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Amendment 69: Pros and Cons

This November, Coloradans will have the opportunity to vote on a yet another historic referendum. Amendment 69 would replace the Affordable Care Act with a statewide, single-payer plan, offering comprehensive health coverage, from preventative check ups to end-of-life care for all Colorado residents.

The plan, if enacted, would be funded by a payroll tax of 10 percent, of which employers would pay 6.7 percent and workers 3.3 percent. An additional 10 percent tax on investment income, income from the self-employed, and some small business income would help fund the program as well.

We asked two local health care professionals, one active, the other retired, to weigh in on the pros and cons of the Amendment. Dr. Joe Lyford had a family practice in Buena Vista from 1964-67 and was then a member of the Army Medical Corps for two years during the Vietnam War. Afterwards he did an ophthalmology residency and then practiced in Arkansas and Salida until his retirement in 2005. Dr. Robert Hunter is the director of the Orthopedic Center of Excellence at Heart of the Rockies Regional Medical Center in Salida. He is also a board member of the Arthroscopy Association of North America.



By Dr. Joe Lyford

When I started my ophthalmology practice, cataract surgery was performed using five large sutures. Patients were hospitalized for five days post-op. They were then fitted with very thick cataract glasses which significantly limited side vision and caused magnification and visual distortion. Today, cataract surgery takes only a few minutes. An artificial lens is placed in the eye and sutures are seldom required. Patients experience good vision almost immediately, often without the need for glasses.
Research has made possible unbelievable advances in my field and in every field of medicine: in internal medicine, pediatrics, psychiatry, dermatology, surgery, audiology, etc. We live in a wondrous age for medical care.
The areas of medicine that have not advanced in this country are patient access and payment for medical services. We can point to two main reasons for the very expensive, convoluted, inefficient and irrational payment system that we have today – the domination of for-profit medical insurance companies and pharmaceutical corporations.
A most recent and very significant effort to improve the access to, and to address the high cost of care is represented by ColoradoCare, Amendment 69. This health care proposal will provide the same comprehensive, cost effective health care coverage for every citizen of Colorado.
Universal healthcare proposals were introduced in the Colorado Legislature in two previous sessions and were stopped in committee due to the strong opposition and lobbying by medical insurance and pharmaceutical companies. A petition drive was therefore started which obtained enough signatures to put it on the November 2016 ballot as Amendment 69 (ColoradoCare).
In our area of Central Colorado, an example of the unnecessarily high costs of medical coverage can be found by looking at the excessive and increasing rates for medical insurance that local tax-supported public institutions now pay.
If ColoradoCare had been in place for the 2015-16 fiscal year, savings would have been for the City of Salida – about $500,000, Chaffee County – about $1,000,000, Salida School District – more than $500,000, and Buena Vista School District – about $600,000. These figures were calculated using 6.67 percent of payroll for medical premium costs and a savings of 59 percent of current workman’s compensation rates (as detailed in Amendment 69). Multiply these savings by the 150-plus school districts in Colorado and all of the cities and counties, and you can see the millions of dollars that would be saved in just the public sector.
These savings will be generated because taxpayers will no longer be paying premiums to private insurance companies. A major portion of these premiums now go to paying hundreds of millions in executive salaries, stockholder profits, advertising, lobbyists and politicians. This is essentially millions of taxpayer dollars currently paid going directly to the private insurance companies instead of paying for the public healthcare that citizens expect their tax dollars to support. Another benefit of Amendment 69 will be dollars savings to individuals from lower negotiated drug costs.

