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Lemon: We need to solve health care crisis

Heather Lemon
Vail CO, Colorado

Juan Martinez needed a lot of work done on his teeth. Colorado Smile Makers took care of that through the generous time and contributions of the University of Colorado School of Dentistry, Rotary International, and other private charities. Supported by Eagle County Public Health Department, Colorado Smile Makers will provide care to 170 patients until August 3. My daughter, Kelly, who was a volunteer through the Edwards Rotary Club as a translator for these volunteer dentists, told us of the stories of other kids similar to Juan. This dental mission only highlights the overall health care needs of residents in Eagle County.

According to Eagle County Public Health Department, Eagle County has a higher incidence of uninsured residents than either the state or national averages. Eighteen to 26 percent of people living in Eagle County report that at least one in their household does not have insurance. That means there are more than 10,000 people without health insurance. With a low unemployment rate, this means that working families are either not provided, or cannot afford basic health insurance.

In the County Health Assessment Report due to be published soon, the health department identifies five basic priority needs for improving health care in our county. The first is improved access. State-mandated insurance coverage programs force insurance companies out of Colorado and drives premium costs beyond the affordability for medium and small business. So far neither national political candidates nor state government has produced a viable, funded plan to address this issue. While government programs are available, not enough providers accept Medicaid or the public child health insurance due to high administrative costs or low and slow reimbursement. Thus far, the Colorado legislature seems content to be locked in ideological rhetoric without addressing a workable solution. Somehow it is easier to simply say “raise new taxes” or alternatively, “no means no” than to actually think through creative answers to real problems.

Public service groups such as the Rotary, Lions, Elks, religious organizations and other non-government agencies are addressing a sector of the greatest need. We need to continue to support these efforts and expand their capabilities. The Eagle Care Clinic provides a huge service. Many doctors and dentists donate their time and services to provide basic care. But a more comprehensive solution needs to be explored.

What was interesting to me about the Great You-Tube Debate was not the number of health care related questions (and there were a lot), but the attitude that was reflected in those questions ” what are you going to do for me, candidate? As our society moves closer and closer to entitlement, the “I deserve to be served” expectations, we either need to re-discover our “bootstrap” DIY (do-it-yourself) practical solution making, or sink into the morass of big government inefficiencies and ineptitude.

Why not explore a county program while our national and state leaders debate the finer points of principled spending?

We could expand the care for the truly indigent through greater support of the service groups, non-governmental organizations, and the public health department. Another possible solution would be for small- and medium-sized businesses to establish a self-funded program where basic underwriting premiums could be determined for the class of business and the number of employees. This pool would be used to cover medical costs for every employee in the program up to a pre-determined limit. The pool would then explore various levels of catastrophic coverage, and negotiate premiums for group plans with a self-funded and sizable deductible.

Charges could be negotiated with providers to relieve them of high administrative costs and give them fair, cost-plus reimbursements. Companies that exceed their pre-determined limit through more claims than anticipated would “borrow credits” from the group and “top up” their contributions going forward. The pooled premiums would be reviewed each year on an underwriting and claims-made basis and the premiums would be adjusted for the coming year. Employees would participate on a co-pay program basis to share the risk as well.

Obviously, this is “pie-in-the-sky” at this point. I do not claim to have the answers, but I believe that the situation is serious enough that we must open the discussion to explore the possibilities. Rather than wait for some national solution ” it is time to be pro-active.

Speaking of service groups, remember to buy your ducks for the Rotary Duck Race on August 19, 2007. One-hundred percent of the proceeds go to scholarships for needy and deserving Eagle County students going on to college. Ducks are available at the day fairs and the grocery stores.

Heather Lemon of Eagle-Vail writes a biweekly column for the Vail Daily. She can be reached at lemonvail@aol.com.


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