Colorado Care

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Danoff

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Colorado is considering essentially kicking me, and everyone who makes decent money here, out of the state.

http://www.coloradocare.org/

Colorado Care is a universal healthcare program that imposes an additional 10% tax on all income on all residents of the state. The money is then given to a private company which will have a defacto legislated monopoly across the state. The company will then cover health care costs at an unknown rate for an unknown number of procedures.

No joke, if this goes through in November I will have to leave this state, which I am quite fond of. In the short term, I'd expect everyone who is a decent earner to pack up and move out. Meanwhile I'd expect retirees to flock here ready to collect on healthcare that they'll pay essentially nothing for.

This one means a great deal more to me than Trump vs. Hillary.
 
3,439
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DG Silva
Sorry to be ignorant here @Danoff, this looks like a state-wide NHS, am I correct? Would you not get a refund on the your existing health insurance, or is it just a big middle finger to all those who work? What's the standard of care like?
 
6,803
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...I'm guessing it's yet to be approved? Or is it already rubber stamped, ready to implement?

Didn't have the time to go through the link in detail. Sorry.
 

Danoff

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Sorry to be ignorant here @Danoff, this looks like a state-wide NHS, am I correct? Would you not get a refund on the your existing health insurance, or is it just a big middle finger to all those who work? What's the standard of care like?

We could all drop out existing health insurance (at least that's the idea). No details on standard of care. No details on what is covered or what the cost to the customer will be at the point of service.

It's not an NHS equivalent because it's not a government agency (at least I don't think the NHS is a private company). This is more like the monopolies we give our power companies, but without any details for services rendered. What we're voting on is imposing an additional 10% tax on everyone's income in exchange for something to do with healthcare.

Even if it were the NHS (which needs funding if I understand correctly?), it wouldn't work at a state level - because everyone paying in would leave, and everyone pulling out would take up residency here. For something like the NHS to work, you essentially have to hold captive the people who take a net loss.

The proposal has been designed so that 80% of voters will save money at the expense of the other 20%, thereby helping ensure that it passes (that's the idea anyway, hard to say given the lack of details whether it's accurate).

...I'm guessing it's yet to be approved? Or is it already rubber stamped, ready to implement?

Didn't have the time to go through the link in detail. Sorry.

To be voted on in November.
 
3,439
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DG Silva
We could all drop out existing health insurance (at least that's the idea). No details on standard of care. No details on what is covered or what the cost to the customer will be at the point of service.

That is really not a very good idea. With no specifics, how the hell are you supposed to know what is covered and what is not?

It's not an NHS equivalent because it's not a government agency (at least I don't think the NHS is a private company).

Not yet it's not. Thankfully we are out before the TTIP gets enshrined into our law. However, the NHS does fund their patients to use private services when the opportunity arises (or it is in the interests of the patient).

Even if it were the NHS (which needs funding if I understand correctly?), it wouldn't work at a state level - because everyone paying in would leave, and everyone pulling out would take up residency here. For something like the NHS to work, you essentially have to hold captive the people who take a net loss.
The NHS is funded by the UK taxpayer from a combination of income tax, national insurance (community charge) and other taxes. The biggest issue I can see is what happens, if you do decide to stop your health insurance, when you need healthcare outside of your state.
 

Danoff

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The biggest issue I can see is what happens, if you do decide to stop your health insurance, when you need healthcare outside of your state.

I imagine they'll play it a bit like insurance companies do now - covering costs at a negotiated rate. But they need to be accepted outside of the state... and I don't know whether that'll be the case. I cannot believe this thing is gaining traction (which it seems to be) given how it is completely devoid of actual thought .
 

TenEightyOne

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While I'm a strong supporter of our own NHS I don't think it would work in Britain if it was introduced now. And I don't think a similar idea will work in Colorado. As @Danoff notes the earners are likely to leave while the needers will arrive in their decrepit droves.
 
