Tuesday, September 27, 2016

Summary ColoradoCare Amendment 69

Here is a copy of the official summary of Amendment 69 and how it will be implemented.

Summary of ColoradoCare Amendment 69
courtesy of info@ColoradoCareYES.co

ColoradoCare is a resident-owned, non-governmental health care financing system designed to ensure comprehensive, quality, accessible, lifetime health care for every Colorado resident. The benefit package will enhance the comprehensive health care services required by Medicaid and the Affordable Care Act. Premiums will be collected from Coloradans based on income, securing health care regardless of financial circumstance. This efficient, universal system will operate in the interests of Coloradans. By eliminating layers of bureaucracy and reducing administrative and other nonmedical costs, ColoradoCare will cover all residents and still cost less than the current system.

Interim Board: A 15-member Interim Board appointed by legislative leaders and the governor will oversee all operations until residents elect the Board of Trustees. The Interim Board will work with state and federal agencies; apply for Section 1332 waivers; coordinate with providers; develop a non-partisan, fair election process for Board elections in seven local Colorado districts; and establish rules to ensure that meetings, records and operations are public and transparent.

Board of Trustees: Within three years, residents from each of the seven Colorado districts will elect three Trustees. These 21 Trustees will be responsible for all operations of ColoradoCare; establish a purchasing authority for pharmaceuticals and medical equipment; establish separate ombudsman offices for beneficiaries and providers; establish and fund an office to prevent and investigate fraud; establish rules and procedures to ensure financial sustainability; ensure beneficiary confidentiality while allowing for research of ColoradoCare’s database; oversee financial management, transparency of operations, and maintenance of patient privacy; and ensure beneficiaries’ access to quality care.

Health Benefits: Comprehensive benefits must include primary and specialty care; hospitalization; prescription drugs and medical equipment; mental health and substance use services, including behavioral health treatment; emergency and urgent care; preventive and wellness services; chronic disease management; rehabilitative and habilitative services and devices; pediatric care including oral, vision and hearing services; laboratory services; maternity and newborn care; and palliative and end-of-life care. Additional benefits can be provided. 

ColoradoCare replaces the medical portion of Workers’ Compensation. There will be no deductibles. Designated primary and preventive care services have no co-payments. Any other co-payments or cost-sharing must have ColoradoCare’s prior approval and can be waived to ensure access to proper care. ColoradoCare will assure statewide access to emergency and trauma services. Beneficiaries will choose their primary care professionals.

Beneficiaries temporarily living or traveling in another state will receive coverage.

Sunday, September 25, 2016

What Pinnacol’s CEO Kalin Doesn’t Want You to Know about 69.

The lawyer Ralph Ogden recently wrote an op-ed countering Pinnacol Assurance's CEO Phil Kalin's claims about how Amendment 69 would impact Workers Comp pricing and practices.  Mr Ogden is a lawyer with an AV rating (very good to pre-eminent) in Martingale-Hubble Lawyers' Directory.  He was a column editor at the Colorado Bar Association journal and author of a book on appellate practice and procedure.  He understands the law.  Recently, among other activities, he's served as chair of the legal committee for the Colorado Foundation for Universal Health Care and has been involved in helping clarify misperceptions about what Amendment 69 will mean for Colorado workers. 

A couple days ago the Pagosa Daily Post printed this excellent op-ed.  Bill Hudson their editor and Ralph Ogden have been kind enough to give me permission to add this to my growing collection and I thank them.

OPINION: Amendment 69 Will Cut Employers’ Workers Comp Premiums

By Ralph Ogden

In writing his opposition to Amendment 69 (ColoradoCare), Pinnacol executive Phil Kalin suggests that health providers outside its network of hand-picked physicians somehow care less about curing and relieving symptoms of injured workers than those inside its network.

Actually, ColoradoCare will benefit Colorado providers (who do in fact, tend to follow the Hippocratic Oath) in two important ways. 

Saturday, September 24, 2016

Response to C.Conover's response to W.Potter's outrage at CEO compensation packages.

It started with an article by Wendell Potter bemoaning extravagant and increasing CEO compensation packages.  Rising to Wendell's challenge Chris Conover over at Forbes wrote an article sharing one of those epiphanies.  He takes CEO pay and divides it by all employees, presto, see there CEOs aren't milking anyone.  It's a great fantasy argument and I'm sure his math holds.  But, ...  

