Amendment 69 will create ColoradoCare. Its supporters say that ColoradoCare will provide outstanding health for everyone for less. Premiums and deductibles will go away. Cede control over your health care, your liberty, and an additional 10 percent of your income to an unaccountable government monopoly health provider, in return you will get cradle-to-grave care.
Monopoly systems like ColoradoCare have been operating for decades. The VA, the Canadian provincial systems, and England’s National Health Service are structured like ColoradoCare. They provide substandard care that bears little resemblance to the outstanding care promised by ColoradoCare supporters.
Monopoly systems spend less on patient care. After an army of administrators pays itself, sets every price, writes tens of thousands of volumes of new rules and then forces everyone to follow them, there’s less money left for patients. Incentives are poor. Good worker or bad, the pay is the same. Productivity plummets. Fewer skilled people care for more patients. Buildings and equipment deteriorate.
In 2015, The Telegraph reported that the NHS had lost about 1/3 of the doctors staffing its emergency rooms. Most went to Australia to escape poor working conditions. Colorado physicians will just move to another state.
Under Amendment 69, ColoradoCare administrators will set medical prices. Administrative pricing creates medical care shortages. Shortages create waiting lists. Waiting lists reduce official expenditures three ways. Some people die before getting treated. Some become too ill to benefit from treatment. Others go elsewhere and pay cash. In British Columbia, the risk of in-hospital death for coronary artery bypass patients with 2-6 week waits is 1/3 of that for those who wait 12 weeks or more. As Canadian shortages become more severe, Canadians are going abroad to avoid average waits of 70 weeks for a hip replacement. In 2014, the Calgary Herald.reported that some Alberta physicians were meeting their patients in Turks and Caicos to circumvent operating-room shortages.
Monopoly systems ignore individual needs. In Colorado, hernia patients can schedule a surgical repair before problems occur. In England, NHS clinical experts have decreed that surgical repair for pain free hernia patients is “low-value” care. In some areas, surgical repair is covered only when a patient reports sufficient pain. Then he gets to wait, in pain, for an average of 3 months.
When Gloucestershire restricted elective hernia repair in 2011, annual operations fell from 857 to 606. Emergency hernia repairs rose from 98 to 150. Official spending fell, but huge costs were shifted to the people who had their lives disrupted when a pain free hernia abruptly turned into emergency bowel surgery and a hospital stay.
Centralized systems spend less by limiting access to physicians. ColoradoCare guarantees a choice of primary care providers, but it does not guarantee that covered primary care providers will be physicians. The Dutch maternity system shows what can happen to patients when lower-skilled people substitute for specialist physicians.
Dutch women with low-risk pregnancies see midwives. Midwives supervise pre and post-natal care, and labor and delivery. Pregnant women see obstetricians only if they have high-risk pregnancies. Studies suggests that midwife led care reduces direct medical expenditures by 14 to 50 percent.
The Dutch have the highest perinatal mortality rate in Western Europe. The risk of a dead baby for low-risk Dutch women delivering under the care of a midwife is 2.33 times higher than that of a high-risk Dutch women delivering under the care of an obstetrician.
When reducing health spending is the primary goal, reducing individual death and suffering becomes less important. In the New England Journal of Medicine, health planners praised the Dutch maternity system. They described one extra dead baby out of 1,000 deliveries as a “small” increase in risk. The U.S. perinatal mortality rate is 6.24 per 1,000 live births. The risk that central planners call “small” would increase it by 16%.
Amendment 69 requires that ColoradoCare health planners focus on lowering expenditure and optimizing population health. Like the British, the Canadians, and the Dutch, it will do this by degrading health care quality and putting hidden limits on access to effective medical treatments. Official expenditure will fall. Unnecessary suffering will increase.
No matter how well intended, a vote for Amendment 69 is a vote to increase unnecessary suffering for Colorado patients and families.
Linda Gorman is the director of the Health Care Policy Center at the Independence Institute, a free market think tank in Denver.
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