4,221
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ukfan758
Imo, if it were to work, they would need to adjust the tax by income and by the chosen plan. A healthy family who has the Bronze plan (60 percent coverage, basically, they only need to visit the doctor for a yearly checkup and for very few minor illnesses such as gastroenteritis) but only makes 40k a year should not have to pay 10%. A middle class family who makes 100k a year but also chooses say the Gold or Platinum plan (80 and 90 percent coverage) should have to pay higher because of their income and the plan they choose.

The tax could be like this (I do not know if this would be feasible :lol:)
Income:
Under $60,000=1%
$60,000-200,000=3%
$200,000+=6%

Plan: (total tax regardless of number of plans, a family of 4 would not pay 4% for 4 bronze plans)
Bronze=1%
Silver=2%
Gold=3%
Platinum=4%
 
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Joel

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Hmm. I generally agree that single payer health care in only one state probably won't work very well due to the already mentioned issue with high earners and healthy people moving out of CO while low earners and retirees move in, and doctors potentially leaving if they earn less money from this program. But then again, it also happened this way in Canada where one province started with universal hospitalization coverage and it progressively became national universal health care. I also think the *10% tax!* is rather misleading when this plan would eliminate people's need to buy health insurance, and eliminate the need of companies to buy insurance for their employees, as well give the single payer huge leverage to eliminate the cycle of suppliers gouging hospitals who gouge insurers who gouge their customers.

The money is then given to a private company which will have a defacto legislated monopoly across the state.
Not a private company, a nonprofit co-op whose members (and owners) are CO residents for 1 year over 18, who elect a board of trustees, which then receives the tax and pays health care providers. If it runs a surplus it will remain in the co-op or be refunded to residents. The money is given to a co-operative owned by the residents of Colorado, acting as an arm of the state government with an elected board of trustees (p. 1). Structure is explained on pages 3-9.

The company will then cover health care costs at an unknown rate for an unknown number of procedures.
Rates realistically couldn't be known because they haven't been negotiated yet, but this co-op would have far more leverage than any existing private insurer in Colorado so it will almost certainly receive better rates, and would lower overall costs to providers by vastly reducing paperwork and admin costs.

List of benefits on page 11. Agree that it's not super clear but it is required to meet what Medicare and Obamacare covers and will have no deductible or co-pay. For comparison, here's the breakdown from the provincial health care plan I'm under. It pays for services or surgeries medically necessary, hospital visits, etc. No elective cosmetic surgery and no quackery (acupuncture, homeopathy etc.). I can't imagine this plan being much different. There's no long list of stuff Ontario covers because "all medically necessary procedures" are covered.

In the short term, I'd expect everyone who is a decent earner to pack up and move out. Meanwhile I'd expect retirees to flock here ready to collect on healthcare that they'll pay essentially nothing for.
P. 11, *If there were a financial strain on ColoradoCare as a result of people with high cost health care needs moving to Colorado for affordable health care, ColoradoCare could establish one-year pre-existing condition limits for new residents. Such limits would need to be in compliance with Medicaid and Affordable Care Act waivers.

There's no other comparable system in the US but I'd think that RomneyCare would have had the same thing (retirees moving in), as it gives free insurance to people earning less than 1.5 times the poverty line. Most retirees would be under that line by income, wouldn't they have moved to MA to take advantage of these benefits?
It's not an NHS equivalent because it's not a government agency (at least I don't think the NHS is a private company). This is more like the monopolies we give our power companies, but without any details for services rendered. What we're voting on is imposing an additional 10% tax on everyone's income in exchange for something to do with healthcare.
Think of it as analogous to the school voucher system I've seen talked about on here before. It isn't really like the NHS, the NHS is a government funded and run health care plan where government funds, administers, and runs the health care facilities themselves. The NHS would be (almost) true socialised health care, while this would be like Canada, France, etc. where a public single payer would pay for services provided by private practices/doctors.

