Reprinted from www.yesmagazine.org by Nathan Schneider
First pot, now health. In November 2012, Colorado voters approved a ballot initiative that made recreational use of marijunana legal, despite a federal ban. In November of next year, the state will have the opportunity to lead the way again--this time, by opting out of Obamacare and replacing it with ColoradoCare, a universal health care system governed by those who rely on it. Proponents presented far more than the requisite 99,000 signatures required to put the initiative on the 2016 ballot in Denver today, though they must be verified in the coming weeks.
ColoradoCare proposes a model that covers every Colorado resident. A tax on income and employers would replace insurance premiums, but the revenue wouldn't be subject to the whims of legislators; instead, it would go directly to a fund overseen by trustees whom the recipients choose. In this respect, it would be a cooperative-like system accountable to everyone in the state, independent from the rest of the government and enshrined in the constitution.
Proponents argue that ColoradoCare will mean better, more accountable care at a lower cost. Opponents, including the Koch brothers-funded Advancing Colorado , say it will be the Obamacare rollout on steroids. But by combining conservative irritation with the Affordable Care Act with liberal ambition toward universal coverage, it may actually have a chance in a purple state like Colorado.
Colorado, also, has a history of building practical, cooperative infrastructure. When energy companies failed to bring power to the state's rural areas quickly enough, communities set up electricity co-ops to power themselves. Credit unions are plentiful. Cooperative business models accommodate both community-mindedness and the state's libertarian streak.
Irene Aguilar, a physician and state senator, is the chief architect of ColoradoCare's unique cooperative approach and one of its leading spokespeople. I sat down with her at an ice cream shop in Louisville, Colorado, to learn more.
Nathan Schneider: What brought you from medical practice to the state legislature?
"It's possible to have an alternative that is both fiscally conservative and socially just"
Irene Aguilar: I was appalled to see how much we were spending on health care. I often think of one woman in particular who was about 42 and working as a secretary when she first saw me. Every year I'd drag her in to write her prescriptions, and she'd say, "I can't really afford these." Because of this, her numbers showed that she was not doing very well at managing her disease. By about 50 she had renal failure, and she qualified for Medicare. I couldn't help her take her medicines, and soon we were paying $70,000 a year to give her dialysis. Because she was on dialysis three days a week, guess what--she couldn't keep her job, and she ended up on Medicaid. This was a woman who had been working. She went on, in her 50s, to have heart disease, and she had a leg amputated, and at 60 she was dead. That is the real human cost of the backward way in which we deal with our health care system.
It was so much more expensive to pay for her to get dialysis, to get all those heart procedures, to lose her leg, and to be on welfare than it would have been if we kept her on her diabetes medicines at the age of 42 and let her control her disease. It's possible to have an alternative that is both fiscally conservative and socially just; it would be win-win in my mind.
Schneider: How did you start to entertain the possibility of an alternative like ColoradoCare?
Aguilar: I worked for 28-years-plus at Denver Health, a county hospital, doing primary-care internal medicine. In 2007, Colorado had something called the 208 Blue Ribbon Commission for Healthcare Reform. The four plans it considered included a single-payer health care plan, and the commissioners created subgroups to consider how the plans would impact certain populations. Since my daughter was disabled, I applied to be on the vulnerable populations task force. We learned that if we adopted the single-payer plan we could have everyone covered and decrease spending by $1.6 billion a year.
Not knowing anything about politics, I assumed that of course the commissioners would pick that one--and then quickly found out how much money there is in health care and how many self-interested individuals were in that pot. I began learning more about the political aspects of this that I needed to be more aware of. In 2009 we tried to run a single-payer bill through the legislature, but the governor managed to kill it. I ran for office in 2010 in order to concentrate on this. Our setbacks gave me motivation to listen to the feedback and see we could to modify this and make it more consistent with Colorado values.
Schneider: How did the initial proposal begin to evolve into ColoradoCare?
"Providers there did not have a disincentive against seeing certain people because of the insurance they had"
Aguilar: In 2009, Atul Gawande published an article in The New Yorker called "The Cost Conundrum." He profiled the impressive health outcomes in Grand Junction, Colorado, alongside those of McAllen, Texas. I went and visited with people in Grand Junction to learn more about what they were doing differently. There, [insurance company] Rocky Mountain Health Plans collected all the payments and paid providers the same, no matter who the individual patient's payer was. They paid them about 80 percent on fee-for-service and kept about 20 percent to be given on a reward basis based on quality of care and patient satisfaction. Unlike my experience as a provider, providers there did not have a disincentive against seeing certain people because of the insurance they had. ColoradoCare is sort of a blend of Rocky Mountain Health Plans and single-payer.
Schneider: A lot of people seem afraid of entrusting health care to the government--"death panels" and so forth. Does the Rocky Mountain model get around that?
Aguilar: Rocky Mountain Health Plans, at the end of the day, is still an insurer. In ColoradoCare, we're all putting our money in, so in some ways it's a cooperative. But it's different from a cooperative because you don't have to put money in if you don't have a lot of money. The pure cooperative people tell us to stop calling it a cooperative, both because it's mandatory and everybody doesn't pay the same. But we like to call it a cooperative because the board is accountable to and elected by the people in the state.