A recent survey revealing that two-thirds of Colorado voters are dissatisfied with the current health insurance system comes as no surprise to local health care professionals. Less obvious, however, is what changes are needed to fix that system.
Nearly half — 45 percent — of the 650 active voters surveyed statewide in early November said health care is unaffordable, with 82 percent saying they believe prescription drug costs are too high, according to the nonprofit Healthier Colorado, which commissions the survey annually.
When presented with the option to keep the current system — in which health insurance is purchased through one’s employer or privately — or move to a public option or Medicare for All, only one-third of voters preferred to keep the current system, according to Healthier Colorado. The other two-thirds were evenly split between wanting a public option and Medicare for All.
“Health care consistently ranks among the top issues for voters, and we’ve seen a range of proposals from 2020 presidential candidates — from tearing down the Affordable Care Act, to building upon it, to Medicare for All,” Jake Williams, executive director of Healthier Colorado, said in a Dec. 4 news release. “It’s clear voters are dissatisfied with our current system.”
Health care reform is “a complex issue with complex answers,” and voters should be wary of what may seem like a quick fix with Medicare for All, said Dr. Julie Marmon, owner of VitalPoint ER Specialists in Colorado Springs.
“Frankly, I would say that 100 percent of Coloradans and Americans should say the current system isn’t working, when 20 percent of Americans can’t pay their bills because they’re so in medical debt,” Marmon said.
Many voters tend to associate Medicare for All with proposals outlined in bills sponsored by Democratic presidential candidate Sen. Bernie Sanders, I-Vt., and Rep. Pramila Jayapal, D-Wash.
Essentially, “those bills would move the United States from our current multi-payer health care system to what is known as a single-payer system,” Katie Keith, a research faculty member for Georgetown University’s Center on Health Insurance Reforms, told Healthline Media, Inc. in September.
Right now, multiple groups pay for health care, including private health insurance companies, through premiums, employers, and taxpayers, through programs like Medicare and Medicaid.
“When people start talking about single payer and those things… what those systems do is shift who pays for a flawed system, versus actually creating a healthy system that delivers good care,” said Mike Ware, CEO of the El Paso County Medical Society.
“When people hear ‘public option’ or ‘Medicare for All,’ they’re thinking, ‘Oh great, I’m not going to have to pay for this,’” Ware added. “You actually do pay for it. It’s just different than the current system. … As somebody who lives in the health care world every day, my fear is that when [voters] hear Medicare for All or public option, they haven’t been given the information on … what it’s going to cost you individually.”
While Medicare for All would “save a ton of money on Day 1,” Marmon said, health care professionals should explore more long-term issues before deciding to go down that path.
“The downstream effects [are] that now we have the government running our health care and it seems like the national progression is … services then get cut,” Marmon said. “So five to 10 years down the road, we are left with a system that’s probably not as robust as what we have now.”
“The system is incredibly flawed and broken,” Ware added. “We’re talking about, ‘How do we lower costs?’ but really it’s, ‘How do we have an effective system that’s done on a cost-efficient basis?’
“That’s a much harder question to answer, and those of us like me, who have been doing this for years, don’t have the answer.”
COLORADO’S PUBLIC OPTION
Ensuring universal access to affordable health care “has vexed public officials and policy experts for decades, despite seemingly constant efforts to address the costs of coverage and care,” according to “The Final Report for Colorado’s Public Option,” released in November by the Colorado Division of insurance, part of the Department of Regulatory Agencies and the Department of Health Care Policy and Financing.
“The Affordable Care Act made great strides in increasing coverage, but it did not address the underlying cost of care,” the report stated. “For many in Colorado and nationally, even the subsidies provided by the federal government are not enough to keep insurance affordable.”
The state’s proposed plan would be sold by licensed insurance companies and cover a comprehensive, standardized set of benefits, according to the report. Any Colorado resident would be able to purchase the public option, although those who qualify for Medicare, Medicaid, Tricare, VA and employer-sponsored coverage may be better served by staying in those programs, the report states.
Current federal law requires that a minimum of 80 cents of every dollar collected as premiums in the individual market be spent on patient care, according to the report. Colorado’s public option would increase that requirement to 85 cents, ensuring that more of a person’s premium dollar is going toward their health care, the report states.
The plan also would require carriers to ensure that pharmaceutical rebates and all other compensation from prescription drug manufacturers paid to carriers or their pharmacy benefit managers are applied to the consumers’ benefit, meaning all such compensation must be passed to consumers, according to the report.
Ware hasn’t seen enough data to say whether the public option plan in its current form is the right answer. However, “I will agree 100 percent it’s one of the right issues to be tackling,” he said.
“We pay the highest cost for prescription drugs in years,” Ware said. “What that tells me is … we’re likely subsidizing the costs for the rest of the world, but also that there is a much more efficient way to go about it.”
For Marmon, transparency is key.
“We need to go after it with everything, because transparency breeds competition, which lowers prices,” Marmon said. “There are contracts that don’t allow you to be transparent about your prices. … I would love to post my prices online but there are so many different ins and outs of the contracts that it feels misleading.”
In the short term, health care professionals’ No. 1 recommendation is that patients know their benefits, Ware said.
“Really, a lot of it comes down to being a good steward of your own health,” Ware added. “One of the things that drive up costs is, as a culture, we really have not taken responsibility for our individual health, which is not something the political class wants to say.”
Industry professionals and politicians would do well to accept that any transitions in the health care system will not happen overnight, Ware said.
“There is no silver bullet,” he said. “What we have is this Frankensteinian process that has been built upon itself over the years. I don’t know how we do it, but it’s almost like we just need to take a holistic look at the entire system and say, ‘We’re going to accept it’s going to take 20 years to transition to something much healthier.
“That’s a really hard sale to make, especially when [politicians] have only got two or four years on the ballot.”