Again, it sounds a lot like how it works here. Doctors aren't public employees; they don't receive a public salary, public pension, and are not managed by a public authority. Most doctors (including specialists) run their own private practices and bill the provincial health plan, while doctors that work in public hospitals are usually incorporated and bill the provincial plan through their corporation. Most Canadians have a private insurance plan through work/university or pay for one which covers dental, prescriptions, travel health insurance, and glasses/optometry visits.

I imagine they'll play it a bit like insurance companies do now - covering costs at a negotiated rate. But they need to be accepted outside of the state... and I don't know whether that'll be the case.
It's not clear what exactly it would cover outside the state but I don't see why it wouldn't be covered outside the state. There's already god knows how many insurance companies and for a hospital outside CO this would be just one of many health insurance providers that hospitals already deal with. Would there be a legal avenue to get emergency and urgent care insurance for the rest of the country? It seems analogous to when Canadians go to the US, we get private insurance that covers travel and it's usually not very expensive since the odds of needing emergency care out of state are low.
 
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410
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hogger129
I'm curious. If a company knew that it was guaranteed a sale, why wouldn't it increase prices? "Universal" health care does nothing to reduce hospital or drug costs, which are the primary issues with health care.
 

Joel

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I'm curious. If a company knew that it was guaranteed a sale, why wouldn't it increase prices?
Because the single payer has all the leverage. They're the only insurer in the state/country so the doctor/hospital can choose to either do business with them or nobody. If they try to charge more than the single payer sets out, they simply won't get it. Other than in tiny niche disciplines, there's no way for another insurer to compete with the volume and guaranteed revenue of a single payer. That doesn't mean the single payer can be cheap either. The single payer has a vested interest in keeping doctors in the state/country, and if the single payer doesn't pay doctors well, they'll leave to other countries or states that will pay them more. The single payer will pay a hospital more than a private practice for the same procedures because otherwise the hospital won't be able to keep a 24 hour ER open.

"Universal" health care does nothing to reduce hospital or drug costs, which are the primary issues with health care.
Single payers and universal health care absolutely reduces hospital and drug costs. This is a report by the International Federation of Health Plans (Insurers) from 2013, comparing drug and other medical procedure costs in the US to other developed countries.

For drugs a single payer massively reduces costs because of the volumes involved. Right now drug companies can choose insurers who will pay more for their drugs, while with a single payer they would either sell to the single payer or not at all. Again, the single payer has a vested interest in having drugs available, so it will offer a profit to drug companies but has the leverage to avoid being gouged. I sound like a broken record here but again, the single payer has the leverage to refuse hospitals gouging them in response to suppliers gouging them, but are forced to pay a fair rate or else the services won't be provided.

Also, what's with the scare quotes around universal? It genuinely is that simple, in countries with universal health care you just go to the doctor or hospital and receive care for anything from something as simple as removing an ingrown toenail, to childbirth, heart surgery, or chemotherapy.
 

Danoff

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Hmm. I generally agree that single payer health care in only one state probably won't work very well due to the already mentioned issue with high earners and healthy people moving out of CO while low earners and retirees move in, and doctors potentially leaving if they earn less money from this program. But then again, it also happened this way in Canada where one province started with universal hospitalization coverage and it progressively became national universal health care. I also think the *10% tax!* is rather misleading when this plan would eliminate people's need to buy health insurance, and eliminate the need of companies to buy insurance for their employees, as well give the single payer huge leverage to eliminate the cycle of suppliers gouging hospitals who gouge insurers who gouge their customers.

First of all, we don't actually know whether it eliminates the need of anyone to buy insurance because we don't know what it covers. All we know is what it costs. Even if I subtract out my health insurance premiums, this thing is going to cost me gobs and gobs of money. The only way I'd stay in Colorado is if somehow my company and my wife's company decided to raise our salaries to compensate... which is highly unlikely.

Not a private company, a nonprofit co-op whose members (and owners) are CO residents for 1 year over 18, who elect a board of trustees,

You didn't quite write that correctly, so I had to dig to figure out where the misunderstanding is. It appears that the owners are all of the residents of the state... rather than residents of the state. Big (but subtle) difference. That's actually disheartening to me because it makes it more likely that this will pass. So you're right, it's not a private company with a monopoly, it's a public company with a monopoly.

