Can we change the story we tell ourselves about how we pay for our health care?
A part of this narrative started with the wage and price controls in place during World War II, when employers offered health insurance coverage to attract good workers since they couldn’t raise wages. After the war, labor unions joined in this approach, negotiating for health care benefits for their members. Health insurance got hitched to employment. The message: “You earned it.”
Then, in the 1960s as part of the Great Society, Medicare and Medicaid were created to fill in some of the gaps left in coverage, as employment-based health insurance did not cover the elderly or the poor.
In the 1980s, the invisible hand of the marketplace was touted as the more trustworthy steward of the common good than dreaded government control. President Ronald Reagan said, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’” This was a turning point in the story, in which the focus of the government tending to the general welfare of the people shifted in many ways, including in health care, toward privatizing public programs.
Under private care, health care’s bureaucratic control skyrocketed. From 1970 to 2010, the number of health care administrators rose 30 times. During those same years, the number of doctors only doubled. This trend has continued.
The insurance, drug, pharmacy benefit manager, hospital chain and durable medical equipment corporations have in effect become a price-fixing cartel. While they complain publicly about the prices each other charges, they actually cooperate, at least through the lobbying arm called the Partnership for America’s Health Care Future, because high costs benefit them all at the expense of the rest of us.
Insurance companies advertise that they will be there for us. Yet high deductibles, prior authorizations, unwarranted claims denials, narrow provider networks, surprise billings and onerous bureaucratic hoops all work together so that insurers can collect premiums and not pay for needed care. Insurers collaborate with high drug, hospital, and equipment costs, as it works for them all: They know we’ll keep paying for the care we need — even if it sometimes means losing our homes.
This is the story of how we have achieved spending twice as much per person compared to countries with universal health care systems, while at the same time having poorer life expectancy, poorer maternal and infant mortality rates, and other overall poor health indicators. The so-called law of supply and demand of the marketplace works for them: limit the supply, while the demand for health care holds steady, and the price goes up.
Hints at another version of the story have been happening in Colorado, but have remained quietly in the background. Both Colorado’s 208 Commission 15 years ago and the Health Care Cost Savings Act Task Force report of 2021 clearly showed that a single, public, nonprofit way to pay for our health care would likely cost less and cover every Coloradan with better care.
This is a very different story than the one we’ve learned to tell ourselves. Can a single, nonprofit way to pay for us all in Colorado actually work? This is exactly the question that a bill introduced in the Colorado House of Representatives will answer.
HB 24-1075, which is an analysis of an Universal Health-Care Payment System, if passed, would fund the Colorado School of Public Health to provide an in-depth analysis of the funding options, as well as the health care, economic and equity impacts of a single system. It is scheduled to be debated Wednesday in the House Health and Human Services Committee.
Would it save money, provide more choice, be able to cover long-term care, lessen homelessness, be equitably affordable to all, and work at the state level? These are all questions that we urgently need answered.
It is clear we live in very polarized times. Can we tell ourselves a different story that pulls us together as a people? We all need health care, whether single, married, older, younger, disabled, employed, laid-off, a person of color, LGBTQ, wealthy or poor. We all have the need to be assured that when health care is needed, it will be there for us, without impoverishing us.
Following the evidence can set us free.
Bill Semple lives in Boulder and is the board chair of the Colorado Foundation for Universal Health Care. He is a retired clinical social worker.
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