Guest opinion: Long-suffering rural areas win with ColoradoCare

The plentiful elbow room and endlessly gorgeous panoramas come at a steep price in Colorado’s rural areas: You can swing a dead cat for a long time before hitting a doctor, and your arm will probably fall off before you find one who actually takes your insurance.

Many Colorado towns will probably never be crawling over with doctors, since limited population does mean limited supply, but we’ve made the situation so much worse than it needs to be. Amendment 69 (ColoradoCare) is our best chance to put things right.

Insurance companies make it their business to negotiate special deals and relationships with certain providers. That means if you take any five doctors at random, perhaps only one will actually practice in your “network” and take your insurance. This may look stupid (and to be fair, it is), but it can actually work in bigger cities, where a big selection means it’s easier to find that doctor needle in the provider haystack.

But in a small town that may or may not be lucky enough to have five doctors, this quickly moves from annoyance to aggravation, as patients are forced into long, unnecessary car trips that no doctor would recommend.

Rural residents, whether buying coverage for themselves or a group of employees, may technically have access to just as many insurance plans as the city-dwellers, but if only one plan has doctors locally, it’s no choice at all. To make matters worse, that lack of competition often forces prices up.

Meanwhile, higher poverty rates in rural areas mean that it’s more likely someone sitting in a doctor’s waiting room right now is uninsured or on Medicaid (the scarlet letter of health insurance). Doctors can take the reimbursement crumbs from Medicaid, maybe work out some arrangement with the uninsured, perhaps chalk up some loss as a public service, then shift the rest of the cost to everyone else. Or, more likely, they’ll avoid setting up shop in that town in the first place.

Rural Colorado can’t afford this. The system we’ve set up somehow takes a bad doctor access situation, makes it worse, then makes it as inconvenient as possible.

The only good news is that you can vote to change it in November.

ColoradoCare covers everybody and standardizes payments to doctors. That may not sound revolutionary, but it would turn that doctor’s waiting area into a room full of paying customers, not some big liability whose costs must be shifted to others. That means practicing medicine in a rural area could suddenly becomes more efficient and more lucrative.

And since ColoradoCare works just like Medicare, that means no special deals with only a select groups of doctors, which means big, wide networks. Those five hypothetical doctors from above probably all take Medicare, since they can’t afford to say “no” to such a big customer. ColoradoCare will be no different, and it will have every incentive to make sure doctors are happy and residents are getting a good deal.

Living in rural Colorado brings incalculable rewards. An overwhelming selection of doctors may never be one of them, but the least we can do is quit making life as difficult as possible for doctors and patients alike. A vote for Amendment 69 means we can shore up what we have, use it easily, and maximize our chances of attracting more medical talent.

Erik Nesse is a Colorado native, doctoral student at the University of Colorado, and former health policy researcher.

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