Legislator Information
Click here to download:a PDF of "Information
for Legislators"
Overview:
Legislators are faced with both the urgent need to reform the financing
of health care in the U.S. and the political hurdles that true change
requires. The need for change is clearly seen when we see that the US
spends almost twice the average of other industrialized countries, yet
leaves one out of six uninsured, lets many underinsured face financial
ruin due to medical expenses, and has worse outcomes than 35 other countries,
measured in part by infant mortality rates, premature deaths due to
illness, and life expectancy.
Most current proposals have major disadvantages. They are either extremely
expensive, have major drawbacks, or are unacceptable from an ideological
perspective. Balanced Choice is a hybrid proposal that combines the
efficiency and universal coverage of a single payer proposal with the
choices offered in preferred provider insurance. It has the prevention
and public health benefits of a unitary system and also responds to
market forces.
Study shows an affordable solution
is possible:
Studies (including the Colorado Legislature’s own independent
Lewin Group report to the 208 Commission) have shown that single-payer
financing of health care is able to cover 100% of the population, to
have robust coverage for all to avoid the pitfalls of the underinsured,
and to contain costs. We can reduce the 30% or more of health care spending
in our multi-payer “system” that goes to the overhead expenses
of insurers and providers. This reduction makes for significant savings
and allows for more money to go directly to providing health care. Having
cradle-to-grave coverage for us all engages a long term perspective.
This perspective incentivizes preventive care, wellness programs, mental
health and substance abuse treatment, in home care, medical home programs
for complex illnesses, and other approaches that have short term expenses
and long term payoffs 10, 20, 40 years down the road.
Balanced Choice modifications show a way Forward:
The need to raise taxes to fund single-payer presents a challenge to
politicians, even though overall health care spending can be reduced
and coverage, accessibility, and financial protection greatly increased.
Consumers fear the loss of the choices they have with their insurance
policy, and providers fear that a single entity might set unreasonably
low reimbursements. Effectively addressing the fears we all have about
fundamental change can free us to move forward. Balanced Choice garners
the advantages of single-payer financing, avoids its downsides, and
engages the market forces of choice and cost awareness. It is a hybrid
that has responded to the best of both single-payer and traditional
financing of health care.
Who benefits:
Providers can focus on health care, as bureaucracy
is greatly streamlined and reimbursements assured. They appreciate the
freedom to set their own rates, if they choose the Independent Option.
If they choose the Copay Option, they are assured that the balanced
funding mechanism will maintain fair reimbursements. Providers can trust
that reimbursements will respond to market forces, not just a centralized
bureaucracy.
Patients are free to choose their provider, not hemmed
in by PPOs, HMOs, ‘Caid, ‘Care, high deductibles, no insurance,
etc. Everyone is covered; no one is out. The fact that all providers
receive fair reimbursements assures patients that accessibility problems
will not get in the way of treatment. Patients will have much more information
about what treatment will cost as well as the comfort of knowing that
the costs won’t be catastrophic.
Employers are relieved of the administrative challenges
and expenses of providing health care and the complications of workers'
comp. They do not have low motivated workers holding on, simply for
health care. Our global competitiveness is greatly enhanced. Entrepreneurial
self-employment efforts are not impeded by health care coverage concerns.
Cost Consciousness:
Patients are cost conscious in Balanced Choice. Co-pays and gap payments
are clearly stated at the time of treatment, so patients can make decisions
with their doctor, with cost in mind. This is often not possible currently.
Lack of accurate information and/or having supplemental and secondary
policies can, unfortunately, eliminate the ability and/or need for patients
to have awareness of what treatment will cost. In Balanced Choice, intelligent,
cost-conscious decisions are made by the patient-consumers, which results
in containment of overall spending.
ERISA:
The ERISA requirement that state laws cannot trump federal laws regarding
employer sponsored insurance is a complication that can be addressed.
In state-wide, or nation-wide, single-payer financing, guaranteed health
coverage is based on residency rather than on employment. Employers
could find ways to support their employees’ health care payments
to the single-payer system, without engaging the ERISA constraints,
since employers would not be providing the coverage.
Conclusion:
Balanced Choice has the advantages of single-payer financing and of
market forces. Fear of change is supplanted by the gains to be had for
providers, patients, and employers with Balanced Choice. While expanding
SCHIP certainly benefits those children who would be covered, it adds
to an exorbitantly expensive system that is not sustainable. We need
citizens and leaders who have the understanding and courage to make
the case for what will truly reform our financing of health care.
