Health Policy Solutions

By Katie Kerwin McCrimmon

Drug possession will not be reduced to a misdemeanor in Colorado this year after opposition from prosecutors torpedoed a sentencing reform bill.

Instead Senate Bill 12-163 will now require a comprehensive study of Colorado’s drug sentencing guidelines that could result in new legislation next year.

Revisions to the bill are expected to be presented to the Senate Appropriations Committee on Friday. The new bill calls for the drug policy task force of the Colorado Commission on Criminal and Juvenile Justice to convene a study and produce draft legislation within six months.

A bipartisan group of lawmakers had hoped that SB 163 would send fewer drug addicts to prison and divert cost savings to expanded treatment programs. But county sheriffs and prosecutors, including Denver District Attorney Mitch Morrissey, fought the bill, saying that without threat of felonies, they could not force drug addicts into treatment.

Backers of the bill said they are disappointed, but hope that new, stronger legislation will result from the study.

“To me it’s very frustrating,” said Sen. Shawn Mitchell, R-Broomfield, one of the bill’s sponsors. “I just don’t think a felony is the right response to a personal weakness.”

While Mitchell is not convinced that drug addiction is always a disease, he said it’s not right to punish people for drug use with the same sentences that are doled out to violent criminals.

Maureen Cain, a criminal defense attorney and legislative policy director for the Colorado Criminal Defense Bar, has been working with the bill sponsors. She said research is clear that felonies don’t help people beat their addictions.

“We had hoped that this year, with all the bipartisan support, we would be able to move forward with substantive changes to the drug sentencing (guidelines) to differentiate between those people who are primarily abusers or addicts of drugs, and those who are in the business of drug dealing and trafficking,” Cain said.

But prosecutors had concerns that made it clear the bill could not move forward this year. Cain said all sides agreed that a six-month study would help bring consensus for comprehensive reform.

“I was disappointed, but not devastated. I’m hoping that we can come back bigger, better and stronger next year,” Cain said. “Once we get (reform) in drug sentencing, then we close more prisons and continue to reduce crime.”

Morrissey had testified about his concerns that the bill would have killed the Denver Drug Court. He said felonies are essential in order to compel drug abusers to participate in tough drug treatment programs.

“I was surprised that this bill was run at all,” said Morrissey. “It was a bad bill. The way it was written, it would have allowed somebody carrying over $1,000-worth of crack cocaine, 80 doses of heroin, over 100 doses of methamphetamine to be walking the streets and that would only be a misdemeanor.”

He described Denver neighborhoods, including Capitol Hill and LoDo, as “open-air drug markets,” and said the impact on the people and businesses in those neighborhoods would have been severe had the bill been enacted.

 Recently, two Colorado congressmen wrote newspaper columns with nearly identical talking points that raised alarms about the future of Medicare and attacked a provision in the Affordable Care Act designed to reduce costs. The larger point in the two columns – one by Rep. Scott Tipton and one by Rep. Mike Coffman – was to endorse the House budget plan, which is based on the so-called Ryan budget, passed by the House last year.  Bob Semro’s response to Tipton first appeared in the Glenwood Springs Post Independent.

By Bob Semro

Rep. Scott Tipton, in an April 2 My Side commentary in the Post Independent, “How I’m fighting for seniors in Washington,” touted a “bold” budget plan approved by House Republicans as the blueprint for preserving “Medicare and other critical safety nets for seniors.”

Bold? Irresponsible is more like it.

The plan would remove the anchors for those safety nets. In order to reduce pressure on the federal budget, the plan would dramatically shift responsibility for those safety nets to the states. More and more seniors would face increasing pressure on costs.

Some clarification and explanation is in order.

Tipton’s commentary described the so-called Ryan budget, named for Wisconsin Rep. Paul Ryan, who chairs the House Budget Committee. Even though it is not likely to become law, the plan has passed the House two years in a row and represents an alternate path on spending. Tipton touched on two major topics: Medicare and the Independent Payment Advisory Board.

Under the Ryan plan, Medicare would cease to exist in its current form for people born after 1957. It would become a voucher-based “premium support” program.

