Who Should Care About ColoradoCare? —It’s A Proposed Single Payer System.

Vermont Senator Bernie Sanders supports the single payer ballot initiative in Colorado. Should you? We spend almost twice as much on health care and have poorer outcomes than other industrialized countries. (Click the pic to listen to Rachel Maddow briefly interview Bernie about this topic.)

If someone tells you that Dr. Jill Stein has endorsed Colorado’s proposed single payer health plan (known -confusingly- as Amendment 69, Initiative #20, and Title XXX ColoradoCare), don’t believe them. She hasn’t.

I’m not kidding. Dr. Stein, a strong supporter of single payer health care, as well as the Green Party candidate for President, told The Colorado Independent on August 27, 2016 that she doesn’t “want to throw my weight behind an endorsement at this point.”

ColoradoCare, she said, has important principles….But…she has concerns about gaps and loopholes in the measure….

Dr. Stein is not the only one who has concerns about this measure. As The Colorado Independent reports, “The state’s leading progressive group, ProgressNow, recently came out against it, and the state’s Democratic establishment have largely panned the proposal.”

But over in Vermont on August 24, Senator Bernie Sanders endorsed it. And here in Colorado, Dr. Irene Aguilar has championed the idea of a Colorado single payer system at least since she was elected to the State Senate in 2010. But apparently she’s a realist as well as an idealist. “I don’t care if we win or lose,” she told The Colorado Independent in the spring. “The system, as is, is so disgusting to me, I just want to get my message out about the need to fix it.” Good for her, and yet….

Colorado Independent: There’s some concern among people who favor universal health care but think this was the wrong year to push it, that a trouncing at the polls this year will discourage anyone from floating the idea in the future. Do you think there could be that kind of chilling effect? And, if so, do you feel responsible for causing it?
Sen. Aguilar: Yes, I absolutely think there will be a chilling effect. ProgressNow managed, all by itself, to achieve that chilling effect this week.

Wow. Divided we fall! Let’s not do this, Democrats!

Meanwhile, in addition to the Democrats who are disappointing Sen. Aguilar, not surprisingly, lots of Republicans, Independents and Libertarians don’t like Amendment 69 either. For one, there is Dr. Jill Vecchio, a Denver radiologist. She’s made a pretty good video explaining her concerns. I don’t agree with everything she says in her video, but she does touch on some good points. For one example, she mentions that Medicare beneficiaries and our military service members will be taxed even though many of them are unlikely to derive much direct benefit from Amendment 69, if any.

Don’t be afraid, be informed.

ColoradoCare estimates that over 80% of people on Medicare will spend less with ColoradoCare . (Some amounts of retirement income are exempt from Colorado taxation, namely, the Federal personal exemption of $4,000, the Federal standard deduction of $6,300, 15% of Social Security benefits, and up to another $24,000 in pension benefits.) But that raises the question of which Medicare beneficiaries are among the estimated 20% that will spend more? Without a doubt, some of them are retired veterans. Anyway, after watching that video, and admittedly scowling at a few of Dr. Vecchio’s assertions, I do sort of wonder if Senator Sanders is aware that some Veterans who live in Colorado will have to pay increased taxes without seeing comparable benefits? I mean, he was once the Chairman of the Veterans Affairs Committee, so he must know, mustn’t he? …Perhaps not.

One of my friends who has long worked very hard to enact single payer in Colorado tells me that ‘the issue with the VA and Tricare is a real issue that will need to be dealt with.’ My friend says that ‘it will take 2 to 3 years for ColoradoCare to be ready to go live, and during that time negotiations will need to happen to integrate ColoradoCare with the VA and Tricare’. Personally, I’m skeptical that any such integration would include a full reduction of the increased State taxes many retired Veterans will have to pay even though they already have excellent health insurance via Medicare and Tricare for Life; but perhaps the folks behind ColoradoCare have a far better understanding of this issue than I do….

Vermont tried, but failed to implement single-payer. Medicare for all is a great idea.

As for me, I very much like the idea of a single payer system; and, like both Dr. Stein and Senator Sanders, I’m confident that a national single payer system has the potential to save considerable money. However, like some other progressives (apparently including Dr. Stein) I don’t much like the thought of suddenly creating one in a single state (ala the failed attempt in Bernie’s very own Vermont).

Murphy’s Law isn’t just about peanut butter sandwiches, and I can foresee lots of unintended consequences if Amendment 69 is enacted. For one thing, until such time as many other attractive states adopted similar measures, it would encourage more sick people to move here, while at the same time motivating the departure of some relatively well people (not just middle-class seniors and veterans, but also some of our most productive “young immortals”). My friend counters that a similar ‘concern was expressed to discourage us from expanding Medicaid a few years back; but Colorado expanded; neighboring states did not; and there was no significant medically driven immigration.’ Fair enough, but Medicaid is strictly for the poor, who have meager resources with which to relocate, while ColoradoCare is for everyone, including people with some major medical challenges who are still well-off enough to move here. Also, there sure are plenty of healthy Colorado tax-payers with the resources to move away if they see fit (no pun intended)….

The guy in this video thinks we could get Medicare for All if we just went all out for it.