If it runs a surplus...

Impossible.

Rates realistically couldn't be known because they haven't been negotiated yet, but this co-op would have far more leverage than any existing private insurer in Colorado so it will almost certainly receive better rates, and would lower overall costs to providers by vastly reducing paperwork and admin costs.

...because our healthcare providers won't accept private insurance anymore?

They could get better rates because they can reduce payouts to the point where doctors flee. Or they could get worse rates because they have a guaranteed income and who really cares right? Regardless, the balance will be wrong. Always wrong. It will either be too low - preventing us from having high quality facilities, or too high - running businesses and customers with money out of the state.

List of benefits on page 11. Agree that it's not super clear but it is required to meet what Medicare and Obamacare covers and will have no deductible or co-pay.

I'm not exactly in a hurry to get on Medicare or Obamacare.

For comparison, here's the breakdown from the provincial health care plan I'm under. It pays for services or surgeries medically necessary, hospital visits, etc. No elective cosmetic surgery and no quackery (acupuncture, homeopathy etc.). I can't imagine this plan being much different. There's no long list of stuff Ontario covers because "all medically necessary procedures" are covered.

...so long as your doctor thinks you absolutely need it and you're willing to wait in line. I've heard a lot of horror stories about Canadian health care. Mostly what I hear is that if it's not life threatening, you wait or don't get treated. Apparently being confined to a wheelchair for months on end is acceptable while you wait. I'm not in a hurry to recreate that in my state.

P. 11, *If there were a financial strain on ColoradoCare as a result of people with high cost health care needs moving to Colorado for affordable health care, ColoradoCare could establish one-year pre-existing condition limits for new residents. Such limits would need to be in compliance with Medicaid and Affordable Care Act waivers.

...which prevents pre-existing condition limits.

There's no other comparable system in the US but I'd think that RomneyCare would have had the same thing (retirees moving in), as it gives free insurance to people earning less than 1.5 times the poverty line. Most retirees would be under that line by income, wouldn't they have moved to MA to take advantage of these benefits?

First of all, MA is not CO. Colorado is a way more attractive place to live. Secondly, it's all about the level of guaranteed coverage. If it exceeds Medicare/aid, they'll come here.

Think of it as analogous to the school voucher system I've seen talked about on here before.

Not even remotely close. It's more analogous to public schools. There's no "voucher". There's no incentive to keep costs down... only incentive to wring every last drop of service you can out of the system by mastering the paperwork and loopholes.

It's not clear what exactly it would cover outside the state but I don't see why it wouldn't be covered outside the state.

...because everyone outside of the state wants more money than they're willing to pay?

There's already god knows how many insurance companies and for a hospital outside CO this would be just one of many health insurance providers that hospitals already deal with. Would there be a legal avenue to get emergency and urgent care insurance for the rest of the country? It seems analogous to when Canadians go to the US, we get private insurance that covers travel and it's usually not very expensive since the odds of needing emergency care out of state are low.

So you end up getting private insurance anyway.

Because the single payer has all the leverage. They're the only insurer in the state/country so the doctor/hospital can choose to either do business with them or nobody. If they try to charge more than the single payer sets out, they simply won't get it. Other than in tiny niche disciplines, there's no way for another insurer to compete with the volume and guaranteed revenue of a single payer. That doesn't mean the single payer can be cheap either. The single payer has a vested interest in keeping doctors in the state/country,

...and what is that vested interest? As long as they can blame greedy doctors, and can tell a story to keep their seat running the company, their interests are met. If the majority of the cost is burdened on the minority, the voting system starts out rigged anyway.

For drugs a single payer massively reduces costs because of the volumes involved. Right now drug companies can choose insurers who will pay more for their drugs, while with a single payer they would either sell to the single payer or not at all.