Insurance companies are throwing millions of dollars and lots of misleading statements into the fight against ColoradoCare. Against common sense, they have as their allies, with a few notable exceptions, most of the politicians of both parties at both the state and national level.
One of the major groups against Amendment 69 is Coloradans for Coloradans. The required reporting of donations to the Secretary of State’s office for the period from January 1, 2016, through May 25, 2016, by Coloradans for Coloradans showed the following: over 99 percent of the donations were from (generally out-of-state) corporations and the private health insurance industry. There were 65 donors, with an average donation of $99,665. Anthem Blue Cross/Blue Shield of Ohio donated $1 million. In June of this year, Anthem asked the Colorado State Insurance Commissioner for a 26.8 percent premium rate increase.
By contrast, 99.67 percent of ColoradoCareYES contributions were from individuals, with an average donation of $48.55.
Opponents say ColoradoCare is “government” health care. The only “government” involvement under Amendment 69 is the collection of the medical premium tax by the Department of Revenue. The funds will then directly be transferred to the Citizens Co-op to pay medical insurance and drug bills, not to general state budget funds. Although this fund will be in the billions, it will be significantly less than funds individuals, businesses and public-funded institutions now pay for private insurance premiums and for deductibles.
A Constitutional Amendment is required in order to ensure that politicians will not be able to make changes to ColoradoCare in a way that would allow private insurance and pharmaceutical companies to continuing exploiting our citizens.
Colorado has a chance to be the first state in the United States to do what every other advanced country in the world has done – get for profit insurance companies out of healthcare! As an example, Denmark, whose population is similar to that of Colorado, has had universal healthcare since 1961. According the World Bank, Denmark, in 2014, spent $6,463 per resident on healthcare. During this same period, the figure for the US was $9,403. Despite this, the US ranked 23rd and Denmark ranked fifth in overall healthcare quality per data collected by Nation Master from multiple sources.
I believe Colorado has a rare opportunity to lead the nation as the first state to have a truly universal, cost effective, streamlined medical coverage system. Every citizen of Colorado will enjoy the same high-level benefit package with no deductibles, primary care physicians and specialists of their choice, coverage when out-of-state, and prescription drug coverage.
The full amendment, extensive explanation of benefits, how it will be funded and administered, frequently asked questions, etc. are on the web site,


NO ON 69

By Dr. Robert Hunter

The fact that I oppose Amendment 69 does not mean I endorse our current health care system. I do not. However, I have real concerns about this amendment for the following reasons.
We will be doubling the Colorado budget adding 25 billion dollars of new taxes. These new funds will be managed by 21 elected board members whose only qualifications for directing this program are that they must be 18 years of age or more and they must be Colorado residents. No medical, no business, no management, no financial nor any other background is required.
This board, once elected to a four-year term is not answerable to either the legislative or the executive branches of our Colorado government. In fact, they answer to no one – not even the residents of the state who may not recall a board member for any reason.
To date, no government sponsored health care system (Medicare, Medicaid, VA) has been able to sustain benefits and viability without adding substantial additional money beyond what was anticipated by optimistic experts. In the case of Amendment 69, it is likely, and in fact, probable, that the program will not be viable without somehow managing the predictable fiscal deficit. There are few options to address this, given the constitutional mandate requiring Colorado to balance its budget. One option can add additional taxes.
One can control patient access to services and/or deny certain treatments, or one can reduce reimbursements to hospitals and medical providers. Any and all of these options could have very serious and negative implications for Coloradans.
Further challenging the anticipated budget strain for Amendment 69 is the inevitable influx of new residents to Colorado who may come to take advantage of the free health care offered to all residents. Remember, one does not have to have a job and pay taxes to take advantage of Amendment 69. One must only be a resident. Those who question this inevitable migration need only look at the new Colorado residents who moved here in order to take advantage of legal marijuana.
The funds needed to administer and deliver health care through Amendment 69 represent a new tax to Coloradans and companies doing business here. Those individuals who are employed will pay an additional 3.3 percent tax. Those self-employed will pay an additional 10 percent. In addition, all taxable income including pension and retirement plans that provide a predictable fixed income for retirees, all military retirement income and any other income source is subject to this new tax. This amounts to an immediate reduction in all Coloradans’ retirement plans by 10 percent! That is just for now. If the plan needs additional funding ,which is very likely, this tax will grow.
The new corporate tax of 6.7 percent, although not a direct challenge to individual residents, has potentially profound indirect implications. Businesses faced with this new tax will be forced to look for savings elsewhere in order to remain competitive. One way to reduce costs is to reduce the number of employees. This may be inevitable and this loss of jobs will have a very negative impact on families, communities and the state. Furthermore, Colorado must compete with other states to keep businesses in the state and to attract new corporate business. By adding a new 6.7 percent corporate tax, Colorado becomes a much less attractive state to maintain a business, for business expansion or new business start-up. This loss of a corporate tax base will further challenge projections for tax support for this amendment’s survival.
Finally, for such an expensive and provocative amendment to our constitution, this document is very lean on specifics and details. It paints a very broad picture which will be completed and implemented by the elected board. Thus we have a completely unknown and potentially unqualified board doing the critical job of writing the details which will ultimately be the real structure of health care delivery for the state. For a document that is to become part of our constitution and therefore a permanent part of Colorado life, this lack of a focused outline or structure is very troubling.
Coloradans can and should demand more of our health care industry than it now provides. Unfortunately, I think Amendment 69 moves us in the wrong direction.

Author’s note: These thoughts and opinions are mine and do not in any way reflect the position of my employer, Heart of the Rockies Regional Medical Center.