I'm bestselling healthcare journalist TR. Reid, and Colorado is about to vote become the first state in the US with universal healthcare. AMA!

AMA Concluded

Hey Reddit! T.R. Reid here -- former Washington Post bureau chief in London and Tokyo, documentarian with PBS and NatGeo, and author of the bestseller The Healing of America, for which I traversed the globe learning about what works in healthcare. I'm now working on the front lines of the fight for universal healthcare in Colorado, which will vote on Amendment 69, ColoradoCare, this November. ColoradoCare would make history by establishing a universal insurance system that would cover every resident, and is supported by Senator Bernie Sanders and several national organizations.

It's a pleasure being here with you today. AMA about ColoradoCare or what I learned about health systems around the world!

You can read a short excerpt from The Healing of America here: http://www.npr.org/templates/story/story.php?storyId=121062452 and learn more about ColoradoCare, Amendment 69, here: http://www.coloradocare.org/?nosplash=true If you can join us in this historic fight, we've got a great campaign going with national volunteer options. Learn more here: http://www.coloradocare.org/national-powerteam/

Posted Sep 29, 2016, 9:28 PM UTC

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1tudore•

Do you have an recommendations on how to organize people to get proposals like this on the ballot?

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TR_ReidOPColoradoCare Representative•

When we started with ColoCare, we had no $$ and no organization. So we went/ to meetings, gatherings, etc. and explained our idea. One great boon for us was the Bernie campaign; whenever he came to Colo., wefound thousands of people who shared the idea that a decent society should provide heaalth care for everybody. So: Get your plan down on paper, so people can see the idea. Then recruit people, and get them to recruit more people, to spread the word. We needed 98,400 signatures in Colo It seemed impossible at the start. Within 6 /months we got 157,000 signatures. When we explained our idea, people all over the state said, "Where do I sign?"

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1tudore•

Thank you for this answer and this AMA.

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TR_ReidOPColoradoCare Representative•

Thanks everybody for tuning in to our AMA. We can change our unfair, inefficient, and exorbitantly expensive health insurance system by creating local low-cost competitors to the Big Five health insurance giants. Then, at last, we can get decent coverage at reasonable cost for Every American. To help us do it, please visit ColoradoCare.org
--Thank you, T. R. Reid

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shantideva01•

What's the best healthcare system in the world? Thanks

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TR_ReidOPColoradoCare Representative•

I looked at health care systems in all the industrialized democracies. There are several models that work, but I concuded that any system that covers everybody with good outcomes at reasonbable cost is a success. The World Health Org. rated France the best in the world (and the USA 37th). In terms of outcomes per dollar, Japan rates high. It has the healthiest populatioin in the world, longest life expectancy, much better recovery rates from major diseases than the U.S. -and spends about 44% as much as we do per capital.

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denumbaone•

It seems like those are the statistics that would be most important as far as Healthcare goes. What are the downside of Japan's plan (if any)? Why doesn't every country try to implement Japan's plan?

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ShkeebsOH•

i don't generally like your comments but in this instance, i feel its absolutely correct. too much money in politics.

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infl1ct1on•

I am studying Epidemiology, so I have a basic understanding of health care systems around the world but I do not consider myself an expert by any means. For the US in particular, our system is one of the most fractured which is why costs are high and health outcomes are low. We have lots of groups and organizations that are just looking out for their self interests, and there is an extreme lack of coordination within our healthcare system. This fractured system prevents us from implementing a lot of healthcare reform, because while it may be extremely beneficial for individuals, insurers and businesses will lobby against it.

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denumbaone•

I should have been more specific. I know the US' Healthcare system is corrupted by special interests/lobbyists/politicians/etc. My question was directed at every other country that has universal healthcare. What does Japan do differently to achieve those statistics, and is there a reason other countries don't strive for Japan's type of plan.

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NearEarthOrbitColoradoCare Organizer •

Hello r/Political_Revolution ! It's been awhile <3 Thank you T.R. Reid for being here with us!!

