Amendment 69 would create a single payer health care system in Colorado. It's one of the hottest statewide issues on the November election ballot.

The Bayfield Area Chamber of Commerce presented a forum of Amendment 69 opponents on Sept. 13. They were insurance agents Terri Will and Mary Hunt and retired cardiac surgeon and former American Medical Association president Bill Plested.

Local Amendment 69 representative Guinn Unger gave a presentation for it on Sept. 28.

Colorado has some of the highest hospital costs in the nation, Will said at the chamber presentation. She said she supports the general idea of Am. 69 but has concerns, such as no qualifications for people on the ColoradoCare governing board, and that the board "will be granted all powers necessary." Costs for the federal Medicare system have become far higher than projected when it started, she said. "We don't know how to project what the cost will be."

Vermont implemented a single payer system that the governor shut down because of increasing costs, Will said. What happens to people on the single payer plan if that happens? she asked.

The new taxes on employers will give them the highest payroll tax in the nation, she said.

"We could be an island, the only ones doing this. That could really hurt the economy, business." Will said she's talked to business owners "who say they'll move out of state because of the tax."

Will continued, "Everyone on a fixed income will have to pay. Also interest and dividend income." She likened it to the much criticized Veterans Administration health care system. "Do we want that? Other countries have tried this (single payer). Not everybody likes those. In Canada there can be long delays for tests or surgery. Will we be asked to wait in line if we have cancer?"

Plested asserted, "69 is a poorly conceived and drafted scheme to deliver socialized medicine. ... The (ColoradoCare) board will not be accountable to anyone and can't be recalled." There's no citizenship or educational requirement to be on the board, which will have "vast powers," he said. He cited one economic projection that the taxes raised to pay for ColoradoCare won't be enough to cover increasing costs.

The result will be cuts in services, he said. "This is the way all socialized medicine systems survive, by reducing services." Free markets always out-perform socialism, he said.

Guinn Unger gave a different perspective and asserted that Amendment 69 opponents are putting out huge amounts of misinformation. Opponents generally represent the insurance industry, drug companies, and big for-profit hospital chains, which have vested interests in the current system, he said. That's the primary opposition group, Coloradans for Coloradans, he said.

"It's a (state) constitutional amendment to cover payments for health care. It doesn't deliver health care or make decisions about how you will be treated," he said. "Most of us working on this say we'd be better off with a national single payer system, but Congress can't even pass a budget."

The hope is that ColoradoCare will "kick-start" movement to a national system, he said. The U.S. is the only developed country that doesn't guarantee health care to all its citizens, and in the U.S. the annual health care cost per person, around $10,000, is twice what it is in those other countries, Unger said. But many health care outcomes are worse in the U.S.

Administrative costs under private insurance are much higher (15 percent) than under Medicare (3 percent), he continued. That money doesn't go into actual health care, and neither do these companies' huge CEO pay packages. There are still many people without health insurance under the Affordable Care Act (Obamacare), and many who have received insurance through the act have high deductibles that block access to actual care, Unger said.

"The number one cause of bankruptcies in the U.S. is medical bills," he said. "No one goes bankrupt for medical bills in the other countries" with a single payer system. "ColoradoCare was designed by people who have looked at health care payment systems around the world" and the failed system in Vermont, he said.

People will have to live in the state for a year to be covered, Unger said. Someone can't just move to Colorado when they are sick and get free care.

At the opposition forum, Plested asserted, "If this passes, I believe most physicians would do their best to make it work, but sooner or later they will be mandated to deliver care that they know to be ineffective or inappropriate. Hospital economic survival depends on higher payments from private insurance to cover everyone else," but 69 will eliminate that, he said. It will force doctors to abandon the medical code of ethics to always put the interests of patients first to instead follow the dictates of the ColoradoCare board, he said.

The benefits listed in Am. 69 are worthless generalities, Plested said. Patients will not have a choice of specialists, and they won't have coverage for out-of-state treatment such as at the Mayo Clinic or M.D. Anderson Cancer Center, he said. "This will put your health care in the hands of a distant board interested only in cost. You will get the cheapest medical care possible," he asserted.

Audience member Mike Larson challenged Plested's assertions about the free market system and asked how much you'll be charged for an aspirin in the hospital. Insurance agent Anne Cook responded, "$67 for that."

Plested blamed government interference and mandates for high costs.

Unger said the cheapest health care is that which catches and treats health conditions early. The most expensive is in the emergency room when an untreated condition becomes a crisis, or end of life care.

"Twenty percent of people have 80 percent of the expenses. There are ideas to manage these people better, take care of them more efficiently. There's a big emphasis on preventive care," he said. Hospital costs will go down if they only have to bill Medicare and ColoradoCare, he said.

"Health care isn't free," Unger said. But the increased taxes for ColoradoCare will in many cases be lower for individuals and businesses, from what they pay now for private insurance, co-pays, Workers Compensation and other expenses that will go away, he said. Retirement income that's exempt from state or federal taxes will continue to be exempt, he said. "A lot of people only have Social Security. They don't make enough to owe taxes," he said. People on Medicare would continue on that, and Colorado Care would cover what Medicare doesn't, he said.

ColoradoCare is contingent on getting a waiver from Obamacare, and to get that, "We have to show that this is fiscally responsible," he said.

It's false that the ColoradoCare board will be able to raise taxes, Unger said. "The board must have it approved by the people."

He also challenged opponent claims that the board will decide what is covered or that out-of-state care won't be covered.

"Opponents say all the doctors will leave because the reimbursement rates will be too low," Unger said. "We have to pay them enough to keep them here. They'll get about the same as now when you eliminate all the current administrative costs (in doctors' offices). That could attract doctors."

Reimbursements to doctors will start at 1.3 times what Medicare pays, Unger said. "Many doctors don't take Medicaid patients because the reimbursements are so bad. ColoradoCare will increase their payments, and their administrative costs are reduced."

As for the 21-member elected board, he said, "We would hope people would vote in some medical people. We don't want all of them to be doctors."

Unger said, "This isn't a perfect system. I think it's much better than anything else we've got."