HUDSON | Colorado’s health care conundrum: Is it a private or public good?
Author: Miller Hudson - October 22, 2018 - Updated: October 22, 2018
The passing of Bill Coors reminds me that the challenge of providing affordable access to health care across Colorado has produced a recurring history of failed reforms. For nearly 40 years voters have reported the cost of medical insurance as their number one, two or three policy concern, depending on what else was jarring the state’s economy at the time. This conundrum has advanced to the front of the governor’s race as Jared Polis promises to search for a way to cover every Coloradan and Walker Stapleton protests we can’t afford universal health care. At the core of this policy dilemma is a failure to reach consensus on whether health care should be treated as a public or private good.
Highways, schools and public safety services (police, fire and ambulance) are generally acknowledged to be most reliably provided by government, although the failure to adequately maintain our roads is prompting a creeping introduction of toll lanes as well as the much vaunted and promising, yet still unproven, public-private partnership (PPP). Until the middle of the last century, health care was regarded as primarily a local responsibility. Communities built hospitals and advertised for doctors, often providing incentives to relocate. States built medical and nursing schools. Together with clergy and teachers, medical careers were perceived as more a vocation than a profession. Family doctors visited you at home if you fell ill and, in my case, drove to the hospital to execute a treatment release when my parents could not be located after I was injured in an auto accident at 17.
By the 1980s, health care was threatening to consume 8 percent of American GDP and medical costs were viewed as spinning intolerably out of control. Our economy would indeed be great again if we could return to those days of relatively cheap health care. Medical costs are now consuming nearly 20 percent of Colorado’s economy. Bill Coors, one of the few Coloradans with even greater resources than Jared Polis, created the Colorado Health Coalition in response, spinning off a co-op for major employers, including his own Coors brewing company, organized as “The Alliance.” Both eventually failed to halt the inexorable escalation in costs. The alliance that really mattered was the one between medical technology and insurers. Today the highest paid salesmen in our country work for the pharmaceutical and medical equipment industries; the highest paid managers are hospital administrators; the most profitable businesses are the hospitals themselves (better than oil land gas).
When Walker Stapleton argues we can’t afford to pay for universal health care at this price, he is on to something. Yet, it is perplexing that 95 percent of the industrialized world has found it possible to provide universal care for its citizens at half our cost while producing better medical outcomes. Not to mention we are still obligated to pay for universal care, in most cases from our other pocket, each time the uninsured seek treatment in an emergency room. A Byzantine set of cross-subsidies requires the insured to pay for their medical care — at an exorbitant cost under conditions where severity has been exacerbated by an absence of preventive care. As Fran Miller, who served as CEO of Coors’ Alliance, recently observed, “…health care in America has become an extractive industry.” Neither does the market mechanism of competition provide a brake. Medical services are rarely a discretionary expenditure. When my brother needed a triple bypass, he wasn’t seeking the low cost provider.
Beyond that, the political muscle of the medical-industrial complex cannot be understated. Don’t worry about the arrival of robots. If we actually move to a single-payer system, what will we do with the millions, yes millions, of workers shuffling paper for insurance companies and third-party administrators fattening their wallets out of the flood of health care dollars? There is a reason Obamacare spurned a “public option” in favor of private insurers. Colorado’s health insurance exchange, together with MEDICAID expansion, have helped hundreds of thousands of families afford coverage, but they serve as little more than Band-Aids on a cancer.
Waiting on a federal solution seems a fool’s errand. If there is a local strategy that might resolve the cost crisis for Colorado, it seems worth exploring. In a recent conversation with a Republican friend whose daughter requires $25,000 a month in health care interventions, he indicated that Obamacare and its mandate for the coverage of pre-existing conditions saved his business from bankruptcy. He surprised me by adding, “When politicians ask how we can pay for universal coverage, my answer is that in the short term we will all have to pay more.” The power of modern medicine has largely been developed with public dollars funneled to university researchers and drug companies. Perhaps these benefits are best regarded as a publicly purchased asset that should be available to all.
If Jared Polis wishes to tackle this festering problem, I have no objection. Of course, Bill Coors, who was long a health junkie, who ate right and exercised, offers evidence that self-care is the cheapest care of all. 102 years isn’t a bad run.