I wanted to pop in here to introduce myself. I am a volunteer organizer in Michigan who is helping to coordinate national (out-of-state) volunteers for ColoradoCare. If you have any questions on how you can get involved, please feel free to ask!

T.R. posted our main signup link above: http://www.coloradocare.org/national-powerteam/

We have a whole bunch of great supporter housing for folks that are willing to travel to Colorado to canvass and help organize on the ground.

We're also working on Slack to make phone calls to voters and volunteers, and to execute an extensive social media plan to engage the national stage and elevate the public consciousness, as well as drive volunteers and donations toward the website.

You can join our Team Colorado Slack group by entering your email in our heroku app and an invite will be emailed to you auto-magically :) We hope to meet you there!

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ampersandaeryn•

I have some concern over folks moving to Colorado, getting residency to qualify for ColoradoCare, but then being too ill to hold down a job and thus not giving back to the pool through payroll tax. Is there a system in place to balance out that potential scenario? Or, is the tax rate set with that possibility in mind?

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TR_ReidOPColoradoCare Representative•

We often hear this concern. By law, ColoradoCare will cover only permanent residents whose primary home is Colorado. To be covered,people will have to prove that they meet this test. My guess is we will adopt the same residency requirement that there is to get in-state tuition; that is, proof that you've lived here at least one year, and intend to stay.

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ampersandaeryn•

How would new residents be covered then? I was a transplant in '08 for grad school, so I know the in-state tuition hoops. Once you move to CO and get an ID/license as part of the residency progression, you can't be covered by your old out-of-state insurance, correct?

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TR_ReidOPColoradoCare Representative•

When you move to Colorado you'll stay on your existing insurance plan until you meet the residency rule. For some newcomers, we are required by the Feds to provide coverage sooner than, say, one year. But that person still has to demonstrate that she's a permanent resident of CO and intends to stay.

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innovativedmm•

Is it true that the Koch brothers and most major pharmaceutical companies are throwing in millions on ads, print, and digital media to stop Colorado Care from cutting into their insane profits? 💊

Source: Koch Brothers Attempt to Kill Single-Payer Health Care in Colorado

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TR_ReidOPColoradoCare Representative•

Yes. Ths has become a textbook case of outside money trying to buy an election. The insurance giants in Minn., Ind., Conn., & Calif. have sent in $4 million so far. Big Pharma, about half a million. And the Koch Brothers, closely allied to investors in the for-profit insurance firms, having been runnng (untrue)ads against our plan for months. Thousannds of volunteers are working their heads off to offset this flood of out-of-state $$. But, frankly, it would be good to have some $$ to spend as well. Pls. take a look at ColoradoCare.org to see how to help in this regard.

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innovativedmm•

When profits over people manipulate and control our health, it's time to stand up and fight back. Access to affordable quality healthcare should be made much easier, simple as a matter of fact. ColoradoCare just makes sense.

I signed up to volunteer using the slack link! Hope others will join me!

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1tudore•

Will the single-payer program include a move to fee for outcome, bundled services, or other reforms?

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TR_ReidOPColoradoCare Representative•

Yes. The author of our plan, Dr Aguilar, is crzy about payfor-performance ideas-- paying docs, hospitals, etc. for/keeping people healthy rather than doing procedures. So we have built in experimental programs in this area.

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1tudore•

Do we over-invest our political resources in healthcare reform versus public health measures? Or do we need to increase our investment in both simultaneously?

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TR_ReidOPColoradoCare Representative•

Public health saves lives and saves money by keeping people out of the hospital or ER. It's always a valuble investment. But people still get sick or injured, and then they're in our rotten, unfair, exorbitant health care system. We could save hundreds of billions by fixing health care -- and use those funds to pay for more public health measures.

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evepizza•

Hi TR Reid, thanks for your time. Active ColoradoCare volunteer here. My questions is to do with the impact of coloradocare on labor market. How many jobs will ColoradoCare create? Clearly a lot of admin roles will be made redundent as currently that's the biggest waste of resources in the current system. Any plan to move these labor force into other roles? Can our job market in Colorado sustain such shift?

How do other countries deal this this shift.. any examples will be most appreciated.