Seniors would get a fixed amount of money to help pay for Medicare or private insurance, with no guarantee that the allotment would keep up with rising health care costs.

Most experts agree that out-of-pocket costs would increase year after year, and according to the nonpartisan Congressional Budget Office, the voucher would be worth 77 percent of current coverage within seven years. Seniors would make up the difference.

By contrast, under the Affordable Care Act, all traditional Medicare benefits are protected. In addition:

• The Medicare Part D prescription drug “doughnut hole” would be virtually closed by the year 2020 (saving affected seniors as much as $3,000 annually).

• Seniors would have access to a range of preventive services without out-of-pocket costs.

• Medicare primary-care providers and general surgeons would be given bonuses to practice in rural areas.

Currently, Medicare spending grows at an average rate of about 6.4 percent per year. Under the new health care law, Medicare spending will be allowed to grow by 5.4 percent. That reduction in spending growth will extend the solvency of the Medicare program by at least seven years, with no reduction in benefits.

The lower growth rate will require a reduction in spending, and one mechanism for achieving that is the Independent Payment Advisory Board.

Congressman Tipton’s commentary described the board as “unelected,” “unaccountable,” “federal bureaucrats” who would “make critical health care decisions for patients” and make “cuts to Medicare.”

Here’s a fuller description of the board: It will be 15 members who are doctors, medical professionals and consumer advocates, each confirmed by the Senate. They will make recommendations to reduce spending growth in Medicare, after reviewing new technologies and best practices from across the country.

And note: the board is prohibited from making recommendations that would ration care, raise taxes, increase premiums, restrict benefits or modify Medicare eligibility.

Congress also has the authority to override any board recommendation, provided that it meets the same spending-reduction targets.

Tipton argued for supporting a bill that would repeal the board. That repeal would do little more than keep the current system – which has failed to reduce spending – in place.

His commentary did not mention Medicaid, the state-federal program for low-income families and seniors. Medicaid represents the most important safety net for seniors for long-term care because it covers the cost of nursing home care when they can’t pay for it on their own.

The Ryan budget would cut Medicaid by $810 billion over the next 10 years and convert it to a block-grant program, with each state getting a fixed amount of money. States then would be required to pay for services, using the fixed amount plus their own funds. As the costs increase, states would either have to put in more of their own money, raise fees or reduce services.

The way to preserve Medicare and other safety nets for seniors is to implement the Affordable Care Act and build on its mechanisms to expand health care coverage, make it more affordable and, over time, control costs.

Bob Semro is a health care policy analyst with the Bell Policy Center, a non-partisan policy research center that advocates public policies that reflect progressive values.

By Katie Kerwin McCrimmon

Justin Swanstrom used to be set for life.

The 56-year-old Denver lawyer and his partner owned a loft in the trendy Ballpark neighborhood downtown. And Swanstrom had a rental home that provided extra income.

Then, last January, he lost his job and two months later, had a heart attack that landed him in St. Joseph Hospital with massive bills and no health insurance.

“I received excellent care. I just feel guilty that I couldn’t pay them,” Swanstrom said.

He and his partner had to sell the loft. Swanstrom lost the rental to foreclosure. And, he’s subsisting now on $700 on month in unemployment, unable to find work and barely able to contribute his share of the rent, much less make a dent in his bills.

The medical debt has wrecked Swanstrom’s financial reputation and he’s now hunting for jobs far beneath his education level.

“Nobody is going to hire me with a bad credit rating. I look like a deadbeat,” Swanstrom said.

A new bill in Colorado, SB 12-134, has passed both houses and is expected to receive the governor’s signature. It requires Colorado hospitals to help uninsured and people like Swanstrom by automatically billing them at the lowest-negotiated fee for their medical care. People without insurance often pay much higher costs for health care than those with health insurance. Billing discrimination has meant that people who suffer a single health calamity can face a lifetime of financial ruin.

