A healthy - and critical - debate

Rachel Brand, Rocky Mountain News

Published August 12, 2006 at midnight

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Health care promises to be high on the list of hotly debated issues in this year's election.

About 770,000 Coloradans are uninsured - 17 percent of the population. Health insurance premiums are rising at three times the rate of inflation. And Medicaid is the fastest- growing part of the state budget.

With the stage set, the Rocky Mountain News asked gubernatorial candidates Bill Ritter and Bob Beauprez how they would reform health care if elected governor.

Republican Gov. Bill Owens' second term expires in 2007, and, by law, he cannot run for another consecutive term. Whoever gathers the most votes in November will become Colorado's 41st governor.

Republican Beauprez is concerned with overhauling Medi-caid to make it "consumer driven" and giving states more flexibility within federal programs.

He is less clear about how to cover the uninsured, offering minor tweaks to the current system.

Democrat Ritter, who declined to answer when he didn't have a response, said he wants Colorado to develop a plan - similar to one in Massachusetts - to cover the uninsured.

But he offered few specifics. Instead he has committed to a "process" toward universal coverage.

Central to the debate about health care: defining "unnecessary" costs. Whatever is unnecessary must be driven from the system, the argument goes.

Beauprez says administrative waste, medical litigation and overusing doctor visits are the problem. He'd support a statewide wellness initiative, nurse help lines, high-deductible health plans paired with health savings accounts, and tort reform as remedies.

It's not clear, though, how much further Colorado can go with tort reform.

The state already has some of the most restrictive caps on malpractice damages in the county. They don't appear to have lowered costs.

Ritter, for his part, pointed to new medical technology and the uninsured as the crux of rising costs.

The uninsured get care in emergency rooms, a wasteful cycle. He was less sure when asked how he would halt the medical arms race.

"Good question," he said, veering into a discussion of how patients aren't good customers.

Meet the candidates

Bob Beauprez

• Age: 57

• Family: Wife Claudia, four children

• Bio: Two-term congressman, 7th District

• Key strengths: Business success, experience in Congress and tenure as former state GOP chairman

Bill Ritter

• Age: 49

• Family: Wife Jeannie, four children

• Bio: Former Denver district attorney

• Key strengths: Served as a missionary in Africa, law-enforcement background

Who are your health care gurus?

Ritter: Joan Henneberry and Sue Williamson at the Denver think tank Policy Studies Inc. Barbara Yondorf, senior program officer at the Rose Community Foundation, has helped talk me through this. I have talked to former Oregon Gov. Dr. John Kitzhaber. I met with John McDonough, executive director of Health Care For All, the group that helped craft the Massachusetts Health Plan legislation. I've also met with CEOs of health insurance companies, hospitals, doctors and members of the Colorado Medical Society.

Beauprez: I consider Dr. Patty Gabow, CEO of Denver Health, one of my very good gurus. I've grown rapidly fond of Dr. Michael Salem, CEO of National Jewish. I have an exceptionally good staffer in Jake Allen in my congressional office. A number of doctors, including a radiologist, Dr. Steve Brown, and Dr. Jack Kletcher, who heads the Colorado Medical Society's political action committee. As a member of the House Ways and Means Committee, on a regular basis we've had Secretary Leavitt in front of us. I have a personal relationship with Dr. Mark McClellan, head administrator for the Centers for Medicare and Medicaid.

How would you take on Medicaid?

Ritter: Certainly the rate of increase in Medicaid spending has outstripped every other category. So it is a big budgetary pressure. There are things you can do to address Medicaid spending, to address prescription drug purchasing that Owens decided not to do. But you can't do it piecemeal. Look at what Massachusetts did: They went to the federal government, received a waiver, then they combined all their state dollar spending - Medicaid, state employees and money for businesses, and they said, we're going to have a statewide health plan. They didn't do it piece by piece by piece.

Beauprez: We need to make Medicaid consumer-driven. And South Carolina and Florida provide some great models. It's what most of us, who have an employer- based system, use: a defined contribution. They tell patients, "Here's your contribution based on your needs." Then, suppose your defined contribution is $1,000. You can use it to buy health insurance. But if you adopt a wellness program, a preventive care program, or get into job training, that's worth some more. And if you end up with some change in your pocket, we'll split it with you. Now we're really changing the paradigm.

What can we learn from Massachusetts?

