I've received multiple e-mails in response to my recent letter to the editor in the May 11, 2008 New York Times advocating a free market in health insurance.

I received a number of good questions about the nature of a free market in health insurance, as well as more fundamental issues of individual rights and the proper role of government in health care. Even though we didn't always agree on some important issues, all of the e-mails I received were polite, thoughtful, and articulate.

One correspondent recommended that I post my responses online so that other interested parties (supporters and opponents alike) would have a place to read a more fully developed and explicit explanation of the ideas related to a free market in health insurance. Hence, I've paraphrased and collated an essentialized set of questions and my subsequent responses in the form of this brief FAQ.

The permanent location for this FAQ is at the Freedom and Individual Rights in Medicine (FIRM) website at:
http://www.westandfirm.org/blog/2008/05/faq-on-free-market-health-insurance.html

The FAQ follows below.

Throughout the process of the Colorado Blue Ribbon Commission for Health Care Reform, the two large Denver newspapers have consistently failed to present factual information about the Colorado Health Services Single Payer Proposal -- the one that was most favorably evaluated by the Lewin Group.

Since March of 2007 both The Denver Post and the Rocky Mountain News have each printed a number of commentaries by 'free-market' health care advocates Brian T. Schwartz and Paul Hsieh, as well as commentaries by Sen. Andy McElhany and ex-Senator Mark Hillman. Only Rep. Claire Levy was granted a commentary in the Post that dissented from the predominant 'free market' view.

At least five commentaries since the Spring of 2007 have been submitted by myself and others about the advantages of the Single Payer proposal, as well as the broken system of third-party multi-payer commercial health insurances. The information has been ignored by the Post and the News. Only out-state papers like the Pueblo Chieftain and some northern Colorado papers, including the Fort Collins Coloradoan and the Northern Colorado Business Report, have consistently printed different perspectives of health care reform, including the Single Payer perspective.

Remember grade school, when teachers would punish the whole class for the actions of just a few troublemakers? This is collective punishment, which is typically practiced during wartime or under martial law.

Collective punishment has now arrived with compulsory medical insurance. Known as an "individual mandate," it's the law in Massachusetts. In Colorado, it is central to the "Blue Ribbon" Commission's recommendations, which commissioners presented to the General Assembly on January 31.

Politicians peddle compulsory insurance under the guise of eliminating the "cost shift from the uninsured" by making individuals "responsible." The story is that the uninsured get medical care without paying, which increases premium costs for the insured. So why not simply force everyone to buy insurance?

Because it scapegoats the victim and empowers the true perpetrators of our insurance mess: politicians who pass laws that make insurance and medical care so expensive.

NPR reported on January 15 about a study released in the Journal of Health Affairs the same day, describing increasing waits in U.S. Emergency Rooms, even for the very sick. This on the heels of the Institutes of Medicine recent report that ERs are at a breaking point.

Dr. Arthur Kellerman, professor of emergency medicine at Emory U., noted that though it is popular to point to Canada and the UK for their long wait times for elective procedures, the waits in U.S. emergency rooms are "the waits that matter" -- heart attack victims and other true emergencies are receiving delayed care. Waits for heart attack victims doubled between 1997 and 2004.

U.S. Emergency Rooms bear the brunt of the burden of the crisis in health care access -- those who cannot access primary preventive care resort to emergency rooms for basic health care or delayed crisis care.

In his State of the State speech to the state Senate and House of Representatives, Governor Ritter made it clear that health care reform is one his top priorities for this year. "On health care, my goal remains the same- that all Coloradans have access to some basic level of health care." He stated that we have to keep addressing the cost of health care, but "in a way that acknowledges fiscal constraints of the this state."

Gov. Ritter conceded that there is "no magic bullet to fix a system that is fundamentally broken," and acknowledged the efforts of the 208 commission to take a "thoughtful approach to systemic reform."

The Governor highlighted accomplishments in health care reform that were already made in 2007, such as the 10,000 children enrolled in CHP+ and the new medical home program.

As for upcoming plans, Gov. Ritter spoke of saving costs with the new disease-management programs and the Childhood Immunization Information System.

Read about the speech in the news:

Rocky Mountain News article

Denver Post article

During its nearly 16-month length of service, the Colorado Blue Ribbon Commission for Health Care Reform comprised of 27 members statewide appointed by two governors and 4 legislators -- will have received 31 proposals (23 comprehensive, 7 Single Payer). Four of these proposals were selected for evaluation by the Lewin Group, in addition to a 5th Proposal written by a subcommittee of the Commission. The Colorado Health Services Single Payer Proposal is the only reform proposal that demonstrated any savings for the state -- $1.4 billion -- and also the only one capable of providing comprehensive health care for all. The Colorado Commission chose to base most of its recommendations on its own (5th) Proposal.

The 208 Commission Recommendations fail to address:

In today's Rocky Mountain News has an opinion piece by Sally Pipes of the Pacific Research Institute. She writes: "Ever wonder why health insurance costs so much in Colorado? Well, maybe it has something to do with the fact that every insurance policy in the state must cover all kinds of services — including professional counseling — deemed unnecessary by many."

In October former state senator Mark Hillman wrote about the same topic in the Denver Post: "Women who plan to never have children or who are beyond childbearing years must buy maternity coverage. They also, inexplicably, must pay for prostate screening. People who don't drink must purchase coverage for alcoholism. And despite the added cost of mental health coverage, everyone who buys insurance must purchase it."

Robin Baker, senior policy analyst for the Bell Policy Center, took a close look at the five proposals now being evaluated by the Colorado Blue Ribbon Commission for Health Care Reform and prepared a two-page matrix comparing the options.

"Looking through all these proposals is a big investment of time," Baker said. "I thought it would be helpful for people to be able to compare key elements in each plan at a glance."

To develop the matrix, Baker used the commission’s technical advisory review and evaluation standards and the Lewin Group’s analysis of the estimated impacts.

The matrix compares what the five plans offer in terms of Medicaid and CHP+ coverage, insurance premium and benefits, cost control provisions, provider reimbursement rates and mandates.

It also compares how the five proposals would change total yearly health care spending from all sources in Colorado (currently at $30 billion), changes in health care spending by state government, and reductions in the number of uninsured Coloradans.

The good news is that all five proposals made significant inroads into Colorado's high number of uninsured residents. The five proposals would cover 70 to 100 percent of the estimated 791,800 uninsured people in Colorado.

The 208 Commission met Monday and approved recommendations for health care reform that closely mirror its own "fifth proposal."

The package is estimated to cost the state $1.1 billion more than the $30 billion it now spends on health care each year. It would provide health insurance coverage to 85 percent of Colorado's 792,000 uninsured residents. The plan would also require Colorado residents to buy health insurance or pay a tax penalty, similar to a plan adopted by the state of Massachusetts.

The commission is slated to present its findings to the legislature on Jan. 31, 2008.

For details, read these news reports:

Rocky Mountain News, Nov. 20, 2007
Health care panel offers plan to cover 85% of uninsured, by Bill Scanlon

The Denver Post, Nov. 20, 2007
Health panel OKs options, by Jennifer Brown

Colorado Springs Gazette, Nov. 20, 2007
State panel calls for mandatory insurance, by Ed Sealover