Conover deftly skips over the reason for the outrage at health insurance company executives with his little math trick. First Mr. Potter:
Skyrocketing Salaries for Health Insurance CEOs 
By Wendell Potter, Center for Public Integrity | Commentary | June 10, 2014 
If health insurance companies announce big premium increases on policies for 2015, I hope regulators, lawmakers and the media will look closely at whether they are justified, especially in light of recent disclosures of better-than-expected profits in 2013, rosy outlooks for the rest of this year and soaring CEO compensation.
Almost all of the publicly traded health insurers reported big increases in revenue and profits last year. The big winners have been the top executives of those companies, led by Mark Bertolini, CEO of Aetna, the nation’s third largest health insurer. Bertolini’s total compensation of $30.7 million in 2013 was 131 percent higher than in 2012. … {read on}
Mr. Conover's retort at Forbes:
What If We Confiscated CEO Compensation For Large Health Insurers And Redistributed It To Members? 
Chris Conover | March 31, 2016

Physician suicides, courtesy of our profits driven medical industry.

(originally posted September 17th, 2016)
These past few days I’ve been spending my spare time trying to learn more about Dr. Tom Horiagon MD, MoccH and his conflict with the Colorado Board of Medicine, or more accurately with some powerful bureaucrats who seem to think they are above the law.

One of the things I was curious about was why he become involved with Colorado Physician Help Program (CPHP) in 2011 and then with the Center for Personalized Education for Physicians (CPEP).  Embarrassingly someone like me, who knows little of the state of today’s medical industry, might first suspect drug or alcohol dependence.  It had been gnawing at me so I wrote him another email asking him about it.

His answer blindsided me: 

In 2011 I was an intensivist at St Mary's Hospital in Grand Junction and I worked hours that were so intolerably long, I was not getting home for days on occasion, needed IV's to remain upright and that sort of thing.  I wrote a letter to my colleagues at Western Colorado Lung Center stating that my condition was deteriorating and I needed a change in schedule or format or contract or something.  My colleagues took the letter to St. Mary's Hospital administration who immediately convened a committee to try to find something wrong with my patient care.  

They worked in secret for year and finally presented me with a list on concerns never raised before (except one I discussed), and initiated a quasi-legal process to exclude from the hospital staff and report me to the state board.  I became suicidal, never had an attorney help, and "lost" the fair hearing.  I started making pretty significant suicide efforts and I reached out to CPHP for help.  I closed my practice and moved back to my home in the Front Range.

Later he added:

Physician suicide is VERY frequently precipitated by these board actions (see Pam Wible MD or Michael Langan MD or Kernan Manion MD on this topic).

That sent me back to the internet and the only way to describe what I found is to share it.  I keep thinking this is what the corporate obsession with profits has achieved for USA’s medical arts.  Time to make a course change, reject the corporate mindset with all it's ills and refocus medicine on healing !

 Vote Yes On Heath Care Reform Amendment 69

400 Doctors Commit Suicide Every Year

Published by PhysicianForFairness on May 14, 2014 | < 3 minutes

Dr. Pamela Wible from Oregon explains that 400 doctors commit suicide every year. 

Colorado Medical Board "adjusts" policy 40-3 Physician Patient Relationship

In doing more research I found this example of the subtle way that our Colorado Medical Board (CMB) is slowly dehumanizing our medical system and evolving it into a corporate industry.

My source is “The Colorado Medical Board Abolished The Hippocratic Duties” written by Dr. Horiagon MD MOccH October 10th, 2015

He starts his story: 

“In the wake of complaints about Colorado physicians involved in occupational medicine and other types of "forensic" practice who violated the Colorado Medical Practice Act Policy 40-3 addressing the doctor-patient relationship, the Colorado Medical Board, without much notice, essentially eliminated the duties embodied in the Hippocratic (and other professional medical oaths) to accommodate corporate interests.”

Then he presents the before and after of CMB 40-3 Policy Statement and I must say it’s creepy the way the thing got artfully watered down.  (Green background represents the old policy statement, pink is the revised version.)

Here is the original policy:
40-3 Policy Statement Regarding the Physician/Patient Relationship
Date Issued:
Date(s) Revised:
And here is the new policy:
40-3 Policy Statement Regarding the Provider/Patient
Date Issued: 11/13/97
Date(s) Revised: 7/1/10; 8/20/15

Purpose: To clarify the Colorado Medical Board’s position concerning the physician/patient relationship
Purpose: To clarify the Colorado Medical Board’s definition of, and position concerning the provider/patient relationship

POLICY: The following statement reflects the policy of the Colorado Medical Board regarding the physicians it licenses.
POLICY: The Colorado Medical Board (“Board”) adopts the following policy regarding the provider patient

A Colorado physician has both medical-legal and ethical obligations to his or her patients. These are well established in both law and professional tradition. 

