By Francis M. Miller
Donna Smith recently penned an opinion piece about accountability at the Connect for Health Colorado health exchange.
Smith and I are usually at opposite ends of the opinion spectrum. But, sometimes that spectrum is really a circle and the ends meet. Smith’s series of opinion pieces are spot-on and she writes from the heart. She has the unique ability to perceive the problems with the exchange and call a spade a spade. I admire that in her. That being said, I think we need to reframe this discussion.
The exchange was a mud-child birthed by people without the requisite skills to develop and implement such a grand idea. At present, those who should be held accountable are rapidly distancing themselves to evade blame. That will only hasten the death of the exchange.
I assert that a functioning health exchange is of paramount importance to Colorado’s future economic development for four reasons:
- Colorado’s cost of living relative to coastal areas is lower and attracting hundreds of thousands of disabled, Medicaid and low-income people who are moving inland. It is a mass migration. If you don’t believe me, take a lawn chair and sit at the entrance to any Walmart. This demographic surge threatens to bankrupt Colorado’s health and education entitlement budget over the next decade. We willingly chose to expand Medicaid. Eventually, as health care costs inflate, public entitlement costs will be borne by the citizens of Colorado. We took the bait and now we must fight like a fish on the line.
- Entrepreneurial start-ups need to have health benefits to attract the best people. California has done a bang-up job with Covered CA. Colorado initially appeared successful, but recent revelations suggest we built a parade float. Colorado will pay a huge price if the only new businesses we can incubate are big box retail businesses. We’ll all end up working for $15 an hour without benefits.
- Federal monies flowing into an expanded Medicaid and health exchange are, in a perverse way, sources of economic development. An economic multiplier of 2.75 means these transfer payments have a huge ripple effect on the surrounding economy. Those nurses and doctors take their salaries and buy houses and cars, go to the movies, pay taxes and eat sushi – lots of sushi. Its really big money.
- Individuals and families such as Smith’s were brutalized by the past medical underwriting practices of the insurance industry. They are now praying that the problems at the exchange get fixed. Any close observer of the exchange organization sees half of them tied up in their underwear and the other half whittling wood.
I for one would start at the top in this matter and take a scorched-earth approach. Political operatives, including Gov. Hickenlooper, are spending more time keeping dandruff off their suits than being leaders. The political establishment is noticeably avoiding an intelligent and civil discussion about the exchange. The leaders persist in indulging in partisan bickering. Most of the bloviators are clueless about how to solve the problems, short of auditing the place into oblivion.
The board of the exchange is revealing itself to be a confederacy of dunces. Their participation initially stemmed out of self-interest and a desire for public attention. Now when the chips are down, they can’t seem to work as a team to pull the beer wagon forward. They allowed this problem to develop because they were engaged in social and political “I’m OK – You’re OK” inter-personal transactions to the exclusion of fundamental economic concerns. They let the previous director and management group lead them around by the ring in their noses.
The exchange does not have a viable business model. It is unsustainable under any assumption. It has 45 highly paid employees and a huge call center that it can’t afford. It is being molested by computer vendors. The exchange has, at best, a hostile co-dependent relationship with Medicaid.
There are less than eight months before the next open enrollment begins. A repeat of this opera will result in Connect for Health Colorado suffering the same fate as Heritage Square. It will become a scrape-off.
The essential life-saving moves need to be made in the next 90 days. That doesn’t leave time for a new executive director to develop a checklist. It necessitates a George Patton taking control and moving the organization forward with all deliberate speed. The board has frittered away months of opportunity since Patty Fontenau and her gang revealed themselves not equal to the task. It is the board of directors who must now fall on their swords.
I believe Gov. Hickenlooper should quit trying to appease everyone. He should shake the Etch-a-Sketch and ask everyone on the board to resign. He should then appoint an overseer to take control of the organization. He should give that individual orders to remove anyone who stands in the way of success. The Colorado attorney general should begin an investigation of Deloitte (Medicaid) and CGI (the exchange) with the possibility of suing them for racketeering and corrupt practices.
You might think my suggestions overly aggressive. I guess that comes from years of dealing with politicians, managers and directors who couldn’t light a cigarette with a blow torch. The citizens of Colorado have been betrayed.
I have spent the better part of my life thinking, writing and engaging in health reform endeavors. There have been many people who I came to respect immensely. Former Gov. Richard Lamm, William K. Coors, F. Charles Froelicher, Ron Strahle, Rex Morgan and Joyce Neville are my heroes.
On the darker side are people who have been more like earthworms, insinuating themselves into the process for myriad reasons. But they should not be in charge of something when the stakes are this high.
Donna Smith sees the problem at the surface level and she is gutsy enough to speak out. Her voice comes from personal experience and we should listened to her. She and I would likely part company on the what, when, where, why and how of solving the problems. Despite that listen to her over me. She comes at it from the heart.
The health care system is a layered, nuanced, complex machine. Any economic system that comprises 20 percent of the GDP and affects the lives of every citizen is also political and social. We all have opinions and one vote. But, you don’t build the Empire State Building using a committee of people who will reside in cubicles inside the building once it is built. You hire an architect, a builder and put together a team of professionals who know what they are doing.
That simply has not happened at Connect for Health Colorado and, as a result, we are sinking into the quicksand.
Francis M. Miller is the past president of the Colorado Business Coalition for Health and the vice chairman of the Colorado Health Data Commission. He founded the first consumer cooperative for health care called the Alliance and is the current president of Health Smart Co-op. He blogs on www.thethoughtczar.com.
Opinions expressed in Health News Colorado represent the view of individual authors.