Ever since I was a kid, I’ve been fascinated by tourbillon wristwatches that let me witness the inner workings, movements and complexities of their mechanics. Three centuries of technical refinement have produced marvels of analog accuracy, although it is apparent repairs should never be attempted at home. For those, you should rely on costly expertise. Following the introduction of electronic timepieces, only to be replaced by Fitbits and smart watches, reliance today on a tourbillon is a declaration of Luddite inclinations. For a genuinely conspicuous display, the Tag Heuer Carrera clocks in at a jaw-dropping $75,000.

Last week Andrew Forbes of the Joint Budget Committee staff provided an eye-opening glimpse at the intricacies embedded in Colorado’s proposed public option insurance program. No Good Housekeeping, blue ribbon certificate of approval for what constitutes an effective public option plan exists. The sponsors of last session’s HB-1004 empowered a panel to devise a uniquely Colorado version. While the concept of a non-profit insurance plan, aided by regulatory supports, is easy to describe, its mechanics are devilishly difficult to conceive.

The recommendation which emerged, following statewide hearings conducted by the Division of Insurance (DOI) and the Health Care Policy and Financing department (HCPF), came as a surprise to most stakeholders. Ostensibly intended to lower health care premiums within the individual health care market, tampering with 20% of the state’s economy thrusts the legislature into a future of unpredictable economic consequences. Engineering a cost advantage for those in the individual market, indisputably those who are currently most disadvantaged, is unlikely to be funded from a cushion of waste, fraud and abuse.

It is hoped the public option will reduce individual premiums between 8% and 17%. This reduction in revenue, however, may be recouped by providers simply raising rates for all other health care purchasers. Since the proportion of individual participants is estimated variously at no more than 3% to 7% of insured Coloradans, initially such a bump would prove small. The real hurdle identified by Forbes is the fact that, “The proposed plan will require changes to statute in the upcoming session, including the ability to mandate carrier and provider participation (and) the ability to implement benefit design and rate setting…” This is an ambitious agenda.

Insurers selling plans on the Connect for Health Exchange will be required to offer the public option plan. The state will establish reimbursement caps on pharmaceuticals and hospital services, while the medical loss ratio for public option plans would rise from 80% to 85%. In other words, a lot of oxen are scheduled for goring. The public option proposal suggests the legislature can avoid any risk to Colorado taxpayers by placing the fiscal burden on existing insurance carriers and hospitals — avoiding the operation of a stand-alone, state-run plan. Despite assurances of individualized rate-setting, rural hospitals are already sending out protests that statewide fee regulation could doom their survival. There are also questions whether a mandatory requirement for carriers to offer public option plans may drive some of them, perhaps many or most, off the Health Care Exchange.

Republican state Sen. Paul Lundeen of Monument, who attended the JBC hearing as an observer, asked about the possibility of second- and third-order repercussions. Specifically, he inquired whether the DOI and HCPF currently have the authority envisioned in the public option recommendation. He was told such authority would have to be endowed through the legislation that is considered in the 2020 session. State Sen. Kerry Donovan, D-Vail, who carried HB-1004 in the Senate last year, indicated she couldn’t enlighten her colleagues on how this will be addressed in the eventual bill. Her comment that, “I will have to carry the legislation, and I haven’t seen it yet,” appeared to imply she is not crafting its language but, rather, that the governor and his staff are crafting the initial draft.

In other comments, it was noted that the bundling or capitation of patients, where coverage is compensated on a flat fee paid for each enrollee, often reduces the quality of patient care. There were also vague suggestions that the Connect for Health Exchange may be facing solvency challenges that would be aggravated by the public option. And then, of course, there is the 800% increase in the estimated cost of the state’s reinsurance program during the next two years. This innovation was the source of the administration’s claim it has reduced premiums on the individual market by 20%. DOI insists it has identified the funds to keep the reinsurance program off life support until the arrival of the public option in 2023.

Nonetheless, the governor has requested an additional $60 million in his 2020 budget. Perhaps half this amount is a by-product of TABOR requirements, but it remains a significant miss. Just because we can’t watch the moving parts doesn’t mean they aren’t turning.

Miller Hudson is a public affairs consultant and a former legislator. He can be reached at mnhwriter@msn.com.