Thursday, January 31, 2008

What next? We have just begun to fight!

Today the 208 Commission delivered its final recommendations in a 178 page report to the joint legislative committed on Health and Human Services. I think everyone was just glad this process was at an end. (I certainly was!!) There were the usual congratulations by Committee Chair Representative McGihon, but it will be interesting to see what becomes of the recommendations by the Commission.

The legislative committee declined to hear from the authors of the two minority reports, one authored by by Linda Gorman and Allan Jensen (pages 107-142 of the Commission's report) and the other authored by Mark Simon (pages 154-176 of the Commission's report). Mark Simon liked many Commission recommendations, but disagreed about subsidies to insurance companies (by requiring the poor to obtain insurance and then subsidizing them in the process), and has many good technical criticisms of the assumptions about coverage equaling access.

The Gorman-Jensen report is very good on what is wrong with the Commission's report, and has several positive recommendations that would deregulate the insurance market. I recommend reading both of those reports rather than reading the Commission's same-old, same-old recommendations.

The Commission's recommendations are the same tired, hackneyed, trite proposals of expanding government programs to include more people, requiring people to purchase health insurance or face tax consequences or other financial penalties, adding more regulations limiting the kinds of policies that insurance companies can offer, creating yet another quasi-governmental agency (like the PUC) to regulate providers and insurers, and more and more of the same.

There is some room for optimism in the legislature. But, we must be ever vigilant and stay focused on this issue of health care reform -- both large and small issues -- for some time.

During the 80 minute question period, many of the legislators asked good questions of the Commission. The first question by Senator Shawn Mitchell was whether the projections claimed by the 208 Commission were based on real hard evidence or were they more academic in nature -- in other words, and he focused on Hawaii which requires that employers provide health insurance to their employees and still has a 10% uninsured rate, can the legislature be confident that any of the five proposals will do what they say. Commissioner Chair Bill Lindsay said a number of things, but admitted that these five proposals were "merely projections."

Representative Ellen Roberts asked about the inadequate Medicaid reimbursement rate -- and where was the funding going to come from to increase that reimbursement rate to providers. Again, Lindsay indicated that the Lewin group modeled rate reimbursement increases from 60% (the current reimbursement rate) to 75%, and the cost was huge. He also admitted that doctors are not only opting out of Medicaid because of the low reimbursement rate, but because of the paperwork hassles regarding the eligibility and enrollment of citizens as well as the hassle in getting timely paid.

Representative Swalm said he was nervous about turning more money and control over to the federal government and expanding public programs.

Representative Riesberg commented that he was concerned because health insurance coverage did not equal access to health care, which was linked to the provider reimbursement rate. Having Medicaid did not mean that a person had access to a doctor. Lindsay then admitted that if every person in this state were to obtain health insurance tomorrow, there would not be enough primary care physicians to treat them --- another issue of access, not health insurance.

Representative Marostica was concerned to find out whether Lewin used their own modeling assumptions. Lindsay replied that the Commission chose Lewin because Lewin had malleable assumptions (whatever that means).

Representative Kefalas was concerned about whether it was proper to use tax dollars to subsidize private health insurance -- and wondered if it wouldn't it be better to put those people on a public health program, for example, allowing consumers to buy in to the Medicaid program.

After the legislators queried the Commission about its recommendations, there was opportunity for public comment. About 45 people signed up to speak and each had 3 minutes to speak.

Dr. Vernon, President-Elect of the Colorado Medical Society said that he spoke on behalf of the 7,000 doctors who are members of the Society and, like Commissioner David Downs, MD, the Colorado Medical Society supported the Commission, its report, and all efforts along those lines to have the government more involved to fix the current "unsustainable system or lack of a system". Clearly, more doctors need to make their voices heard about whether the state medical society speaks for them.

I was the fifth person to speak and I spoke in opposition to the 208 Commission recommendations. I advocated that each legislator read the minority reports. I then said that the individual mandate was completely unworkable and unenforceable because it is wrong and Un-American. It violates the rights of every Colorado resident to determine their own priorities and elevates health insurance to be more important than food, clothing, housing, transportation or any other family need.

I said that the Commission has essentially agreed that government programs have created much of the problem because of the low Medicaid and Medicare reimbursement rates, and that putting more people into government programs is wrong. I asked when did we become a state that supports putting more people on public programs, rather than encouraging those same individuals to become self-sufficient.

I then said that the 208 recommendation of guaranteed issue with modified community rating will only cause insurance rates to increase, likely make it more difficult to buy insurance, and perhaps even cause insurers to leave the state as they have done in New York, New Jersey, Massachusetts, Kentucky and Vermont.

Finally, I asked the legislative committee to do what the 208 Commission did not do -- to look at deregulation and limiting government involvement in medicine and health insurance.

To my pleasant surprise, I received scattered applause after my remarks. So there is hope -- many of these legislators asked thoughtful questions, and some in the audience apparently agreed with my remarks.

So, what next?

We must continue to speak up in favor of capitalist health insurance and medicine. We must continue to speak out against government intrusion and regulation. At the beginning of 2007, I thought we were like John Paul Jones and his sinking ship -- where he is said to have cried "We have just begun to fight." A year later, the ship is not yet sinking; it is listing, and there is significant damage, but there is still a real fighting chance to save American medicine and American health insurance.