HCAC Foundation provides education and research regarding a national single-payer, comprehensive healthcare system for all.
One of the questions we are most often asked at HCACF is to explain the difference between what we support -- a single standard of high quality care for all without financial barrier as financed by a universal, public, single-payer system -- and other plans for reforming Colorado's health care system. The plan we support could be best described as improved or enhanced Medicare for All -- minimizing administrative overhead and maximizing funds for the direct provision of healthcare.
Specifically, some people want to know what is different between our plan, the Colorado Health Security Act, and the health care plan that was offered by Co-Operate Colorado (supported in the Colorado legislature by Sen. Irene Aguilar). The plan supported by HCACF in previous legislative sessions was based on the bill drafted by Dr. Rocky White, reviewed by Colorado's 2008 Blue Ribbon Commission on Health Care, and evaluated by the Lewin Group which found massive cost savings if single-payer were implemented as drafted.
For those interested, the evaluation of the differences is explained below and in this document.
Universal Health Care Financed by a Public Single Payer System:
Key Features of Single-Payer:
1. Universal, comprehensive coverage
2. No out-of-pocket payments
3. An actuarially-sound single insurance plan for pre-retirement US residents administered by an experienced public agency like Medicare
4. Global operating budgets for hospitals, nursing homes, allowed groups and staff model HMOs and other providers with separate allocation of capital funds.
5. Free choice of Providers
6. Public accountability, not corporate dictates
7. The right of the single insurer to negotiate drug prices for beneficiaries
1. Universal Health Care–Universal coverage of health care means that everyone in the population has access to appropriate preventive, curative and rehabilitative health care when they need it, and at an affordable cost. Universal coverage thus implies equity of access and financial risk protection.
2. Public - Public financing is defined as a health care system which utilizes public entities (government) for collecting premiums and paying providers. There is no private or quasi-private or quasi-public "middle man" either collecting the premiums/taxes or paying the claims to providers. We do not isolate the collection of premiums/taxes as the public portion and privatize the payment of claims or other administration.
3. Single Payer - Single payer refers to a type of financing, i.e. a single entity acts as the administrator (payer). When related to an insurance plan, the single payer system refers to a single risk pool. This entity will collect all the fees and pay out all health care costs.
The economic analysis of Health Care in Colorado by Gerald Friedman, PhD, Professor of Economics, University of Massachusetts Amherst, was completed March 2013. This report presents the economic implications through 2024 of three alternative programs for financing and delivering health care in Colorado:
1. A system prior to the enactment of the Affordable Care Act (ACA),
2. The current system with the Affordable Care
3. The adoption under Section 1332 of the Affordable Care Act of the Colorado Health Care Cooperative (CHCC)
The Gerald Friedman analysis was done to evaluate three economic scenarios in Colorado as noted above.
Significant economic impact is noted for the third scenario (The CHCC) with the assumption that the CHCC fulfilled all characteristics for a single payer system.
The CHCC does not fulfill all the characteristics for a single payer system.
Several modifications will allow the CHCC to fulfill the economic predictions. Dr. Friedman is explicit in his analysis of the CHCC proposal that if it was weakened, for example, in any of the following ways, that it would not generate the administrative and other savings he projected:
- If CHCC does not prohibit the sale of duplicate private insurance coverage, or
- If the CHCC does not provide for a comprehensive benefits package, including critical services like rehabilitative services and long term care, thereby eliminating the need for the purchase of supplemental coverage. In ACA terms he assumed the CHCC plan would have at least a 90% actuarial value or "gold" benefits, not skimpy "platinum," "silver" or "bronze" benefits that burden the sick with high out-of-pocket costs, or
- If the CHCC envisions a delivery system of giant ACO’s reimbursed on a risk-adjusted basis.
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