Health reform taking root

Forget repeal. Health reform is taking root in Colorado and forcing doctors and insurers to face the facts of their new existence. 

Take, for example, the complaint of nurse practitioner Mary Lou Hendrix in yesterday's Denver Post. In a story by Nancy Lofholm, Hendrix described the difficulties she has encountered trying to be "credentialed" by health insurers whose pregnant customers want to use Hendrix's skills without her being supervised by a doctor.

"Credentialed" means the insurer agrees to pay Hendrix for her services when their customers make a claim through her for payment. According to Lofholm, a 2008 state law allows Hendrix to operate without supervision, at the same rates as physicians. After working for doctors for years,  Hendrix opened her own practice last spring.

In late September, Gov. Bill Ritter officially notified Medicare that Colorado is opting out of a federal rule that nurse anesthetists also must be supervised by a doctor, a full-fledged anesthesiologist. The next day, the Colorado Society of Anesthesiologists and the Colorado Medical Society, representing doctors, sued the state to block Ritter's decision. The lawsuit is pending.

Both developments reflect progress and resistance toward enactment of health reform meant to improve the lives of Coloradans. Nurse practitioners and nurse anesthetists can make competent health care available to more people across the state, expanding the market for their services and providing a measure of competition to doctors. Perhaps even driving down some prices.

For nurse anesthetists, the argument for their not needing a doctor's supervision is more than two decades old. I dated a nurse anesthetist in Texas, before coming to Colorado, who had to leave Austin for Idaho in order to practice her skill in a market unfettered by rules protecting the livelihood and wealth of doctors.

But when Ritter opted Colorado out of the Medicare rule this year, only 15 other states had done the same, showing how long it takes some reforms to take root. Hendrix's continuing problems with insurers illustrates the same slow creep of progress.

Following Ritter's decision and the filing of the lawsuit, the Colorado Society of Anesthesiologists posted on its website a call for members to register their displeasure with Ritter by calling or e-mailing his office. Lorez Meinhold said the office has received one complaint since the Sept. 28 announcement; that e-mail came in on Nov. 1. 

Health care in these United States can hardly be called a revolution, despite the Tea Party's Revolutionary War custumes during the last election campaign. Evolution occurs with each dying dinosaur's extinction. One day in Colorado, the evolution of a 21st century health-care system will be complete.