What Would Colorado's Proposed Health System Mean for NPs?
In my last post, I discussed Amendment 69, legislation proposed to bring universal healthcare to Colorado residents. If approved in the November election, the amendment would make Colorado the first state with a single-payer healthcare system. Politicians in Colorado have varied opinions on the amendment, and spirited debate surrounds its presence on the ballot. Not only are politicians talking pros and cons of single-payer systems, healthcare providers also stand to be significantly impacted with the passing of proposed legislation. What could a single-payer system mean for Colorado's nurse practitioners?
Since Colorado would be the first state to implement a system providing government funded healthcare to all citizens, we can't be sure exactly how the new system would play out. We can, however, look to other single-payer health systems such as that in Canada, and make a few guesses. While there are several examples of similar systems that have been implemented in other countries, debate still exists as to their efficacy. Here's a look at how proponents and opponents of Colorado's proposed single-payer system anticipate its effect on nurse practitioners and healthcare providers as a whole.
Proponents of Amendment 69
Concerning healthcare providers, nurse practitioners included, proponents of single-payer health systems say that the simplicity of dealing with just one entity is a huge benefit. Billing becomes much easier with a single payer system, cutting practice overhead costs that come with dealing with multiple insurance companies. Payments are easier to track, and are guaranteed, eliminating most costs associated with billing and record keeping.
When it comes to patient care, those who favor single-payer systems also argue that this mode of healthcare delivery would be a win for nurse practitioners. Universal coverage allows providers to treat all patients equally. Nurse practitioners, for example, would not be placed in the position of favoring one patient over another based on the type of health insurance the patient carries. Healthcare providers would not need to worry about patients' ability to afford follow-up appointments or medications. In turn, proponents argue that the system would help providers achieve better patient outcomes.
Like opponents of single-payer systems, those in favor of the Colorado amendment, acknowledge that the legislation means reduced salaries for physicians, nurse practitioners, and physician assistants. The state is likely to reimburse providers at lower rates than private insurers, meaning less take-home pay. In Canada's single-payer system, for example, physicians earn lower salaries than their U.S. counterparts. Advocates of Amendment 69 note that although salaries are lower, like other Colorado citizens, providers can expect to receive health coverage through the universal health plan offsetting some of this reduction in pay.
Opponents of Amendment 69
Opponents of ColoradoCare argue that giving the government control of healthcare is a big mistake. A government monopoly over the healthcare system injects politics into the patient care equation. Rather than making decisions that are favorable for patients and providers, legislators look first to satisfy political agendas in the creation and maintenance of such health systems. In the case of Colorado, they say that the state government would be given the power to decide when, where, why, and how patients are treated, rather than the healthcare professional. Regulations that restrict the care a patient may receive will be difficult to circumvent.
Many physicians, NPs, and PAs, also fear that a state-operated single payer system will significantly limit providers' professional freedom. With a single-payer system, providers must either opt into the system, accepting with it the bureaucratic challenges of working within a care delivery model structured by the government at government dictated reimbursement rates, or, opt out. A single-payer system gives healthcare providers fewer options when it comes to structuring their practices and patient panels.
Healthcare providers opposed to Amendment 69 also contend that single payer systems do not reduce practice overhead costs. Billing and coding may become easier, however, within a bureaucratic system, complying with government regulations will inevitably increase practice overhead in other areas.
Perhaps the strongest argument opponents make against Colorado's proposed single-payer system is that of reduced competition in the healthcare industry. Eliminating the free market healthcare economy reduces competition among healthcare providers and facilities. Healthcare providers and practices have less incentive to provide quality, efficient care in a market with low levels of competition. Rather, quality of care, and improvements in the medical field, are fueled by competition among healthcare entities.
It remains to be seen if Colorado's proposed healthcare agenda will pass. If it does, the new face of healthcare delivery in the Rocky Mountain State means significant changes for nurse practitioners working in Colorado.
How do you think Amendment 69 would change your practice as a nurse practitioner?
I think that Universal Healthcare has just too many public benefits for me to consider it based on WIFM (What's In it For Me?) principles. The thing that Canada's universal program has shown is that it increases length of life. I think that one of the things that MUST be considered is a quality-based system, with increases in pay for healthier outcomes. If pay is based solely on use, it will be a disservice to all involved.