Ritter: Colorado should be looking to create its own universal coverage plan. The genius of the Massachusetts plan is shared responsibility. I've committed to a planning process that brings everybody with an interest in trying to solve this to the table. People say that sounds vague because we can't offer a specific answer. But even the architect of the Massachusetts plan said, "Don't think you can take our plan and transfer it to Colorado. Commit to a process that has transparency in it, and that's ultimately how you get to a Colorado plan." And if you have to take on interest groups to get there, that's part of being a leader.

Beauprez: We'll know in hopefully a little while. You want to see some results.

The effort is noble if the effort is to give everyone you can insurance coverage.

Gov. Mitt Romney himself has told me he has a problem with the mandatory employer contribution. I understand the argument: Like auto insurance, you ought to have to have health care. We ought to have that debate. I'm usually a mandate-light sort of a guy. But I also recognize when you've got in excess of 17 percent of our state's population uninsured - some of them by choice, some by necessity - that you've got a problem.

Is there the political will to take on the uninsured?

Ritter: The problem with the uninsured is they are not people who exercise their political voice, who show up at political gatherings and meet-and-greets. But I don't talk to anybody who doesn't think the health care system is broken. The conversation this year shows that businesses really believe it is in need of fixing. CEOs and large-business people talk about it, as do small businesses. It's really fascinating the number of businesses around the state that are making business decisions around health care costs.

Beauprez: It's a must-do. We're on an unsustainable path, and health care is rapidly getting more and more expensive.The solution is to make health care and health insurance less expensive. It's a free-market approach. If cars are too expensive, somebody comes in with a more affordable product to get the job done. The other option is to say we'll tax somebody. Who? The health care fairy who is going to pay for somebody's health insurance tomorrow? If we are going to become the caretaker of all people, maybe we ought to do that with the autos you buy, the house you live in, the food you eat. I look at solutions I think are consumer-driven. If people are in charge of their own decisions and their own money, we'll all get along a lot better.

What's driving health care cost increases?

Ritter: One is this race to medical technology, the medical arms race. Look at the technology that's available - we select out the people in need of medical care and least able to afford it, and provide better and better technology to people with private health insurance. That again drives up the cost of insurance and creates more uninsured people. The second driver of health care cost increases is the uninsured because they use emergency rooms for their health care rather than primary care. The cost of caring for someone in an emergency room is greater than in a clinic.

Beauprez: Medical malpractice costs. When 80 percent of doctors readily admit they are practicing defensive medicine, something is wrong. Administrative overhead accounts for 30 percent of medical, and inefficiencies of systems when you don't adopt technology. Excess utilization, too many doctor visits. Is that a surprise? My mom is on Medicare. When you've got a very low or no co-pay, your back is a little sore, you're going to go see a doctor. Somebody else is paying for it.

What do you propose doing about it?

Ritter: In terms of the race to technology: We're not great consumers of health care. Patients and doctors don't look at the cost of care. One solution to the medical arms race is asking hospitals to be more transparent, and to compete on outcomes.

Beauprez: You start with a wellness initiative in the state. People who watch their weight, watch their diet, really reduce the cost of health care. We need a statewide initiative to get kids going to medical school because we need more primary care doctors. The next one is the integration of electronic records. That will save us $3.5 billion nationally, reduce errors and improve quality of care. Nurse help lines and school health clinics, the evidence is overwhelming they improve access to care. Health Savings Accounts aren't for everybody, but 41 percent of people who have HSAs were previously uninsured. Need to rethink the number of mandates we impose on policies in Colorado. We need to look at mandate-light insurance.

What's your take on undocumented immigrants getting care in the emergency room and using hospitals' charity care programs?

Ritter: A part of this issue of the uninsured has to do with illegals, but it's not the driver. Illegals aren't driving unreimbursed care or the numbers of the uninsured. But we need to solve this thing broadly. If people are here illegally, and are working, and you have a system that has shared social and employer-based responsibility - you solve that problem. I'm a person who supports a guest worker visa program.

Beauprez: No doubt that it's a problem. It would be nice if we knew how big a problem. We don't know. Solutions? It's a piece of getting our arms around the whole issue of border security. We need to know who's here, what they're doing here and if they're supposed to go home. Secure the borders and accurately identify workers. I don't have a problem with someone who is legally here participating in the system.

What's your take on mandating that employers provide health care coverage?

Ritter: The Massachusetts plan says there has to be some responsibility on the part of employers. It mandated an employer contribution, although small. Employers have to be part of the solution.

Beauprez: I'm not a big mandate fan. It's fine if employers want to provide health insurance, but that should be a choice that they make.

Gov. Owens vetoed a measure that would have allowed women easier access to the morning-after pill. What would you have done?

Ritter: Signed it.

Beauprez: Vetoed it.

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