“The goal of the Hospital Payment Assistance Program is to provide a way for hard-working, uninsured Coloradans to responsibly pay a fair price for their medical care,” said the bill’s sponsor, Sen. Irene Aguilar, D-Denver, who is also an internal medicine doctor at Denver Health. “And equally importantly, the bill calls for steps to ensure that all Coloradans know this program exists so that they don’t endanger their health and livelihood out of fear of bankruptcy.”

Hospitals have so-called “sticker prices” for every procedure and supply item. Insurance companies never pay full price, but individuals without insurance often get stuck being billed the sticker price or higher. Aguilar said that in Colorado costs for uninsured people can soar to as high as 495 percent of the cost for hospital services and 842 percent of the cost for outpatient procedures. In other words, low-income and uninsured people who are least able to afford expensive health care often are billed the highest rates.

The Colorado Hospital Association supported Aguilar’s bill after she agreed to lower the threshold for participating from 400 percent of the federal poverty level (about $92,000 a year for a family of four) to 250 percent (about $56,000 for a family of four). Hospitals are already supposed to publish guidelines for offering charity care to the poorest patients. But few consumers without adequate insurance know their rights and often end up saddled with massive health debt.

SB 12-134 requires hospitals to be transparent about their financial assistance and charity programs by posting them in hospital waiting rooms and printing the policies on bills. They also must screen the uninsured for discount programs, limit charges to the hospitals’ lowest negotiated private payer price, offer reasonable payment plans, and ensure that patients have received payment options before their bills are sent to collections.

Advocates with the Colorado Consumer Health Initiative, a consortium of 50 health organizations and 500,000 consumer members, pushed for passage of the bill.

“Nobody wants to end up in this situation,” said Serena Woods, director of strategic engagement for the CCHI. “Because uninsured Coloradans lack the bargaining power of insurance companies, they are charged, twice, three times, even four times as much as their insured neighbors.”

Justin Swanstrom suffered chest pains for two days, tried to ignore the pain and went to a chiropractor before his partner tricked him into going to the ER. Once there, doctors hooked Swanstrom to monitors, found he was having a heart attack and wheeled him directly into surgery.

Paramedics have told Aguilar of other cases where people suffering heart attacks and other health emergencies refused medical care because they didn’t want to destroy their families’ finances.

“You shouldn’t have to worry about going bankrupt. You should take care of your health and do the right thing. If you need to go to the hospital, you should go,” Aguilar said.

Each hospital system has a different policy. Many for-profit hospitals require patients to agree to pay up front before they receive treatment.

That type of policy can blindside people, even those who think they have good health insurance.

Leadville teacher Heidi Johnson, 33, was snowboarding at Loveland a month ago and blew out her knee.

Ski patrol workers helped her down the mountain and she received emergency care at Centura’s Keystone Medical Clinic. Days later, on the morning that Johnson was supposed to have surgery at the Vail Valley Surgery Center, she said she received a call telling her that she would have to agree to pay $2,750 up front or she wouldn’t get the surgery. The center is partially owned, but not operated by the Vail Valley Medical Center.

After a snowboarding accident, Heidi Johnson needed knee surgery. Before the surgery, she said she had to sign papers promising to may nearly $3,000 even though she's a teacher and thought she had good health insurance.

“What are you talking about?” Johnson remembers saying. “But it was right before I went in. They said, ‘This is what you have to pay. The best we can do is give you four payments.’

“What am I going to do? I needed the surgery. I can’t walk. I figured I have to do this now. I’ll figure this out. I’ll just have to take it out of savings,” Johnson said.

Feeling she had no choice, Johnson signed the paper and received surgery for two torn ligaments in her left knee, her anterior cruciate ligament (ACL) and her lateral collateral ligament (LCL).

After the surgery, as she began to recover, Johnson realized that she was facing a financial mess.

“I’m looking at all of these bills and I can’t afford that. I’m out of work for the next month and now I have to pay for physical therapy three or four times a week,” she said. “I thought teachers are supposed to have good health insurance.”

Instead, she learned that her policy has a $1,000 deductible and that she’ll have to pay at least $3,750 out of pocket because her insurance covers 80 percent of her expenses while she has to cover 20 percent.

She’s trying to go to physical therapy and heal as quickly as possible, but each time she goes, she has to a pay a $37 co-pay, which can add up to hundreds of dollars a month.

