Colorado’s Single-Payer Ballot Initiative

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Michael Cain

Michael is a systems analyst, with a taste for obscure applied math. He's interested in energy supplies, the urban/rural divide, regional political differences in the US, and map-like things. Bicycling, and fencing (with swords, that is) act as stress relief.

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13 Responses

  1. Avatar Will Truman
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    says:

    This is really a bummer. I have my reservations about a nationwide single payer and would really like to see it tried at a state-wide level (willing to support outsized national dollars going into the experiment to help with the experiment transition). Colorado seems like a better field test than the two other states that had thrown the idea around (Montana and Vermont).Report

    • Avatar Morat20 in reply to Will Truman
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      says:

      You need a certain population and demographic diversity to make single-payer work — I’d prefer to see it tested in California, but Colorado isn’t too bad.

      Then again, it’s not like single-payer has never been tried anywhere. That’s one of the weird thing about healthcare debates in the US. There’s about fifteen different models of universal coverage out there, ranging from full-on socialized healthcare to heavily market based solutions, all with at least a few decades of experience and data.

      And yet, we still talk about it like we’re inventing it from scratch sometimes. (The weird hybrid model we have is unique, and yes, the ACA itself is pretty unique because it’s a patch on a crazy system anyways).

      But I would have loved it if the debate over universal health care in America was a heavy debate on whether we wanted something modeled on France, Germany, the UK, Canada, Singapore, etc….

      Sadly, instead we had six months of courting Olympia Snowe (no matter how crazy the proposal had to be to get her to look interested) and Joe Lieberman throwing fits over losing a primary (so dealing with whatever crazy thing he requested). It’s amazing it got done at all.

      Then numerous lawsuits, of course.Report

    • Avatar Stillwater in reply to Will Truman
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      says:

      Yeah. A total bummer. And what’s worse (maybe) is that it’s not even single payer but more like a “payer of last resort” sorta thing.

      I wish I had more to say about a really good post, but I’m just too depressed.Report

  2. Avatar DensityDuck
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    says:

    I wonder how many of those who signed heard “single-payer” and thought “ACA only better”, rather than “supplement to Medicare”.Report

  3. Avatar dragonfrog
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    says:

    FWIW that’s how Canada got single payer health care – Saskatchewan instituted it first, then Alberta, then the feds proposed to fund 50% of any single payer program the provinces might institute, within five years of which the remaining provinces had single payer healthcare. Kind of the same way the US got same sex marriage, and the way they’ll get legal marijuana, both of which looked totally impossible right up until they didn’t.

    The estimate of roughly doubling government expenditures sounds reasonable – healthcare accounts for something like 40% of provincial government spending in Canada.Report

    • Avatar North in reply to dragonfrog
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      says:

      Part of it was probably the times too. I doubt healthcare was 40% of provincial spending in Canada as it was implemented province to province. Most of the modern west implemented healthcare when it was cheaper/less effective and then evolved with it as modern medicine grew up. The US doesn’t have that option.Report

      • Avatar dragonfrog in reply to North
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        says:

        That’s a very good point. Switching into single payer now is a much bigger jump than it was in the 1940s and 50s, when far more conditions had a treatment course of “administer the most effective painkillers we can for the patient’s few remaining weeks of life”Report

    • Avatar Jesse Ewiak in reply to dragonfrog
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      says:

      Are Canadian provinces constitutionally mandated to run a balanced budget? That’s actually what really kills the idea of state-based single payer.Report

      • Avatar North in reply to Jesse Ewiak
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        says:

        No, they are not, Canadian Provinces have bond issues just like the Federal Government does. That is not, however, an answer to cost concerns of healthcare. At some point you’ve gotta recoup the dough from the taxpayers.Report

        • Avatar Michael Cain in reply to North
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          says:

          Most US states can take on debt in the form of bonds, but only for specified things (eg, roads). What most of them are not allowed to do is borrow to raise cash for the operating budget. There are even exceptions to that. As of the middle of December, California has an outstanding debt of $6.2B in its unemployment insurance trust fund (effectively, money borrowed from the feds to meet UI expenses). That’s on the order of a year’s worth of UI payments for them.Report

  4. Avatar Zane
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    says:

    Regarding this part of footnote 2 about long term care: “Almost all states have received waivers from the CMS to use Medicaid dollars to provide in-home assistance because that’s so much less expensive than institutional care.”

    In-home assistance is only less expensive than institutional care under certain circumstances. As a part of of a mix of solutions, using in-home assistance for some patients does reduce the aggregate expense to the state of all long-term care. It is a solution for people who do not require all the services offered in a long-term care facility. These include relatively healthier individuals who lack severe cognitive impairment. Most importantly, these individuals usually have informal caregiving, typically from family members, available to them. The state saves money by shifting part of the care burden from paid providers to unpaid providers.

    Providing the same level of care provided in long-term care facilities (24 hour supervision, some level of medical care and monitoring, bathing, cleaning, cooking, feeding, socialization, physical plant maintenance, etc.) to people living in their own homes without shifting part of the care burden would be far more expensive than providing those services within a facility.

    I’m a fan of Medicaid waiver programs that allow people to stay within their own homes. At the same time, I think it’s important to know why these programs are less expensive. Some of that lower cost is due to unpaid caregiver/family labor.Report

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