A ballot proposal for single-payer health care


We have an epidemic market failure in the way we pay for our health care.

Per person, we spend nearly twice as much on healthcare compared to peer countries with universal healthcare systems, but we’re doing worse, according to the Organization for Economic Co-operation and Development. Although the United States has some of the best specialist care in the world, OECD data shows that we have lower life expectancies and higher infant and maternal mortality rates than any of its peer countries.

Bill Semple

The way we pay for our health care creates inequality in our pursuit of life, freedom and happiness. It is rigged against us, impoverishes the middle class and the poor, and is a source of anxiety for everyone. Even before COVID-19, our unjust healthcare system was pushing 7-9 million Americans into poverty every year. Our healthcare system does even worse for people of color, with maternal mortality rates two to three times higher for women of color.

Our health care payment system only works well for shareholders and executives of insurance companies, drug companies and large hospitals. They count on us to pay anything for health care, especially when the need is dire. Allowing these intermediaries to profit from our pain and disease is corrupting. Insurers plunder our health system like pirates. They now have their eyes on Medicare and are rewarding Medicare Advantage plans by denying health care claims that traditional Medicare would have paid for.

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To create a return on investment, insurance companies collect premiums and strive not to pay for our health care. That’s why when health care is needed, we see high deductibles, high copayments, tight networks, pre-authorizations, spurious claim denials, and surprise billings. And when they have to pay for care, they partner with exorbitant drug and hospitalization costs, acting together as a legal price-fixing cartel.

Contrary to this reality, a study from the Colorado School of Public Health points to a viable solution. The report compares the way we currently pay for health care to a single, publicly funded, privately delivered system. This clearly shows that the simplicity and focus of a nonprofit payment system can cost billions of dollars less, cover everyone, support better health care, and even increase overall employment.

With a single, publicly funded, privately provided way to pay for health care, there is lifetime coverage, guaranteed regardless of employment, marital status, income, immigration, disability status, race or creed. It would be a bonus system based on income, therefore accessible to all. When care is needed, the focus would be on health care, not how to pay for it.

This would reduce costs for payers and for medical providers. Suppliers would not need to give voluntarily care, wouldn’t have to take 50 cents out of every dollar for patients sent to clinics – and, most importantly, could focus a lot more on care and less on data entry. A single Colorado-wide health care system would have the clout to negotiate fair prices for drugs and hospitals.

Although the Colorado General Assembly considered many measures related to health care during the recent 2022 session, it did not adopt the fundamental wisdom contained in the task force report.

So here’s what would work:

Ask the 2023 General Assembly to consider a bill returning to the November 2023 ballot a measure allowing the creation of a company to pay for our health care that meets the following essential criteria:

  • It will provide comprehensive benefits for medically necessary care, including dental, hearing, vision and mental care.
  • It will provide home care and long-term care at least at the level of coverage currently available to those eligible for Medicaid in Colorado.
  • Health care decisions should be made by patients and their health care providers.
  • Patients should have free choice among qualified providers.
  • To address health care disparities, it will cover all Colorado residents.
  • The system and the cost of care are financed by premiums based on ability to pay.
  • Health care should be prepaid through premiums, with no deductibles or co-payments that create barriers to care.
  • The agency must ensure fair prices for drugs and hospitals as well as fair payment to providers.
  • It will be a state-administered nonprofit and the only health-care paying agency in Colorado.
  • To avoid profiteering, there must be no middlemen with the incentives and power to limit benefits or impose other barriers to care.

By approving this measure, Colorado voters will empower the General Assembly to then design implementing legislation that meets the essential elements above. It’s a proven way to pay for health care.

We currently have a way to pay for our health care that guarantees there will be winners and losers. Some will be well cared for and the shareholders will be enriched. Many will be impoverished and fall through the cracks as racial and economic disparities grow.

A system that works is both simpler and bolder. And that would take care of us, the people.


Bill Semple, of Boulder, is president of the Colorado Foundation for Universal Health Care.


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