The prevailing model of medical practice, as it is implemented by some plans, may result in an inappropriate restriction of the physician's ability to practice quality medicine. This may create negative consequences for the public. It is incumbent that physicians take those actions they consider necessary to assure that the procedures in question do not adversely affect the care that they render to their patients

{ Why would the fundamental principles summarized in that paragraph be eliminated? }

Colorado Open Records Act pries into Pinnacol Assurance’s dirty laundry

 and they don't like what they found.  Not much to add to this one, it speaks volumes by itself.


Judge orders Pinnacol to comply with CORA on golf trip

After suing KMGH Channel 7 to block a Colorado Open Records Act (CORA) inquiry into expenses related to an “extravagant” golf trip to Pebble Beach, Calif., Pinnacol Assurance was told Thursday by a Denver District Court judge that the state workers’ compensation giant should adhere to the same CORA requirements as any other public entity.

“This is the right decision under the law and the right decision for the people of Colorado,” said Sen. Morgan Carroll, D-Aurora, who testified before the court Thursday. “If we learned anything over the past year, it is that Pinnacol needs to answer to injured workers, to the businesses it serves, and to taxpayers about how it does business, just like any governmental agency. I’m glad the courts agreed.”

Carroll serves on the Legislative Audit Committee that released Pinnacol’s financial and performance audit in June. That report found numerous faults with Pinnacol’s procedures and practices.

About ColoradoCare, Amendment 69

Before continuing I think I should share details of what ColoradoCare Amendment 69 is all about, courtesy of BallotPedia.org.  Sure Amendment 69 isn't perfect.  But, consider our current profits driven health care system that too often turns into a people crushing mess that gets less responsive and ever more client hostile all the time.  ColoradoCare is a solid effort to turn that around.  

I know that today if you have issues regarding any mistakes with your health care provider or insurer rather than a constructive focused dialogue to understand and resolve the issue(s), the patient is more likely to find themselves marginalized, even made to feel villainized because it seems that all the system sees is an enemy to be ignored as much as possible.  Why have we let that happen?

All too many Colorado citizens have experienced a hostile monolithic system that sees its priorities as savings, profits, and bonuses with patient needs relegated to a distrusted bottomline threatening irritant.  

Consider the various letters and articles that Pinnacol Assurance's president and CEO Phil Kalin has peppered around Colorado these past months attacking Amendment 69 - has he ever once mentioned any of the substantive problems with Colorado's workers comp system?  Nope he gives it a white wash, like he believes it's a perfect system.  For him and his fellow executives I'm sure it is.

He'll never acknowledge that luxurious executive perks and administering compassionate effect health care for our citizens doesn't fit together.  Nope, he will use every device to encourage voters to continue their gravy train.  Will we Colorado citizens and voters give in to their PR machine?  

November 8th is the only time your opinion is taken seriously.  But only if make the effort to vote.



ColoradoCare would contract with healthcare providers to pay for certain healthcare benefits and be responsible for administering Medicaid, children's basic health programs, and all other state and federal healthcare funds.

What would ColoradoCare do?

Al Tompkins explains how NPR and ProPublica exposed unequal workers’ comp system

Al Tompkins at poynter.org tells us about the background story to Michael Grabell's "Insult to Injury" series which looks into how certain self-interests have stealthily been eroding state workers comp programs.  Always seeming to put the workers interests last and executive incentives first.  It's a frightening trend that will continue without an engaged public that stands up and says enough is enough.  We deserve fair and available health care!  Vote Yes on Amendment 69.

How NPR and ProPublica exposed America’s unequal workers’ compensation system
By Al Tompkins • April 12, 2016 Last updated by Kristen Hare April 12, 2016

Michael Grabell's "Insult to Injury" workers comp investigation

Michael Grabell has written an impressive collection of articles looking at today's Workers Comp realities.  He uncovers plenty of information to help us put Pinnacol Assurance's CEO Phil Kalin's misleading Amendment 69 articles into a more realistic light.

Become familiar with the following and you too will be wondering: Why do we allow them to get away with it?  Hopeful this information will help some understand why it's very important for you and your friends to get out and vote this election.  

Help create a Colorado health care system responsive to the people's needs rather than to corporate bonus incentive packages.  Vote Yes on Amendment 69!

Insult to Injury
America’s vanishing worker protections.