I’m pretty certain I’m not alone in preferring to see Medicare expanded. My friend says that 80% of Democrats are in favor of Medicare for All. I may be way too optimistic, but I actually think we could get Medicare gradually expanded by lowering the eligibility age to include more and more people until we’ve achieved universal coverage. But in order to get that started, I think a substantial majority of Democrats must prevail in the upcoming elections. I’m also confident that we could do so via buy-ins and without such a large increase in our taxes (10% of your Colorado taxable income is how much? - My friend says, ‘For most people it’s less than they’re paying now for premiums, out-of-pockets, and surprise bills.’ That’s almost certainly true, but you and I aren’t necessarily “most people” are we? We’re sort of uniquely us when it comes to income, health status, employment, age, etc.. So I recommend that you do the math. But, I digress.)

I think we could gradually fashion a single payer buy-in system at the national level for an additional tax rate far less than 10% in part because of the much larger national risk pools involved in any sensible Medicare expansion. For example, we could start by allowing those 39 million Americans aged 55–65 to buy in. Those Boomers constitute a much bigger risk pool as they outnumber all Coloradans by a ratio of around 7 to 1. Then, once the dust settled, we could further lower the age of Medicare eligibility. Private insurance carriers actually might not entirely oppose this method, as it would enable them to reduce their risks and cover healthier populations on the average, while looking around for other businesses to invest in.

Meanwhile, even my friend agrees that ‘a national plan would be better.’ However, they also say, ‘Hell will freeze over first….If you’re for a universal system of health care, this is the opportunity. There will be years of medically driven bankruptcies if ColoradoCare does not lead the way.’ I agree that this is -an- opportunity for a Statewide single payer system, and I’m aware that many personal bankruptcies are medically driven. But I’m not so sure that with ‘2 to 3 years for ColoradoCare to be ready to go live’ that the people in other states will be sufficiently impressed to push for similar single payer statewide systems any time in the near future. So, I’m thinking, instead of grinding away on negotiations and administrative set-up for a very bold statewide experiment, perhaps it would be better for all of us to use the possibility of all those medically driven bankruptcies to push harder for Medicare for All before hell freezes over? Like maybe in the first 100 days after Democrats hold on to the White House and recapture Congress? Isn’t it possible that our time and effort might be better spent doing that?

The devil is in the details, as usual. For some more devilish details that concern some progressive Democrats, including lots of pro-choice advocates, click the pic.

Finally (almost), speaking of the increased taxes proposed (have you done your own math yet?), did you know that Amendment 69 provides that “THE TOTAL AMOUNT OF PAYROLL EARNINGS BY EMPLOYEES AND OF NON PAYROLL INCOME SUBJECT TO THE TAXES LEVIED PURSUANT TO THIS SECTION SHALL NOT EXCEED THREE HUNDRED FIFTY THOUSAND DOLLARS FOR THOSE FILING INDIVIDUAL INCOME TAX RETURNS AND FOUR HUNDRED FIFTY THOUSAND DOLLARS FOR COUPLES FILING JOINTLY”? Sorry for the caps. That’s just how ColoradoCare presents this. It’s a nice provision for the 1%, don’t you think? It says that any income a couple earns over $400,000 per year won’t be taxed to fund ColoradoCare. Can you hear the sound of around 50 Billionaires in Aspen breathing a big sigh of relief concerning the millions of dollars in taxes they might otherwise have to fork over? Er, and also quite a few paltry Millionaires concerning the tens of thousands they won’t have to pay? No worries, though. Surely Colorado can win sufficient Federal funds and tax the middle class and the poor to the tune of 25 Billion dollars to fund this 38 billion dollar idea, can’t we? I mean, aren’t most of us already paying big bucks to the insurance companies (except possibly for some Veterans, some retirees, some “young immortals”, and a whole bunch of people who are presently uninsured, underinsured or already covered by Medicaid)? Maybe we should all do the math?

Anyway, if you live in Colorado, I hope you care about ColoradoCare. As my friend points out, ‘One out of four Coloradans are uninsured or underinsured, facing financial ruin when medical bad news comes.’ That’s definitely unacceptable, and whether or not ColoradoCare is enacted, we really should come up with a way to eliminate medically driven bankruptcies. That’s the right thing to do all over America. Also, if you know any military families, veterans, “young immortals” or retirees who reside and vote in Colorado, I hope you will discuss this with them. As potential members of the 20% who will probably pay more in taxes than they save if Amendment 69 is enacted, they deserve the courtesy of being constructively informed. Who knows, perhaps some of them will support Amendment 69 against their own best interests out of a desire to serve a greater good? Regardless, we can all stand to be better informed before we mark our (mostly mail-in) ballots one way or the other in time for election day, Tuesday, November 8. In the meantime, let’s try our best to engage in constructive discussion about this important matter.

Last, but not least, however you decide to vote on Amendment 69, please don’t vote for the “reality” TV star who just loves to fire people. (Sorry, just had to include that.) And also please don’t forget that the Green Party Presidential candidate has not endorsed ColoradoCare…. No, really. She hasn’t. I am not kidding….No, this is not The Onion….

Before hell freezes over, please click on this pic to learn the story of Medicare so far. Thank you for your interest in single-payer health care.