I do love the notion that we can just cut revenue to drug companies and it's mana from heaven without any adverse effects. In this case, one adverse effect may be that we can't get certain drugs in the state. Another could be that whole swathes of drugs are missing. If done at a national level, it means drastically reduced R&D from pharmaceutical companies and lower quality care as a result. No free lunches.

Again, the single payer has a vested interest in having drugs available, so it will offer a profit to drug companies but has the leverage to avoid being gouged. I sound like a broken record here but again, the single payer has the leverage to refuse hospitals gouging them in response to suppliers gouging them, but are forced to pay a fair rate or else the services won't be provided.

It's an ongoing theme... take this deal or get out. Lots will opt to get out, resulting in a shortage, resulting in waiting lines.

I won't pay what amounts to... let me do the math for a second... 30 times as much for healthcare as I do now for worse service and to be told to wait in line behind someone who is not paying at all. I'll leave the state, and many many others will make the same decision. Ultimately people will move in looking for handouts, and jobs will move out following people who don't feel like paying the highest income tax rate in the country by far (and CA was already doing a fantastic job on that one). So with additional unemployment and handouts, the single payer system has to cut costs to survive, driving doctors out, causing a shortage - and ultimately driving people back out of the state. Property values will go down (in the long term, in the short term they may go up due to retirees looking for handouts), people will leave, industry will leave, doctors will leave, and the state will be... for all intents and purposes... trashed by the ridiculous notion that you can get everyone else to pay for your healthcare costs so that you don't have to worry about the size of the bill you run up.

Maybe I should put a for sale sign out today. People are greedy, given the opportunity for 80% to vote away the property of the other 20%, they will... even if it kills the golden goose.
 
906
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orlando,FL,USA
More the reason to legalize free market healthcare; sadly the knuckleheads we put into your office don't believe in such a thing.
 

Ken

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Colorado really seems to have gone down hill. With the high taxes, increased cost of living, the serial killers, higher crime rates, and now this. I can't say that I'm upset that I left when I did.
 

Danoff

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http://www.9news.com/news/local/politics/study-coloradocare-cant-cover-its-costs/290819566

So an independent assessment says colorado care will run out of money. Coloradocare proponents say "no we won't", of course, but then they add something to it.

article
No waivers could mean no program, ColoradoCareYES spokesman Owen Perkins said.

The initiative has a termination clause that states it would “shut down operations and return unused funds” or “notify the governor … of ColoradoCare's inability to function” if the waivers aren't “sufficient for its fiscally sound operation.”

That's a good thing in Perkins' opinion.

It's a "built in guardrail" that "guarantees we aren't going to pass something that's reckless and irresponsible," Perkins said.

So there's a provision in the plan that says it will shut down if it can't raise enough money. The spokesperson for the plan says that there's a failsafe saying that it goes back to the way things are now if their funding is insufficient for fiscally sound operation. And independent assessment says that it can't raise enough money.

Think about that for a second. You're telling a bunch of people to drop the coverage for their children and get onto coloradocare, which will evaporate if it runs out of money - keep in mind they cannot raise revenue on their own, that requires a vote. How many people are going to vote for something that could disappear their family's coverage out from under them?

Even if the plan is guaranteed to be around for a year, and then would go away and you could get back on your employer's plan... is your employer still offering a plan? Will they? What will it cover? It's a very precarious proposition.
 

Danoff

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I am hoping that since it's clear that Hillary is going to win, people will expect that she will fix obamacare and shy away from voting for state run healthcare here in CO. I'm nervous about this. Polls show that Coloradocare is trailing, but not by a large enough margin for me to be anywhere near comfortable.

I have put off improvements to my house, just in case this thing passes and I ultimately have to sell.
 

Danoff

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3598882.jpg


Coloradocare dies to the tune of 4:1 against, and with it comes a constitutional amendment making it harder to try again. Putting it back on the ballot would require more signatures, and would require a 55% vote to put it in place instead of a 50% vote.