Johnson called the surgery center back and tried to negotiate a better deal. She hoped to make smaller payments.

“I was under the impression that if you paid at least $10 a month, you could do that,” Johnson said.

But, she said the billing department told her that she signed the financial agreement and would have to abide by it or they’d turn her over to debt collectors. Knowing she wouldn’t have enough to cover payments to the clinic, Johnson canceled the debit card she had given to the surgery center on the morning of her procedure. The new law focuses on people who are uninsured, not those who are underinsured like Johnson. But many hospitals have charity policies and sometimes negotiate with patients who are having trouble paying for care. For now, Johnson  is trying to heal and plans to sort out bills later.

On top of getting better financial advice about surgery, Johnson thinks consumers need more help understanding health insurance.

“I just wish I got more explanation on the insurance (through my work). I had two choices. Maybe I chose the wrong one.”

Altogether, Johnson thinks she’s facing about $4,000 in medical bills. Since she can’t walk, she can’t teach. She says she’s missing herfifth-graders and doesn’t know if she’ll be able to wait tables this summer to supplement her income.

“It’s terrible. This isn’t what I want to be doing. I want to be teaching and hiking, running and biking,” she said.

Shewit Doherty is still paying off medical bills from a snowboarding accident three years ago. She was 19, uninsured and a student at the University of Denver when she broke her wrist while snowboarding at Arapahoe Basin in 2009. She went for help to the Keystone Medical Clinic.

“I told them I didn’t have insurance. They said that in order to be seen, I had to put down $400 up front,” Doherty said. “When you’re in pain like that, you’ll say yes to anything. I put in on my credit card and had to agree to accept the bill later.”

Justin Swanstrom was sure he was going to die when he suffered a heart attack two months after losing his job. As he had surgery, he repeated prayers. Now he helps in his partner's book store, but can't find work and still faces thousands of dollars in medical bills.

A bill for a couple thousand dollars did arrive later. Doherty had heard that if you offer to pay cash up front, hospitals would sometimes negotiate a smaller fee. But, she said they refused and never offered her any sort of payment plan.

“I was really amazed that even after we enquired (about charity care or negotiated rates) information was not given up front to me. The bill now is requiring that they do make it readily available and inform the consumer. It felt like they didn’t want you to know there was another option,” Doherty said.

The full-time student, who only had part-time work, has been paying off her bill a few dollars at a time. Now 21 and preparing for a study abroad program in Argentina, she’s just about to make her last payment.

“I haven’t neglected the bill,” she said. “It’s not that we don’t want to pay. But if it’s not reasonable or affordable, it’s not going to happen.”

When Justin Swanstrom was having his heart attack, he was sure he was going to die. He lay on the surgery table repeating Jewish prayers, assuming his life had ended.

He survived only to find that he was facing $60,000 in medical bills and wouldn’t even have enough money to buy the Lipitor he’s supposed to take for high cholesterol. Finally after nearly a year of negotiating, the hospital has reduced his charges to about $4,000.

Swanstrom is continuing his job search and works occasionally at his partner’s Denver bookstore. Full of mystical books and spiritual symbols, it’s a peaceful place.

Even so, after losing so much over the past year, Swanstrom has to think hard about advice he would give to a friend who needed to go to the hospital, but didn’t have insurance.

“Don’t go,” he says, only half kidding. “It’s going to be much worse than you expect.”

Correction: An earlier version of this story said that the Steadman Clinic in Vail told Heidi Johnson that she had to pay in advance before receiving surgery. That was incorrect. While Dr. Robert LaPrade of the Steadman Clinic performed Johnson’s surgery, the procedure took place at the Vail Valley Surgery Center. That was the entity that requested payment from Johnson.

By Katie Kerwin McCrimmon

Circumcisions for low-income babies could once again be covered in Colorado after a bill seeking to restore funding moved forward Tuesday in the Senate.

Circumcision has become a polarizing issue in Colorado after the legislature last year voted to make Colorado the 18^th state to ban Medicaid funding for the procedure. The state stopped paying for routine circumcisions last July.

