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Amendment 69 and ColoradoCare: If you like your doctor, you might not get to keep your doctor

Amendment 69 guarantees that people can pick their own primary care provider. What it doesn’t say, and its supporters go to great lengths to deny, is that it does not guarantee that covered primary care “providers” will be physicians.

File photo - Todd Shepherd
File photo – Todd Shepherd

The problem is that Amendment 69 creates ColoradoCare, a government run monopoly health care system, and then directs ColoradoCare to control per person health care costs. People who study health systems incentives and outcomes know that the incentives built into government run monopoly health care systems encourage system managers to reduce the overall quality of the workforce.

ColoradoCare supporters say that such concerns are silly. ColoradoCare will never replace physicians with less skilled practitioners, they say. Unfortunately, their protestations make about as much sense as President Obama’s assurance that under Obamacare, if you like your doctor, you can keep your doctor.

It works like this. Existing bureaucratic measures of government health care system costs are generally too unsophisticated to handle anything much more complex than hourly wage comparisons. They ignore many important costs borne by icon_2016_report_commpatients. As physician substitutes have lower hourly wages, they are said to be less expensive. Absent strong evidence that they harm patients overall in a way the system must take into account, bureaucrats generally conclude that system costs can be reduced by substituting nurses for physicians.

Never mind that more sophisticated evaluations suggest that physicians properly diagnose and treat patients more rapidly than people with less training, and that they do so with fewer tests.

Recently the Veterans Administration proposed doing exactly what ColoradoCare supporters claim will never happen. MD reported that in May, 2016, the VA proposed dealing with physician shortages caused by its budget problems by replacing expensive physicians with less expensive advanced practice nurses. Nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse-midwives will be given “full practice authority” to treat patients without physician supervision.

Like the VA, ColoradoCare will have the power to determine the standard of care, treatment guidelines, and the price that all health care providers in the system get for their services. It can make physicians available or replace them with nurses empowered to treat patients without physician supervision.

Amendment 69 isn’t about keeping your doctor, it’s about whether you will have access to one at all.

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