Investigations by ProPublica Journalism in the Public Interest

List of articles authored and co-authored by Michael Grabell.

by Michael Grabell, ProPublica, and Howard Berkes, NPR, March 4, 2015

Over the past decade, states have slashed workers’ compensation benefits, denying injured workers help when they need it most and shifting the costs of workplace accidents to taxpayers. More »

by Yue Qiu and Michael Grabell, ProPublica, March 4, 2015

In all, 33 states have passed laws that reduce benefits, create hurdles to getting medical care or make it more difficult to qualify for workers’ comp. Explore the interactive »

by Sisi Wei and Michael Grabell, ProPublica, March 4, 2015

Despite the drumbeat of complaints about costs, employers are paying the lowest rates for workers’ compensation insurance than at any time in the past 25 years, even as the costs of health care have increased dramatically. More »

by Michael Grabell, ProPublica, and Howard Berkes, NPR 
March 18, 2015

Insurance Information Institute challenges ProPublica/NPR’s workers’ comp investigation. Here's our response.

Dr. Horiagon responds to Pinnacol's Phil Kalin's Amendment 69 bashing.

For an introduction to this response by Dr. Horiagon 
visit this link

By Tom Horiagon MD MOccH

This commentary is written is response to an article appearing in:  http://www.journal-advocate.com/sterling-columnists/ci_30282396/amendment-69-damaging-workers-comp-system

Mr. Kalin's assertions fly in the face of the facts. 

Let's address the big errors: Kalin cites the CHI report that had to use very tortured and adverse assumptions in order to derive a year 10 deficit. This long-range prediction assumes no dynamism or adjustment by the ColoradoCare board of directors, no structural cost savings, no effects of decreased administrative costs, no effects of decreasing unnecessary capital expenditures in over-served areas, and adverse assumptions about Federal actions. 

It is also worth considering the source. CHI is an extension of the hospital lobby and hospital networks that thrive by market segmentation and running away from under-served populations will be losers under Amendment 69. 

The claim that Colorado's workers compensation system is one of the nation's best is beyond preposterous. The notion that ColoradoCare would take away access to occupational medicine specialists in Colorado is a lie. 

The fact is that hardly any of the physicians participating in Colorado worker's compensation have any training in occupational medicine beyond what they got in the Level II certification course. 

The Regional OSHA Director cannot recall ever receiving a notification from a Colorado physician about unsafe or unhealthy work environments. 

Why start this blog? + Intro to Dr. Horiagon's response to Kalin

{Originally published September 11, 2016}

My little excursion into ColoradoCare's Amendment 69 has snowballed on me.  All I was doing was researching my response to the Pinnacol CEO's flippant letter to the Durango Telegraph because I have personal reasons to be irritated with Pinnacol Assurance's dishonest practices, but I had no idea...

It's turned into an adventure of dark discovery that just keeps on going.  I documented the first leg of this journey in my previous post.  One of the articles that didn't make the cut

Response to Pinnacol's CEO Kalin's Amendment 69 bashing letter.

{Originally published September 11, 2016}

Phil Kalin Pinnacol Assurance president and CEO has been going around Colorado writing self-serving letters and articles denouncing Amendment 69 the ColoradoCare health care reform amendment on this November's ballot.  I'm responding to the letter he had published in the September 8th issue of the Durango Telegraph and titled "Amendment 69 and workers comp." I have made the effort to incline footnotes with links to further information for your convenience.

Having direct experience with Pinnacol Assurance practices I found their CEO Phil Kalin’s self-serving Amendment 69 bashing letter to the Durango Telegraph (Sept. 8) rather fascinating and I’d like to respond to him.

In his first sentence Phil Kalin voices his opinion: “Is there any question about the damage Amendment 69 would do (to Colorado’s Worker’s Comp program)?” He simply presents this query as a self-evident truth and moved on. But what is it that would be damaged? Worker’s Comp or Pinnacol Assurance’s cozy and profitable arrangement?
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Irene Aguilar, M.D. Colorado State Senator and Primary Care Physician

Yes on Amendment 69: ColoradoCare makes sense economically

Knopf: Slaying myths around ColoradoCare and single-payer health care (column)
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ _____________________________________
Mind you, this is the same Pinnacol Assurance that was taken to task by Colorado legislators for having an excessive profits driven culture of refusing claims. Then reprimanded for spending hundreds of thousands of dollars on an executive golf vacation to Pebble Beach, giving 4.3 million in golden parachutes to 12 outgoing executives and other excessive bonuses.
See footnotes ¶3
Pinnacol Assurance | Performance Audit May 2010 
Colo. lawmakers question bonuses paid by insurer 
Audit: Pinnacol shows abuses  
More Scandal Ahead for Pinnacol?