Cost is not the primary point of contention. Circumcisions – which cost about $200 to $400 each  – for low-income babies add up to a relatively small tab according to state fiscal analysts: about $195,000 next year and $230,000 the year after that.

Instead, activists on both sides are battling over whether the ancient practice of cutting an infant boy’s foreskin from the head of his penis is healthy. Opponents argue that the procedure is medically unnecessary, and elsewhere in the country, foes are trying to ban it altogether. Supporters believe circumcision should be a personal choice. They say it has health benefits including reduction of urinary tract infections in babies and prevention of HIV and AIDS among adults.

Debate over circumcision taps into deeply held personal and religious beliefs that often spark fights between new parents, medical professionals and lawmakers.

Sen. Joyce Foster, D-Denver, was alarmed to learn last summer that funding for circumcisions had been cut from Colorado’s Medicaid budget last year. So, this year, she introduced Senate Bill 12-90, which would restore the funding.

“It’s a fairness issue. It’s a prevention issue. It’s a social justice issue,” Foster said. “I’ve always cared about low-income people. I’ve worked my whole life in that arena. When a person is on Medicaid and they don’t have the ability to make the same decisions that I do, that’s unfair.”

Foster also happens to be Jewish and her husband is the influential retired Temple Emanuel rabbi, Steven Foster. Ritual male circumcision is a fundamental tradition in Jewish culture.

Foster said her own religious views and those of her husband have nothing to do with her support for Medicaid funding of circumcision. She said traditional Jewish families typically don’t opt for circumcisions in a hospital. Rather a religious leader called a mohel performs the circumcision either at home or in a temple when the baby is about eight days old.

“This bill will have absolutely nothing to do with the Jewish community of Colorado,” she said.

Mohels don’t get reimbursement from Medicaid and Foster said that if a family can’t pay for a religious circumcision, the community helps.

Foster said opponents of circumcision who are seeking to ban the procedure altogether would be abridging religious rights, not only for Jews, but also for others.

“Some people don’t want anybody to have it. That would be an attack not only on Jews, but on Christianity, which is based on Judaism, and on the Muslim community. If their goal is to infringe on my rights, that’s where I take issue,” Foster said.

With respect to babies on Medicaid, Foster said she is most persuaded by the medical evidence.

She said treatment of infant urinary tract infections in Colorado cost about $3.4 million from 2009-2010 when she says 147 baby boys had to be hospitalized. She also cited the work of the Bill and Melinda Gates Foundation, which is supporting circumcision in Africa to prevent the spread of HIV.

At an earlier hearing, Gillian Longley, a registered nurse from Louisville, was among those who testified against public funding for circumcision. She described routine circumcision of newborn boys as “elective, non-therapeutic, cosmetic surgery.

“It is neither medically necessary nor cost effective,” Longley said.

Lawmakers in the Senate last week nixed an amendment that would have added funding for Medicaid circumcisions to the budget bill, known as the long bill. But, on Tuesday, the Senate Appropriations Committee voted to move the bill forward. Now it goes to the full Senate; then if it passes, on to the House.

By Katie Kerwin McCrimmon

Colorado has made substantial progress in implementing a health insurance exchange, but significant work remains in part because of Colorado’s flawed computer systems, a new report from the Urban Institute has found.

The biggest challenge for Colorado may be that the state “is starting with a flawed foundation, a legacy computer system – CBMS (Colorado Benefits Management System) – that is inflexible and difficult to modify,” the report states.

Researchers from the Urban Institute are conducting a comprehensive monitoring and tracking project to assess implementation of the Affordable Care Act throughout the U.S. The Robert Wood Johnson Foundation is funding the project, which started in 2011 and will last for several years.

The U.S. Supreme Court heard arguments on the legality of the Affordable Care Act in March and could strike down all or parts of the law by the end of June.

Leaders in Colorado have said that regardless of the Supreme Court ruling, Colorado will move forward with its health insurance exchange, which is designed to create an online market where consumers can shop for health insurance options.

Along with Colorado, researchers from the Urban Institute are evaluating health reform efforts in Alabama, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia.

