, "Chris J. Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation." And what manner of group is that? According to its web page:

In November of 1999, Anthem Insurance, a for-profit company, purchased Blue Cross Blue Shield of Colorado, which had non-profit status. This sale yielded proceeds of $155 million. As mandated by Colorado state law, the profit from the sale was dedicated to benefit the health of the people of Colorado. Caring for Colorado Foundation, a non-profit 501(c)(4), tax-exempt Foundation, was endowed to fulfill this responsibilty (sic).

Let us leave aside the absurdity of state laws stacked on federal tax codes micromanaging mergers. Chris J. Wiant, M.P.H., Ph.D., is, by advocating more political control of medicine, actively undermining " the health of the people of Colorado."

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According to some people, there is this group of people out there called the "un-insured" who are the root cause of rising health care costs. It is believed that their failure to buy insurance results in receiving care too little, too late and then, when they can't pay their hospital bills, the unpaid costs are shifted to you and me.

Ask the hospitals, doctors, insurance companies and government and they will say these people are basically irresponsible deadbeats who don't assume their social responsibilities and they are monkey-wrenching the whole health system. I say, Whoa! Wait a Minute, comrade! Perhaps the 208 Commission has reached its verdict too soon without considering all the facts.

...To me, the uninsured are basically our young people, your children and mine who are getting out of college, paying off their student loans, getting married, buying a car and a home and trying to move from their starter job up a couple of notches.

They are also young immigrant families who are attempting to do the same thing on a smaller scale. They are not a bunch of deadbeats who will only act in Society's best interest if mandated to buy health insurance and threatened with tax penalties.

...There is another aspect to all of this. Those young people we disparage for not buying health insurance are paying payroll and income taxes. Nearly 15% of what would essentially be take-home pay to them is carved out, up-front, to pay for Medicare and Social Security.

And, a significant portion of their income taxes goes to pay for Medicaid recipients. This young generation we are painting red is paying for the health care and retirement benefits for their elders and the poor, when they can't even afford health insurance for themselves and their kids. Talk about the cart behind the horse!

...The stakeholders for health care reform are really the young wage earners and families who are about to be targeted by the 208 Commission to have mandated health care insurance rammed down their throats. Their parents are blissfully enjoying benefits provided by their employers and their grandparents are shuffling off to Arizona and Florida for the winter, assuming their Medicare and Social Security checks are in the mail.

Is there something wrong with this picture?

Labels: 208, Insurance

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Under the plan, Coloradans would be required to provide proof of health insurance when filing their state income taxes. Failure to do so could result in a tax penalty equal to the cost of a year's worth of coverage.

About 160,000 uninsured people in the state have incomes that are too high to qualify for subsidized health insurance -- but too low to afford the lowest-cost unsubsidized plans. About 60,000 of these working poor won't face a penalty for not getting insurance, but the 100,000 others are in a bind.

"What I'm starting to see," [single mother Maureen] Linehan said, "is the people have to pay for their health care, and now they can't afford to pay their rent."

There is no individual mandate in Mr. Romney’s plan for the rest of the country. Instead, it concentrates on a "federalist" approach, premised on the belief that it is impossible to create a uniform system for the entire country.

..."He's run away from the Massachusetts plan," said Stuart Altman, a health economist at Brandeis University who worked in the Nixon administration and has helped advise many politicians since, including Senator Barack Obama, a Democratic presidential contender.

Labels: 208, Insurance, MA, States

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