Chances are you haven’t given much thought to serving on the bridge of an aircraft carrier. The newest class of nuclear-powered carriers weigh 20 million pounds and can cruise at a top speed of 35 miles per hour. They are accompanied by a task force of faster, more responsive ships, including anti-submarine warfare cruisers, minesweepers, anti-aircraft missile defense batteries and an assortment of armored destroyers with considerable conventional firepower. These are all required to provide the defensive perimeter that protects a carrier and its complement of aircraft from torpedoes, incoming cruise missiles, air to sea rockets and mines. Carriers are sitting ducks. Even when you throw the rudder to force a 90-degree turn, they will travel nearly two miles before they begin to turn, another three before that turn is completed. Inertia is not their friend.
I bring your attention to this before tackling health care reform, which will soon consume 20% of the American economy. This juggernaut, just like the aircraft carrier, is zealously guarded by a phalanx of related industries benefitting from the river of cash feeding the most munificent employer in the country. Pharmaceutical sales reps are the highest paid in the entire economy. Hospital administrators are our highest paid executives, closely followed by higher education administrators, many of whom include medical schools and hospitals in their portfolio. You don’t have to be a socialist to recognize health care costs are too damned high. There was a time when health care lobbyists would claim that, despite the expense, Americans enjoy the finest medical care in the world. This is no longer true. Average lifespans are declining, and our infant mortality leads the developed world. All of which brings us to Catherine Rampell’s question in her recent Washington Post column, “Will you require doctors to make less money?” addressed to the Democratic Presidential candidates advocating Medicare for all.
This question could also be addressed to Gov. Polis’ Office of Saving People Money on Healthcare. There were cost saving victories during the past legislative session, but industry and consumer leaders claim these occurred at the margins. The reinsurance program that recently received a federal 1332 waiver (don’t ask, it’s too complicated), will significantly reduce premiums for consumers in the individual market. Yet this only represents 8% of those served by the Colorado Health Insurance Exchange and likely even fewer in the private insurance market. Nonetheless, this represents a victory for self-employed individuals, who have been screwed the worst by insurers, even though several states beat us to the punch on the concept. And, of course, taxpayers will stand at risk if claims experience turns sour. The cap on insulin prices was set high enough that most existing plans won’t be affected. Those in the individual market, by contrast, or those who are uninsured could soon find themselves at risk as it seems unlikely retailers will accept a financial hit just to keep them alive. At the same time, medical specialists earn 68% more than their Canadian counterparts, according to the Journal of the American Medical Association.
Many of the more systemic reform proposals were diverted into legislative study committees that will offer recommendations to the 2020 Legislature. The most promising of these, for those who rely on either Exchange or private employer coverage, is the creation of a public option insurance plan. At the one public hearing I attended at the Capitol, 50 or 60 citizens (in contrast with the largely mute lobbyists) who testified, appeared to offer 70 or 80 ideas for what a public option plan should encompass. The prohibition against out-of-network charges applied during emergency room visits was another victory for consumers. Whether it works out in practice remains to be seen. There are a bevy of additional requirements established for price transparency, data reporting, prior authorization and rate setting that may make the prevailing consumer theft more apparent but appear doubtful cost control measures.
The health care Leviathan is rumbling on national rails. There is reason to doubt whether any state, however well intentioned, can significantly alter this dynamic. Attempts to institute single payer plans have failed with voters in both Colorado and Vermont. Why neither Michael Bennet nor John Hickenlooper thought to mention this during their recent Democratic debates is a mystery. Single payer may be the right policy destination, but any transition will almost certainly occur in fits and starts as profiteers throw up blockades. Medicare “buy-in” would make sense for those past 50 who retire prior to the age of 65. Meanwhile, those Coloradans who are increasingly self-employed in a gig economy will probably continue to accept the risk of running naked between jobs that offer health insurance. That also saves people on health care. Not so much on stress.
Miller Hudson is a public affairs consultant and a former state legislator. He can be reached at firstname.lastname@example.org.