The researchers found that Colorado had a head start on the nation because of the 2006 Blue Ribbon Commission, also known as the 208 Commission. Members of the bipartisan commission endorsed a slate of reforms, many of which later became components of the Affordable Care Act, and created a blueprint for reform in Colorado.

Colorado was the first state where a divided legislature voted to create a health insurance exchange. Leaders in many other states have refused to move forward on implementation of the Affordable Care Act until the Supreme Court rules.

The Urban Institute researchers found that it was key for state leaders to adopt a “Colorado-specific” version of health reform. Backers did extensive work to win endorsements from business leaders and survey the uninsured about their needs. Researchers noted that the contentious battle over health reform in Washington, along with emerging Tea Party influence on Colorado politics significantly eroded the cooperative, bipartisan spirit that had animated the Blue Ribbon Commission.

Even so, “strong relationships” among policymakers allowed Colorado to move forward. Yet, the study authors noted that the exchange legislation primarily addressed “structure and governance issues” rather than establishing exactly how the exchange will operate. The researchers commended the exchange staff and board chair, Gretchen Hammer, who is also executive director of the Colorado Coalition for the Medically Underserved.

Work groups have been investigating options for future design and decision-making.

“Despite this progress, many difficult and technical decisions remain on exchange operations, enrollment methods, plan participation, risk adjustment and reinsurance, and subsidy determination and management,” the report authors found.

They also noted that meddling from a legislative review committee could “inject politics into ongoing decision-making.”

The biggest concern, however, remains with the troubled IT system.

CBMS has been the target of consumer lawsuits and a thorny problem for multiple governors and their IT chiefs. Lawmakers will get an update this month on attempts to improve the system.

Researchers also underscored challenges with Medicaid because determining eligibility for programs that provide health care to the poor along with multiple other human services programs is the responsibility of counties in Colorado. Many have unique processes and may be resistant to the changes required for successful IT implementation. Responsibility for IT problems is divided among multiple state agencies, including health exchange leaders, Medicaid managers and the relatively new Office of Information Technology.

“Thus far, it is not clear that these offices can work in complete harmony. Still the state has made rapid progress over the past several months, and expects to award vendor contracts for exchange IT development and upgrades to CBMS…by mid-2012,” the study authors found.

By Katie Kerwin McCrimmon

Good health makes us happy and happiness makes us healthy.

So what are the secrets to becoming happier and healthier?

Daniel Gilbert, a Harvard psychologist and author of the bestseller, “Stumbling on Happiness,” shared his insights on Monday during a speech at his alma mater, the University of Colorado Denver..

His prescription for a happy life could be summed up with these mini-mantras:

Get married. Earn at least $50 K. Have sex. Skip kids. Work. Don’t try to predict happiness — you’ll be wrong. Women: talk and eat with friends.

(Ahh. Happiness is summing up happiness in 143 characters!)

But, wait a minute. Children don’t make you happy?

“In study after study after study…non-parents are happier than parents,” says Gilbert. “People’s happiness plummets when they have children.”

Gilbert knows that this statement is heretical among parents, so he dangles some hope that humans will continue to ditch their own happiness and perpetuate the species. Happiness among parents is highest when a woman is pregnant, then starts plummeting during the toddler years, bottoms out when kids are adolescents, then returns to baseline by the time the kids leave. Note to parents: hold your breath until the kids go to college.

Studies show that people are happy in happy marriages, at least until about their 15^th anniversary. Then they might hit a rough patch. People in unhappy marriages get happier  when they get divorced.

Harvard psychologist Daniel Gilbert returned to his alma mater, University of Colorado Denver, this week to discuss his research on happiness. Gilbert is the author of the bestseller, Stumbling on Happiness, and hosted the PBS show, This Emotional Life. Photo by Nathan W. Armes.

And money is a complex predictor of happiness. The first dollar a person earns makes them very happy. But once people earn about $50,000, their happiness barely increases with each additional dollar. Economists call this an “inflection point.”

“A little money makes for a lot of happiness,” Gilbert says. “More money won’t make you happier.”