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TR_ReidOPColoradoCare Representative•

ColoradoCare will obviate some of the jobs unique to U.S. health insurance --e.g., the people who deny your claims, the people who decide which doctors ad hospitals the plans will pay for. ColoradoCare willcover every doc, hospital, PT, chiropractor, etc., and will pay their claims, But most of the people doing those jobs for the insurance companies don't work in Colo. The big difference will be that the $35 billion we now send to outof-state insurance companies will stay in Colorado--creating demand and business activity and jobs. Ans employers will see that they can provide excellent coverage for employees in Colo at half the average national cost for health insurance; that will draw employers, abd jobs, to our state

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marionsunshine•

Great point.

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evepizza•

This is awesome! I will be pushing this point as I canvass! Thank you so much.

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Patently_Offensive•

Hi, thanks for doing this AMA.

Regarding ColoradoCare, I have tons of questions, but here are just a few:

  1. why did you think it necessary to tax non-payroll income at a significantly higher rate (10%)?

  2. I've used the calculator located here and I'd be paying approximately $2,700 more per year for healthcare. That means I'll be spending well over twice (almost three times, actually) as much as I currently spend to get what is mostly comparable care. How do you justify that cost increase to me, especially when healthcare is easily individualized (I.e., the actual cost of my healthcare is easily differentiated from the actual cost of another's)? Similarly, why should those without children or spouses be paying the same as those with literally any number of dependents?

  3. Why did you cap the income for both the payroll income tax and the non-payroll income tax at $350k (single)/$450k (filing jointly)? Why not higher or lower (with an appropriate change in the tax rate, perhaps)?

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TR_ReidOPColoradoCare Representative•

We taxed non-payroll income because we need that revenue to provide care for everybody in the state. By federal law, our plan has to operate in the black. So we need to tax non-payroll income. However, seniors will get a significant exemption from this tax. And since it is a tax, you can deduct it on your federal income tax return. The self-empployed can get an "adjustment" for paying this tax that will reduce federal income tax. I think we should have had progressive tax rates, as you suggest. I think the theory was that the damn thing is complicated enough already, so we'll just use one tax rate. For simplicity

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Patently_Offensive•

Thanks for the response! I will still be voting "no," but I appreciate all your work and I hope we can get to a more reasonable and fair plan for everyone in the future!

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pternera•

Do you think that Colorado is in a very unique situation wherein Universal Healthcare is possible only in that state? Are there pre-conditions or legislations that have to happen before other states can do their own Universal Healthcare?

Is ColoradoCare a model that any states can do?

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TR_ReidOPColoradoCare Representative•

I strongly believe that Colorado can lead our great country to a destination we should have reached long ago: quality health care at reasonable xcost, for Everybody. (Sometimes called "Medicare Part E" We have become a national leader on issues like teen pregnancy, fracking regulation, and of course, marijuana (We are the highest state in the nation in more ways than one). The problem is, the giant insurance companies also know that Colorado could be a leader. So they are pouring $$millions into our state to buy a No vote. They've decided it's cheaper to try to buy an election in Colorado than in bigger states like NY or Cal.

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bizmarxie•

New Yorker here. Although we don't have ballot initiatives here, my state senator has a bill for single payer in our state legislature. While true universal coverage is fantastic, Isn't for profit medicine and fee for service the underlying issue... and that's why any healthcare reform would ultimately be bankrupting itself?

What has to change to move towards a fee for positive outcome system?

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evepizza•

Another question is on what would ColoradoCare deal with residents travel out of town and fall ill and require medical in other states? I know Canada started with one province too, how did they deal with that?

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TR_ReidOPColoradoCare Representative•

Just like current insurance: if you get sick or hurt when out of the state, we cover tha treatment you need until you are stable enough to come home to Colorado.

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evepizza•

Thank you so much TR!

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pilgrayMI•

Hello!

SO excited to have you here!

Sorry for the generic questions but I'm not super familiar with your work (yet).

What have been the biggest struggles for the (ColoradoCare) campaign? What are the struggles ahead?

