3 Similar regulations had similar effects in other states, effectively destroying the individual insurance markets in New Jersey, Maine, Tennessee, Kentucky, New York, and Vermont. Their imposition in Colorado will crippleits individual market, increase health insurance costs for large numbers of people, expand dependence ongovernment programs, and retard innovation in health care delivery and coverage.The
major area of disagreement is the Commission’s neglect of promising developments in account- based consumer-directed health care initiatives and the decision to instead favor various mandated insurance programs directed or controlled by government. While there is considerable evidence that account-basedconsumer-directed programs reduce costs, there is no evidence that the Commission recommendations for government expansion programs decrease costs. There is, in fact, some evidence that such programs actuallyincrease them.The
area of disagreement is that the Commission recommendations substantially extend governmentcontrol of medical practice without addressing compelling evidence that this has the potential to degrade careand increase costs. Though the Commission frequently asserts that its recommendations will lower costs,improve care, extend medical care to more people, or foster useful innovation, it does not provide adequateevidence to support its case. Cost estimates for the reform plans are likely understated because the model usedto estimate costs was subject to a number of known problems. They are discussed further in Section 4.It is the authors’ view that any successful health care reform policy needs to address: 1) substantive reform of government programs, 2) incentives to reduce waste, and 3) the reduction of costly and unneeded administrativeand regulatory burdens. These are the foci of the largest cost problems in the current health care deliverysystem. When the cost of health care drops, health insurance premiums drop and paying cash for care becomes possible. Paying cash further reduces costs by reducing third party payer overhead, with the result that more people can receive better health care for the same money.The authors also believe that the organizational processes adopted by the Commission likely caused its decisionmaking to suffer from moderate to severe anchoring, framing, and availability biases. The lack of structured factfinding, discussed in detail in Section 5.4, was an important contributor to these problems.
The second section of this document summarizes the areas of agreement and dissent. The third section providesdetailed explanations of the authors’ reasons for dissenting. The fourth section discusses the organizationalimperatives that impelled the Commission to produce recommendations with such a narrow view of health carereform and includes alternative recommendations for the operational structure of future Commissions. The fifthsection provides recommendations for health care reform not endorsed by the Commission.The authors would like to thank their colleagues on the Commission for the time they spent on Commissionactivities, their principled participation, and the education that they provided. The Commission consisted of twenty seven citizens with different backgrounds, experiences, and areas of expertise that provided a valuableresource.The Commission staff was notable for its efficiency, knowledge, and good work in keeping Commissiondeliberations on track.