We have an epidemic market failure in how we pay for our healthcare.
According to the Organization for Economic Co-operation and Development, we spend almost twice as much on health care per person as comparable countries with universal health care systems, but the results are worse. Even though the United States has some of the best specialized healthcare services in the world, OECD data shows that we have lower life expectancy and higher rates of infant and maternal mortality than all of these comparator countries.
The way we pay for our health creates inequalities in our pursuit of life, liberty, and happiness. This is fabricated against us, makes the middle class and the poor even poorer, and is a source of concern for everyone. Even before COVID-19, our unfair healthcare system pushed 7 to 9 million Americans into poverty each year. Our healthcare system is getting worse because of people of color, with maternal mortality is two to three times higher in women of color.
Our health care payment system only works well for shareholders and executives of insurance, pharmaceutical, and large hospital corporations. They are counting on us to pay for anything for medical care, especially when it is badly needed. Allowing these intermediaries to profit from our pain and disease is corrupting. The insurers are robbing our healthcare system like pirates. Now they have turned their attention to Medicare and are rewarding Medicare Advantage plans by waiving health care claims that traditional Medicare would pay for.
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To ensure a return on investment, insurance corporations collect premiums and go out of their way to avoid paying for our health care. That’s why, when medical care is needed, we see high deductibles, high co-payments, tight networks, prior approvals, false denials, and unexpected bills. And when they do have to pay for care, they collude with exorbitant drug and hospital costs, acting together as a legal price-setting cartel.
Unlike this reality, Colorado School of Public Health study indicates a workable solution. The report compares how we pay for health care now with a single, publicly funded and private system. This clearly shows that the simplicity and focus of a non-profit payment system can cost several billion dollars less, reach everyone, support better healthcare, and even boost overall employment.
The single, publicly funded, private health care payment method guarantees lifetime coverage, guaranteed regardless of employment, marital status, income, immigration status, disability, race, or creed. It will be a revenue-based premium system, so it will be available to everyone. When help is needed, the focus will be on healthcare, not how to pay for it.
This will reduce costs for payers and health care providers. Providers should not give free of charge care, there would be no need to charge 50 cents on the dollar for patients sent in for collections, and most importantly, much more focus could be placed on care rather than data entry. A one-size-fits-all health care system in Colorado could negotiate fair prices for medicines and hospitals.
While the Colorado General Assembly considered many health-related measures in its recent 2022 session, they did not accept the fundamental wisdom contained in the Task Force report.
So here’s what will work:
Let’s ask the 2023 General Assembly to consider legislation to put to a vote in November 2023 a measure that would allow the creation of an enterprise to pay for our medical care that meets the following basic criteria:
- It must provide comprehensive benefits for medically necessary care, including dental, hearing, visual, and mental health.
- It must provide home care and long-term care at least the level of coverage currently available to Medicaid-eligible people in Colorado.
- Health care decisions must be made by patients and health care providers.
- Patients should have free choice among qualified providers.
- To eliminate disparities in health care, it must cover all Colorados.
- The system and the cost of care should be funded by insurance premiums, depending on the ability to pay.
- Health care must be paid for in advance in premiums, with no deductions or co-payments that create barriers to treatment.
- The agency must ensure fair prices for medicines and hospitals, as well as fair payment to providers.
- It will be a public not-for-profit enterprise and the only agency paying for healthcare costs in Colorado.
- To avoid speculation, there should be no intermediaries with incentives and the power to limit benefits or impose other barriers to health care.
By approving this measure, Colorado voters will authorize the General Assembly to develop an implementing law that meets the above requirements. This is a method of paying for medical services that has proven to be effective.
We currently have a payment method for our healthcare that guarantees there will be winners and losers. Some will be well cared for, and the shareholders will be rich. Many will be impoverished and lose as racial and economic disparities widen.
A working system is both simpler and bolder. And it will take care of us humans.
Bill Semple of Boulder is the chairman Colorado Universal Health Fund.
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