How likely is it that, if Colorado Care is accepted and passed, Universal healthcare will spread to other states and eventually be a federal standard??

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TR_ReidOPColoradoCare Representative•

When we make this work, other states will follow, No doubt. That's how the U.S,. got female suffrage, public education, child labor laws, inter-racial marriage, etc. One state does it. If it works, the others follow. Same sex marriage went from 1 state to 50 in a decade. Our biggest problem is the money that the insurance giants are pouring in to run ads against our plan. Interestingly, none of the "No" ads or op-eds have anything good to say about our current health insurance system. Instead, they just trash our plan: $25 billlion tax increase!" -- when in fact, that's less thab we're paying now,

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pilgrayMI•

As far as universal healthcare legislation is concerned, how does ColoradoCare rate against other universal healthcare systems?

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TR_ReidOPColoradoCare Representative•

ColoradoCare will cover everybody, and will pay every licensed provider (i.e.., no "narrow networks." That's the norm in allother industrialized democracies. We also let people choose to buy private insurance if they want (but they still have to pay the Colocare tax, to fund universal coverage). Some countries allow that --it's often a way to get to the front of the queue-- but many don't. The closest model to ColoradoCare is Medicare --that is, a public payment system that pays private doctors, hospitals, etc. But Medcare starts at age 65. ColoradoCare coverage starts at birth (or, really, 9 months before yorur birth).

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denumbaone•

You hear the downside of Universal Health Care from other countries that doctors don't get paid very well, and that lines for the emergency room are really long and take a while to be seen. How will ColoradoCare address these issues?

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TR_ReidOPColoradoCare Representative•

Those problems are real in some countries (e.g., canada). But most have shorter waiting times for both chronic and elective care than the U.S. And almost all rich denmocracies record higher rates of satisfaction with the health care system than the U.S. U.S. doctors earn more than their counterparts elsewhere. But docs overseas fiinish med school with no debt; their malpractice premiums (if any) are tiny by US standards. In most countries, physicians are comfortable upper-middle-class people, Our image of the doc who drives a Lexus to the country club is not shared o verseas. Totally shameless of me, but there's more fascinating comparative lure like this in the book "The Healing of America, at your favorties book store.

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heally_tonest•

Isn't it obvious this should be done on a national scale? (please don't ruin my state...)

Is it true you guys are going to try this in Washington State next?

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TR_ReidOPColoradoCare Representative•

It should be done on a national scale. It probably won't be, because the insurance/Pharma/Hospital industry lobbyists have a lock on the U.S, Congress --and they fight change. If you get everybody covered, give people their choice of any doctor or hospital, save billions of dollars on insurance preniums, and shift control if health care decisions to people in your own neighborhood, how does that ruin your state? If you want ruin, stick with the big inefficient costly insrance companies,

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TR_ReidOPColoradoCare Representative•

Yes, there is a citizens' effort in Washington to set up a system for universal coverage . Orego, Michigan, California, and the New England states are also moving toward ballot proposals. When Colorado passes this, it will spark similar efforts in many states where people are just fed up with being gouged by the insurance companies with their "narrow networks," high deductibles, denied claims, and annual price hikes ten times the rate of inflation.

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rapicastillo85•

Hi TR! Rapi here, from Progressive Coders Network. First, thank you so much for doing this and we are so so excited to help the campaign to bring Universal Healthcare in Colorado.

Throughout the campaign, what is the most surprising misconception / insight you have encountered when talking to people? Where is / how is the pushback for the idea of healthcare for all?

Also, how can volunteers who are passionate about Universal Healthcare help?

I truly believe that having Universal Healthcare implemented in Colorado is the spark that will bring Healthcare for all in America. Thank you so much for fighting a great fight, and we are ready to help any way we can!

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evepizza•

Here is a question on behalf a friend. She heard that countries like Canada will give preference to overseas travellers who pay better fee? Therefore it leaves long waiting list for locals. Is that true? I am Australian in USA, this is definitely NOT the case in Australia.

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CamoHiddenDJ•

Nope, completely false. I know from personal experience you're waiting in the ER queue just as long as everyone else.

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