Vail Daily column: We never learn: Watch out, Colorado
September 6, 2016
"You can always count on Americans to do the right thing – after they've tried everything else." — Winston Churchill
There are many smart people in America. Americans form opinions from the information presented to them. When the information presented is incorrect or incomplete, it is easy to form the wrong opinion.
The art of presenting misinformation and disinformation has been perfected. The people of Colorado are now being bombarded with the need to pass Amendment 69, or ColoradoCare. Most Coloradans have not paid sufficient attention to the amendment. Their opinions are being influenced by misinformation or inadequate information concerning the unintended consequence that are inevitable.
Many might look at Colora- doCare's official website, http://www.coloradocare.org/know-the-facts/increases-savings, and read the following: "With Amendment 69, ColoradoCare, every Colorado resident can contribute their best, knowing ColoradoCare has everyone covered with universal health care."
"Imagine life with ColoradoCare. If you're a resident and you need any kind of health care (including mental health), you just go to see your provider, and ColoradoCare pays the bill."
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Free is great.
"Without the layers of hassles, businesses, providers, and everyone in the state can go about their important work of contributing to their families and communities knowing ColoradoCare has everyone covered."
The problem is nothing is free.
Doubling Colorado's budget
In a statement to the Colorado Independent in October, Bernie Sanders lent his support to the single-payer measure.
"Colorado could lead the nation in moving toward a system to ensure better healthcare for more people at less cost," he said. "In the richest nation on earth, we should make health care a right for all citizens."
Hillary Clinton has not yet supported ColoradoCare. I believe she is afraid it will steal her thunder by having large increases in government health care expenditures she has planned. She plans to increase taxes and get health care governance firmly in the hands of the federal government.
The ColoradoCare website goes on to say, "An economic analysis of health care spending in Colorado has calculated that comprehensive health coverage for every resident could be paid for with pre-tax payroll premiums of 3.33 percent for employees and 6.67 percent for employers."
There has been no effort to prove these numbers are correct.
In fact, all of the Republican establishment politicians in Colorado are against ColoradoCare as well as many high-ranking members of the Democratic establishment.
The Democratic establishment includes Gov. John Hickenlooper and former Gov. Bill Ritter. They are opposed to Amendment 69's passage because they understand the financial burden ColoradoCare would put on the state's budget and growth.
The size of the current state budget is $25 billion. The tax increase for ColoradoCare would be an additional $25 billion. Everyone can assume the state would need more to implement the program.
"ColoradoCare would be far and away the largest tax increase in state history, and would give Colorado the highest tax rate in the nation," the Guardian reported in May. "This would be implemented as a payroll tax that would be split into 3.33 percent for employees, and 6.67 percent by employers.
An additional $18 billion dollars would be asked of the federal government, as well as a waiver to let the state opt out of the Affordable Care Act in order to fund ColoradoCare.
If voters approve ColoradoCare, it would be written into the state Constitution, making it very difficult to dismantle and impossible to amend.
The president of Denver's chamber of commerce is opposed to ColoradoCare because the chamber knows this will drive businesses out of the state and inhibit businesses from coming into the state. Denver's chamber of commerce has worked very hard and very successfully to bring business into the state.
Most of all, these politicians know that Obamacare has failed. Oregon's attempt at the state being the single party payer has failed. Most recently, Vermont's attempt at a single party payer system has failed. Both Oregon's and Vermont's governance realized the great fiscal burden to the state budget as well as its businesses and residents. These states quit before the taxpayers realized the extraordinary tax burden the single party payer system would have on their state.
However, most progressive thinking people cling to the ideology that a single party payer system is the way to universal coverage.
Why did Vermont fail to institute a single party payer system after the state Legislature passed the bill? I will describe the reasons for failure in my next blog.
Walker Stapleton, the Colorado state treasurer, said "a major part of his responsibilities is attention to the fiscal and economic condition of the state" (Delta County Independent, July 27).
He goes on to say,
"If passed by the voters, the provisions of Amendment 69 will have a great negative impact on the state's fiscal and economic health, as well as impacting individual residents fiscally."
"If passed, Amendment 69 — creating a governmental entity called ColoradoCare to administer the health care payment system — would amend the Colorado Constitution. It would not be a legislative issue to which the Colorado Legislature could make amendments as needed."
Stapleton said the state health exchange was supposed be self-sustaining. However, the state health exchange has blown through federal dollars provided.
The state has no way to fix the state exchange or has no way to pay back the federal loan. Walker Stapleton acknowledged the problems with Colorado Health Benefit Exchange, saying, "The exchange was intended to be self-sustaining, and it is anything but, and we have blown through federal dollars."
United Health and others are leaving the exchange. The exchange has one-fifth of the enrollment anticipated because of cost, network size and service.
"The exchange is in a hole and we have not yet come up with a way to fix it," he said.
He added that Amendment 69 would assume the state health exchange burden in addition to its debt. This burden is not good for the single party payer financial burden.
ColoradoCare (Amendment 69) was proposed by a Boulder state senator, a progressive M.D., with support of the other progressive doctors in the Boulder community.
Most physician's practices in the Boulder community are owned by Boulder Community Hospital.
I wonder if the MDs understand the unintended consequences to the state's fiscal health, the unintended consequence to the business environment as a result of the increase in tax rate and the unintended consequence to residents experiencing increases in taxes.
I wonder if these physicians are aware of the unintended consequences to their ability to practice medicine.
I suspect the author of the amendment and her followers have not thought about the unintended consequences.
1. Amendment 69 authorizes state taxes be increased $25 billion annually in the first full fiscal year and by such amounts that are raised thereafter.
2. ColoradoCare would be exempt from Taxpayer's Bill of Rights (TABOR).
3. "A 10 percent payroll tax for every employer in Colorado," Stapleton said. The employer would pay 6.7 percent and the employee 3.3 percent. If a taxpayer were self-employed, he/she would pay both, for a total 10 percent.
4. Investment income is subject to this tax.
5. If the employer is outside the state, the tax does not apply for the employer's 6.7 percent so the employee pays the full 10 percent. Stapleton said, "It is possible retirement income would be taxed,"
Also of great concern to Stapleton are these additional provisions in Amendment 69:
• Transferring administration of the Medicaid and children's basic health programs and all other state and federal health care funds for Colorado to ColoradoCare.
• Transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers' compensation insurance.
• Requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado health care system.
• And suspending the operation of the Colorado health benefit exchange and transferring its resources to Colorado Care.
I hope the people of Colorado understand what this dangerous amendment represents to the fiscal health of the state. The population will only understand its negative connotations if it starts paying attention to the consequences. If it only believes that free medical care is good they do not understand that nothing is free.
A system in which the state offers free medical care will fail at the expense of all the taxpayers. It has already been proven in Oregon and Vermont. There is a more effective and less expensive way!
If you are interested, please read more at standfeld.com.
My ideal medical savings account is democratic and provides universal coverage with the consumers being responsible for their choice of medical care while being in control of their healthcare dollars. Consumers' responsibility for their health is always left out of models of healthcare reform.
If the federal government or a state government wants a business model to be successful, it should adapt my future state business model. It is a consumer driven model with consumer responsibility built in so that consumers control their healthcare dollars.
Stan Feld, MD, FACP, MACE, is retired from a private practice of clinical endocrinology in Dallas. He developed the largest free standing clinical endocrinology practice in the country. His website, "Repairing the Healthcare System," is at stanfeld.com. He spends six weeks a year in Arrowhead.
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