Colorado's 208 Commission Reinvents the Broken Wheel
By Donna Smith, American SiCKO
DENVER, February 1, 2008 -- California Gov. Arnold Schwarzenegger’s health reform plan that included mandated health insurance purchases crashed and burned early this week on the West Coast legislative highway. But undaunted by that most recent defeat for mandates, Colorado's Blue Ribbon Health Reform panel -- the 208 Commission -- decided to recommend mandates to the Colorado General Assembly on Thursday afternoon even though achieving universal coverage through mandates is already a failed model for reform.
Colorado need not search too hard to see the failures of plans like that recommended by the 208 Commission for Coloradoans. In Massachusetts, a two-tiered system of health care is entrenching itself as the insurance mandates and connectors that were the brainchildren of former Massachusetts Gov. Mitt Romney take hold and price average, working-class citizens out of market for buying affordable, quality health coverage.
Meanwhile, the 208 Commission in Colorado patted itself on the back and soaked up the accolades of legislators as their report was offered up in a 12-page Colorful Colorado brochure. The recommendations read, in part: 'Require every legal resident of Colorado to have at least minimum health coverage(enforce through income tax penalties; provide affordability exemptions)' and 'Create a 'Connector' to assist individuals and small businesses and their employees in offering and enrolling in health coverage.'
Americans throughout the land -- and certainly in Colorado -- should now be feeling a distinct feeling of Deja vu. After months of work, millions of taxpayer dollars, the testimony of hundreds (if not thousands) of citizens and even the independent cost and savings assessments that show single-payer reform as much more cost-effective and efficient, state legislatures continue to ignore factual information and simplicity in favor of complexity and punishment. Citizens already punished by not being able to afford health coverage will then be slapped with penalties administered by new government personnel required to enforce the mandates and collect the fines for non-coverage. Those who raised the red flags about government involvement in the delivery of health care don't seem to have any problem creating new bureaucracy to protect insurance company profits.
As reported in the Boston Globe, 'The (Massachusetts) Connector system is encouraging insurance companies to include only a limited network of cheaper physicians and facilities in some plans to hold down premiums. Patients who wish to see more expensive providers will have to dig into their own pockets. Dr. Steffie Wollhandler, a professor of medicine at Harvard University, worries that the Connector will revive Gov. Romney's original idea of enrolling poor people in plans that only offer access to neighborhood health centers ill-equipped to treat anything beyond routine ailments. Forcing people to buy substandard care they cannot afford is not universal care, she says. 'It is a hoax.' And so Massachusetts is marching toward a system of two-tiered medicine -- the alleged market inequity that universal care is supposed to cure.'
Back in Colorado and with disregard for what other states are already experiencing, the 208 Commission did not march boldly forward with health care reform the would truly provide access and affordability for Colorado's residents but rather chose to dabble in the disappointing -- a retread of the plan least likely to offend the powerful insurance industry lobbyists who lingered gleefully just outside the Old Supreme Court Chambers and greeted legislators as they went in to listen.
The take home lesson: America’s health insurance industry is the problem. Any reform based on a prominent role for the industry precludes success, because the private health insurance industry is simply too bureaucratic and expensive. The administrative overhead in the current private system approaches 30%. The 208 Commission did recommended work on administrative costs and a restructuring and combining of Medicaid and SCHIP offerings, which the state legislature now says may be the only reform it will move forward this session. To do otherwise is simply too costly, said State Sen. Bob Hagedorn, D-Aurora, in Friday morning's Rocky Mountain News.
He's probably right about the cost issue -- at least if he really read the Lewin Group's assessment of the only reform plan that would save Colorado any money at all -- the Colorado Health Services Program, the single payer option supported at public hearings but considered politically controversial. Mandates do cost a lot, as is evidenced in Massachusetts in dollars spent and in difficulties created for working class citizens.
The failure of the mandate model in the six states that have tried it (and as is unfolding currently in Massachusetts) can be directly attributed to the private insurance industry. Each of these state reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.
The “mandate model” for reform rests on political surrender: avoid challenging insurance firms’ stranglehold on health care while coercing the uninsured to purchase costly insufficient insurance policies. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.
It is ironic that what started out as a “politically feasible” alternative to the California single payer bill turned out to have little political support when it came under scrutiny in the California Senate. California mandates failed the “politically feasible” test because supporters surrendered to the insurance industry in advance on cost control and then gave them a blank check in the form of millions of new customers.
Far better for Colorado to learn from the damage done in other states and follow California's lead in rejecting mandates. It's no better in the Rocky Mountain West than on the East or West coasts. Mandates never have and never will take the place of true health care reform. And citizens are waiting for leaders who are bold enough to stop paying tax dollars for the rewrites of broken plans.
