My views on health care are very much informed by my experience. I began working on an ambulance when I was 18 years old. During my first summer as an EMT I saw things that many people don’t see during an entire lifetime. One day I ran seven back to back cardiac arrest calls. That means I saw seven people die in a single day in seven different places without any other intervening emergencies or incidents with even semi-happy endings. Nothing turned out good that day, nothing. I know first hand that bad things happen to good people. I am not afflicted with the fiction that “this will never happen to me.”
As a result, I believe firmly that people should have access to health care so they don’t have to suffer needlessly. Hundreds of times I have responded to tragic scenes where people’s lives started out that morning normal as ever and ended with a situation, often not of their own doing, that changed their lives forever. Some people and families were prepared and took it in stride and many weren’t and didn’t. Compassion requires that we care for all of them, not just some them. Not just those that were smart enough, or wealthy enough, or lucky enough to have health insurance.
Insurance is a mechanism to share risk. It works as long as we all have it and it covers every risk. But we don’t and it doesn’t. In the insurance market companies work very hard to exclude those that are more likely to use the benefits--those with more risk. They miss some and some of those people use the benefits. In those cases the insurance companies are incented to execute a two-part strategy. First, they work to minimize or exclude the claim and then they work to cancel the coverage. Sometimes neither works, but too often, both work and the insured consumer finds they don’t have the coverage they thought they had and then they don’t have coverage at all.
This reaction to claims is all in the insurance company’s best interest and we should not expect them to behave differently. It does not benefit consumers, however, and that’s why health insurance companies need extensive regulations. The insurance market is not a “free market” because the free market assumes perfect information concerning the transaction from both the consumer and the insurance company. We never have perfect information and therefore never have free markets, but this case is particularly bad because the consumer always knows more about their health and needs than the insurance company can ever know. So, the insurance company will be forced to accept more risk than they hope for until everyone is required to be in the pool.
We are currently in the mist of the largest health care reform in the last two generations. There is little disagreement that what we want is a system that addresses cost, quality and affordability. The debate begins with how.
Insurance falls under the category of affordability but is related to the issue of cost. If we can keep the costs low the theory is that insurance will be cheaper and more of us will be able to afford it. Then we see insurance company executives getting multi-hundred million dollar severance packages and we begin to wonder if insurance companies are really passing the savings on to consumers or if they are keeping them for themselves and their shareholders. There is a balance here somewhere.
I worked to pass a bill in the 2010 session to create an all-payor database (HB 10-1330) that will eventually require all health insurance payers to submit their data to a single database so we can see what things really cost. It is very difficult to manage that which you cannot measure and we have struggled with measuring health care costs. This is an important step to help do so.
Access is also challenging. Not only do we have to deal with providing access to those who cannot afford to pay, but here in Colorado we must also deal with the challenge of geography. We do not have doctors in each of our sixty-four counties and many people must travel long distances to see a doctor. Some suggest that we can provide health care services using nurses, advanced nurse practioners and physician assistants in rural areas. We can, but there is a difference between both the service and the expertise that these professionals can offer compared to a board certified physician and we need to make sure to recognize that issue as we plan for the future. We may have little choice.
Health care is not an easy issue and it does not lend itself to easy answers. I enjoy this subject and most of the challenges it presents.
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