We have an epidemic market failure in how we pay for our health care.
Per person, we spend almost twice as much for health care compared to peer countries with universal health care systems, yet we have poorer outcomes, according to the Organization for Economic Cooperation and Development. Despite the United States having some of the world’s best specialty care, OECD data show we have lower life expectancy and higher infant and maternal mortality rates than all those peer countries.
How we pay for our health care creates inequality in our pursuit of life, liberty, and happiness. It’s rigged against us, makes the middle class and poor poorer, and is a source of anxiety for everyone. Even before COVID-19, our unfair health care system drove 7 million to 9 million Americans into poverty each year. Our health care system does even worse by people of color, with maternal mortality rates two to three times higher for women of color.
Our health care payment system works well only for the shareholders and executives of the insurance, drug, and big hospital corporations. They count on us to pay anything for health care, especially when the need is dire. Allowing these middlemen to profit off our pain and illness is corrupting. Insurers plunder our health care system like pirates. They’ve set their eyes on Medicare now, and reward Medicare Advantage plans by denying health care claims that traditional Medicare would have paid for.
To create a return on investment, insurance corporations collect premiums and try hard not to pay for our health care. It’s why, when health care is needed, we see high deductibles, high copays, narrow networks, prior authorizations, spurious claims denials, and surprise billings. And when they do have to pay for care, they collude with exorbitant drug and hospital charges, acting together as a legal, price-fixing cartel.
In contrast to this reality, a study by the Colorado School of Public Health points to a workable solution. The report compares how we pay for health care now to a single, publicly funded, privately delivered system. It shows clearly that the simplicity and focus of a non-profit payment system can cost several billion dollars less, cover everyone, support better health care, and even increase overall employment.
With a single, publicly funded, privately delivered way to pay for health care, there is lifetime coverage, guaranteed regardless of employment, marital status, income, immigration status, disability status, race, or creed. It would be a premium-paid system based on income, so it would be affordable to all. When care is needed, the focus would be on health care, not how to pay for it.
It would lower costs for payers and for medical providers. Providers would not need to give pro bono care, wouldn’t have to take 50 cents on the dollar for patients sent to collections — and, most importantly, would be able to focus much more on care, and less on data entry. A single health care system covering everyone in Colorado would have the heft to negotiate fair drug and hospital prices.
While the Colorado General Assembly considered many health-care related measures in the recent 2022 session, they have not embraced the fundamental wisdom contained in the Task Force report.
So, here’s what would work:
Let’s ask the 2023 General Assembly to consider legislation to refer a measure to the November 2023 ballot enabling the creation of an enterprise to pay for our health care that meets the following essential criteria:
- It shall provide comprehensive benefits for medically necessary care, including dental, hearing, vision, and mental health.
- It shall provide home care and long-term care at least at the level of coverage currently available to Medicaid-eligible persons in Colorado.
- Health-care decisions shall be made by patients and their health care providers.
- Patients shall have free choice among qualified providers.
- To address health-care disparities, it shall cover all Colorado residents.
- The system and the cost of care shall be funded by premiums based on ability to pay.
- Health care shall pre-paid by premiums, with no deductibles or copays that create barriers to care.
- The agency shall ensure fair drug and hospital prices as well as fair payment to providers.
- It shall be a publicly administered nonprofit enterprise and the sole agency paying for Colorado’s health care costs.
- To avoid profiteering, there shall be no middlemen with the incentives and power to limit benefits or impose other barriers to care.
By approving this measure, the voters of Colorado will empower the General Assembly to then design implementing legislation that meets the above essentials. This is a way to pay for health care that is proven to work.
We currently have a way to pay for our health care that ensures there will be winners and losers. Some will get good care and shareholders will be enriched. Many will be impoverished and fall through the cracks, as racial and economic disparities increase.
A system that works is both simpler and bold. And it would take care of we, the people.
Bill Semple, of Boulder, is chairman of the Colorado Foundation for Universal Health Care.
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