Health care hijacked by insurers, hospital interests, lawmaker says

Rachel Brand, Rocky Mountain News

Published July 22, 2006 at midnight

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She who has an enemy will meet him everywhere.

So it was when state Rep. Morgan Carroll - resting from the special session on immigration - read a July 8 Rocky Mountain News story featuring Dave Rivera's take on health insurance.

"I saw red," said the Aurora Democrat, who is the insurance commissioner's frequent nemesis on health policy.

Her anger prompted a flurry of e-mails.

Rivera espoused the Republican credo on health care: Health savings accounts, tort reform and health information systems will save the day.

Carroll, for her part, believes health care has been hijacked by a "jihad" of insurance and hospital special interests and only substantial government intervention will right those wrongs.

She sweetly conceded Rivera's points are "ideologically pure" - but wrong.

Here's her take on the issues.

So what's the problem?

For the last 10 years, businesses, consumers, everyone have been saying, 'Health insurance costs are outrageous - they're killing us. It is a financial crisis.' And for 10 years, largely out of desperation, we've listened to insurers. Their solution has been to further deregulate the industry and increase competition. So we've removed consumer protection and oversight, we've put in a zillion different barriers in the name of tort reform, and we've capped damages in medical malpractice cases. The result? We've sold everybody's rights down the river, and our health care costs have gone through the roof.

On health savings accounts:

They are absolutely a distraction. Look, I wouldn't find any benefit to shutting them down, but they are a fig leaf over the health care problem.

On what can be done to solve the health care crisis:

One, we need to be able to publicly review health insurance rate increases. Colorado is one of five states that has absolutely no rate review process. Every other state, they either make consumer hearings available, which puts the onus on insurance companies to prove why they need to increase rates, or have specialists in the Division of Insurance who review rates. All these states recognize the insurance industry's right to make money. But it protects consumers against price-gouging.

Two, we need stronger medical antitrust laws. The whole love affair with the free market starts to break down when you have oligopolies like UnitedHealthcare. We need to come up with meaningful medical antitrust laws that protect consumers and do ensure there's adequate competition in the marketplace. When it comes to hospitals, there are three corporations - HealthOne, Centura and Exempla - that basically own most of our access to health care.

Three, insurance contracts with physicians need to be transparent. Insurers are saying their terms of contracting with medical providers are none of our business, but really, when you look at these, you'll find they are contracts not to treat. Contracts not to diagnose. There are rewards and punishments to providers based on how much they contain their costs, which is code for not treating patients. These contracts make up the skeletal system of our entire health care system, and they are telling us it's none of our business?

On the root causes of health care cost increases:

One, slow payment or nonpayment feeds as much as 20 percent of our health care cost inflation. It takes doctors a full-time department to handle their bills. The expense of administratively chasing bad debt is between 18 and 20 percent of unnecessary and nonbeneficial inflation.

Two, lack of merger oversight on corporations.

Then there's unrepentant greed. Health care is now a for-profit game. In 2005, the insurance industry had $401.8 billion in profits. I have no problem with profits, but their profits need to be put in context of the financial damage they are causing individuals and businesses.

What about the free market solution?

The free market doesn't work when the state law says you have to buy auto insurance and workers compensation insurance. Even though health insurance isn't mandated, it's a duress purchase - it has to do with whether you, your kids live or die, are sick or well - and the alternative is worse. It's almost like a utility. The only thing that has gone up year after year are their profits and our premiums.

Let's switch to immigration. What's going to be the effect of the laws that require that the state and employers go to greater lengths to check worker identification?

Is this going to stop illegal immigration? It's not. But surely by checking ID and by running it into a database you are going to remove more people who are ineligible to work in the U.S. It will have some effect, but the honest answer is, we don't know how much.

People will recognize that by the time they have to give a sworn affidavit, and we know they are going to do a database check; someone themselves knows if they are here illegally. Most people fear deportation, so it could be a psychological deterrent.

brandr@RockyMountainNews.com or 303-892-5269

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