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2008 Winter Marillac Clinic Director's Corner

Many challenges ahead for health care reform in Colorado...

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As Marillac celebrates its 20th year of service to Mesa County, one constant remains: the need for Marillac’s services continues to grow. This need grows every day, as an increasing number of employers, individuals and families find health insurance simply too expensive to provide or purchase.

As many of you know, the Colorado Legislature created the Blue Ribbon Commission for Health Care Reform to study this complex problem. An estimated 792,000 Coloradans – nearly one-fifth of our state's population – don’t have health insurance at the present time.

On January 31, the Blue Ribbon Panel (also known as the 208 Commission) presented the findings of its year-long study to the state legislature. The entire document can be reviewed at www.Colorado.gov/208commission. The conclusion: The status quo is not sustainable.

Issues

Cost-shifting: A decreasing number of people are paying for the health care costs incurred by the entire population. As health insurance becomes more expensive, fewer people can afford it. This means they lose their medical home. People delay receiving care until they can no longer ignore their symptoms. They receive care in hospital emergency rooms, where they receive the most expensive level of care. They are discharged back into the community, where follow-up care is unavailable.

Health insurance premiums rise to cover the cost of those who don’t pay. This vicious cycle of spiraling costs and fewer payers has resulted in annual double digit increases for premiums and health care costs.

Portability: Our present system of acquiring insurance is largely dependent upon our employer.

This tie needs to be unbound. Having the employer negotiate a plan for its employees is ultimately not an efficient way for people to obtain coverage. When the expense of health care is beyond their ability to control, employers find it nearly impossible to compete in an international economy. This system also depresses the entrepreneurial spirit in this country. People with innovative or creative ideas might want to start a new business, but are reluctant because they are afraid of losing their health insurance. Reimbursement: The current system of reimbursement for health care providers is motivating medical students to move away from general family or pediatric practice toward specialization. Yet most of us would prefer having a long-term personal relationship with a medical provider who knows us as a person.

Mandates: One committee recommendation that will draw considerable discussion is an individual mandate toparticipate in the cost of health care. When I first heard about mandates, my initial reaction was “No...I don’t want government telling me what I must do.”  After much reflection and discussion with colleagues, I realized that all of us need to pay what they can afford in order to minimize cost-shifting. This also gives people the opportunity to lower their health care premiums by living healthier life styles.

What can we expect?

Unfortunately, many bills will be proposed in the current legislative session that will offer piecemeal solutions to the health care crisis. On the other hand, the Blue Ribbon Panel has developed a roadmap that follows a logical sequence of gradual reform. We cannot expect that one bill or one referendum will adequately address the complexity of health care.

My hope is that you’ve learned a bit about health care reform by reading this, and that you will share your knowledge and opinions with your friends and neighbors. The best outcome of open discussion is that we develop a health care plan in Colorado that works for everyone.