A sick way to save

Only way single payer can contain costs is to deny services

Published September 17, 2007 at midnight

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Of the four original proposals submitted to the Colorado Blue Ribbon Commission for Health Care Reform, only one would reportedly cost less than the system we now have: the single-payer plan.

An economic forecast by The Lewin Group, a consulting firm hired by the commission, concluded that had the single-payer proposal been in effect, Coloradans would have spent about 4.7 percent less for medical services this year.

At a legislative briefing Wednesday, Sen. Ken Gordon, D-Denver, suggested that this finding all but settled the matter - the single-payer program is the best way to both expand coverage to the estimated 770,000 Coloradans who are uninsured and control costs.

Not so fast. The commission will host public hearings in each U.S. House district in October, and won't present its recommendations to the legislature until January - when lawmakers will consider asking voters to adopt one of the proposals in the form of a ballot initiative next fall.

We've spelled out some of our objections to the single-payer plan in an earlier editorial, and we haven't changed our minds.

But let's assume that this system indeed guaranteed medical coverage for every resident. And that its 15-member governing board, which will have "constitutional powers to contain costs," kept overall medical spending in check.

Such fiscal discipline would come with an unacceptable price: dramatic compromises in the breadth and quality of care. Say the plan initially reduced overall medical expenses by the 11 percent Lewin suggests, by wringing out administrative inefficiencies and purchasing prescription drugs in bulk.

After that, however, new costs pile up in a hurry. For one thing, single payer would immediately increase the number of Coloradans with guaranteed coverage by 19 percent.

Moreover, the benefits package envisioned by its sponsors, Health Care for All Coloradans, would be recklessly generous.

Consider this, from the group's presentation to the commission: "All residents \[would be] eligible for the same comprehensive benefits package which includes access to all primary and preventive care, specialty care, surgical care, hospitalization, laboratory and X-ray services, emergency care, automobile and work-related injuries, prescription drugs, durable medical equipment, pathology and autopsies, mental health services, substance abuse treatment, patient education, chiropractic services, dental services, basic vision care, audiology services and treatment, medical transport, physical therapy and rehabilitation and home health and hospice care."

And you could get all those treatments with a nominal $5 co-payment for office visits, $15 for prescriptions or trips to the emergency room.

The plan would not be sustainable. Overall health costs are rising faster than the plan's budget could grow (its increases are limited to growth in state GDP). So the board would have to ration services. Some Coloradans would not receive costly remedies, such as chemotherapy, innovative drugs and organ transplants. And elective surgery for conditions that aren't life-threatening (think joint replacements) would be delayed or denied.

Demand will surely soar when more services are promised and more people are covered. Those are fundamental tenets of economics and functions of human nature. No idealistic proposal can overturn either.

Something will have to give, and that will be state-of-the-art medical care.

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