It is a mark of the distortion of language around health care access that in a debate between T.R. Reid and Jon Caldara about Ballot Amendment 63 (to overturn the individual mandate of federal health care reform), Caldara's arguments frequently doubled back on themselves.
Debating on Rocky Mountain PBS's Colorado State of Mind on September 24, Caldara insisted his initiative should be added to the Colorado Constitution's Bill of Rights to "save human lives." Noting that in Canada, people lack the "choice" to pay directly for health care, Caldara asserted such a right - restated, the right of those who cannot afford to pay to go without health care. Caldara's is the political right ideal of multi-tiered health care favoring the wealthy who can afford to pay cash.
Advocating "freedom to choose doctors," Caldara comes up against the fact that full choice of health care providers and hospitals is only possible with a single-risk pool insurance like the improved Medicare-for-All model that he denigrates (again, unless one is filthy rich). Full choice of providers and hospitals is denied by private insurances that maintain limited provider/hospital networks, and often require a change of providers with a change of private plans. Given a choice, most people prefer a full choice of health care providers, rather than choice of multiple limited-benefit insurances with profiteering middlemen.
Caldara flirted with another truth when he stated it is "un-American" to force people to buy a product from a "private corporation making big profits." In fact, spiraling health costs largely derive from a for-profit insurance industry whose middlemen game the system for profits by denying, delaying and reneging on health claims - the $20 billion annual practice of "denial management." Multiple private for-profit insurance middlemen also drive up administrative overhead costs - from 3% for Medicare to 10% or more for private health insurances.
The mandate ostensibly at the center of Caldara's scorn was enacted at the insistence of the health insurance industry, which requires a larger pool of insured to spread the risk as a condition of insuring all, even those with pre-existing conditions. In fact, the individual mandate was originally a Republican idea, proposed during the last big health care reform debate in the '90s. Thus, a number of Republicans -- Sens. Orrin Hatch (R-Ut), Christopher Bond (R-Mo ), and Chuck Grassley (R-Ia) -- supported the individual mandate before they rejected it.
Caldara essentially affirmed host Cynthia Hesson's statement that the purpose of the mandate is to "spread the risk" over a larger risk pool. He noted that some health insurance risk pools are comprised of fewer than 200 people, guaranteeing faster rising costs - further case for the largest possible risk pool, an improved Medicare-for-All. Caldara reached for anecdotal stories of Canadians who had to wait in line for health care, disregarding the fact that many in the U.S. cannot even get in line, and die without access to care.
Citing the tendency of people to go without insurance until needed, e.g., in anticipation of surgery, etc., who then drop coverage when no longer needed, Caldara made the most straight-forward case for the insurance mandate. Formerly named by Republicans "free riders," T.R. Reid called those who opportunistically game insurance "freeloaders" - the purposely uninsured whose health care costs are inevitably picked up by taxpayers. Reid cited $270 million in unpaid hospital bills at University of Colorado Hospital last year, and $90 million unpaid at Denver Health - costs ultimately passed on to taxpayers.
Caldara even advised the conservative bugaboo of a litigious remedy, i.e., filing a lawsuit against the insurance company who denies health coverage - another recourse most likely available to the wealthy.
Despite Republican angst over government involvement in health care, a recent poll demonstrates that twice as many people think the health care law should have gone further to change the system as those who think the government should stay out of it. Forty percent think the health care law should do more. Twenty percent want no government involvement.
It is possible to provide comprehensive coverage for all and save over $350 billion annually to boot, confirmed by over 20 federal and state studies to date. It is this very model of single-risk-pool, full provider coverage that Congress has thus far avoided debating, and free marketers like Caldara reject. Free-market health insurance essentially means that health insurers are free to game the system for profit, at the expense of the insured. Real free-market competition should be among providers, not for-profit insurances.
Truth is, most think health care reform is a work-in-progress. The sooner for-profit insurances are eliminated as the centerpiece of reform, the sooner economically sustainable health care for all will be achieved.
Easy shortcut for marking the general election ballot: "No" on all the numbers.
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