Highlight on Colorado: Residents to vote on adoption of single-payer system

Colorado is considering a giant leap in health care reform. Enough proponents of a single-payer health system submitted signatures to the Colorado Secretary of State’s office to see Initiative 20 placed on the 2016 ballot. This system, named ColoradoCare, would cover everyone who lives and earns income within the state.

Ivan Miller, the executive director of ColoradoCare Yes, believes that the initiative would allow the state’s residents to receive premium health coverage at a $5 billion discount from the current system. Administrative costs associated with private coverage would be reduced, and bulk rates for drugs would be available.

Opinions on the matter are loud and varied. Some opponents are hesitant for Colorado to be the first state to actually operate this type of health care coverage, especially on the heels of Vermont’s failure to implement a single-payer system. Others, such as the president of the board of the Colorado State Association of Health Underwriters, believe that such a system “would destroy our industry.” He notes that almost one-fifth of the state’s jobs are in health care, and he believes that the state would have difficulty recruiting physicians. Hospitals in the Colorado Hospital Association have not yet taken a position.

If the new system passes, ColoradoCare would pay instead of insurance coverage. Employers and employees would be responsible for a total payroll tax of 10 percent, while the self-employed would be required to pay 10 percent of net income. The state would apply for a waiver excusing it from the requirements of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

What is single-payer?

Physicians for a National Health Program (PNHP) emphasizes that national health insurance is not socialized medicine. Single-payer insurance pays physicians on a fee-for-service basis, similar to the Medicare program. In contrast, in a socialized medicine system, doctors work for and receive salaries from the government. PNHP believes that a single-payer system allows physicians to maintain autonomy over patient care. The organization argues that many of the fears surrounding such a system, like care rationing, physician overuse, reduction in physician incomes, and bureaucracy, are unfounded or are already present in the current system.

Those that oppose ColoradoCare and single-payer systems believe that the higher taxes required to finance such a system would cause individuals and business owners to suffer. The decision to shut down the system in Vermont was based on economics, as Governor Pete Shumlin (D), who had promised a new health care system during his campaign, stated that the risk of ‘economic shock’ was too great.

Single-payer internationally

While the single-payer system has yet to gain a foothold in the U.S., it has been implemented in several countries. According to PNHP, Canada, Denmark, Norway, and Sweden have publicly administered health insurance. Canada’s national health insurance covers about 72 percent of the country’s health expenditures, and most citizens maintain supplemental insurance that covers the rest of their needs such as prescriptions and dental care. Most Canadian hospitals are publicly owned. In Denmark, all medical and nursing education is free. Patients are not subject to co-pays for doctor or hospital care, but must share some drug costs and some hold private insurance for medications. Norway provides free medical education as well, and imposes some co-pays for drug costs and doctor visits. Patients must register with a local general practitioner. Sweden also offers free medical education and co-pays for services and drugs are capped at a very low amount.