Gilbert says most people with money don’t spend it well. Happiness goes up when you spend on others, not yourself. Even with just a couple of dollars, he said buying a stranger a coffee for no reason will give the buyer a happiness jolt.

“Buying yourself stuff is good, but not as good as buying for other people.”

Another vexing aspect of happiness is that people are lousy at predicting what will make them happy.

“The reasons you are sometimes unhappy is you aim for the wrong things,” Gilbert says.

For example, surveys show that people across the country are convinced that they would be happier if they lived in California. In fact, people in California rank near the bottom for happiness (46^th). (Colorado ranks 21^st among the states.) Why do California dreamers get it wrong? Gilbert flashes a photo of smiling, tan surfers enjoying the beach. When we contemplate happiness in California, we imagine that beachfront perfection and leave out all the details, like work, traffic jams, earthquakes, expensive housing and the same old problems that dog us wherever we are.

“It’s good that imagination leaves out details,” Gilbert says. “But all of the details will affect your real experience.

“All the stuff that happens in Denver happens in California. You take your life with you.”

Everyone overrates how important big events will be in their lives. Gilbert describes research in which college students were asked to imagine how happy they would be if their football team won or lost a big game. Winners imagined they would be happier. Losers guessed they would be sadder.

The students were much more accurate in their predictions when researchers asked them to also think ahead to specific events that were coming up in the three days after the big game. It turns out that focusing on details helped the students put the game results – both positive and negative – into perspective.

“We are more resilient that we think we are,” Gilbert says.

While humans are tough, they’re not great at imagining the future.

“We have a tendency to think that what we want now is what we’ll want later,” Gilbert says.

Instead, it turns out that what makes us happy changes over time.

For example, Gilbert describes an experiment at the University of Colorado Boulder, where researchers asked people to predict whether hunger or thirst would be more important to them in the future.

When scientists asked people before a workout, answers were divided. But, when they asked after the workout, nearly every respondent said thirst was more important.

“When they are in a state of thirst, it’s very easy to imagine being thirsty,” Gilbert says. “This tendency to assume that tomorrow will be very much like today has interesting consequences.”

Comparative happiness is also important. In one of Gilbert’s experiments, students rated their anticipated pleasure over eating a bag of chips. In one room, some chocolate sat nearby. In another room, there were cans of Spam. The researchers didn’t point out the other food to the students, but they  automatically factored in what they could have had, rating the potato chips lower when compared to chocolate and higher compared to Spam. In reality, the students’ satisfaction ratings were nearly identical when they actually ate the chips.

It turns out that humans are very good at making the best of their circumstances.

“Rationalizing gets a bad name, but it doesn’t mean making things up. Often there are several equally reasonable ways to look at things.

“You get fired. This could be an opportunity to start writing poetry. That’s rationalizing, not making stuff up.

“By and large people fare much better in the face of tragedy and trauma than anyone, especially they themselves, would have predicted.”

The bottom line is that pondering happiness is a luxury that only recently became possible for humans, including Americans who embedded the “pursuit of happiness” in the Declaration of Independence.

Now there’s an explosion of happiness research among economists, brain scientists, and policy wonks, all of whom think happier people will be healthier and more productive.

Once upon a time, life was “nasty, short and brutish,” Gilbert says. “You woke up in the morning and tried not to die.

“There was no secret to happiness. There just wasn’t any.”

By Steve Melek

Depression, like many other physical and behavioral conditions, is a prevalent and expensive disorder. However, depression often goes undiagnosed and hence untreated for a significant period of time. The median delay from onset to a formal diagnosis and treatment is about six to eight years for depression.

The health care expenses and lost productivity due to diagnosed depression have been widely studied. While the lost productivity due to absence from work is relevant primarily for the employers, the health care costs are relevant to both the insurers and the employers. A less studied topic is the impact on health care and workplace productivity for costs from depression that has not yet been diagnosed. Do people with not-yet-diagnosed depression have higher health care costs than similar people without depression? Do they miss more time from work? Can the gap between depression onset and depression diagnosis be shortened? We are currently working on an analysis that seeks to address these questions.

We designed a matched case-control study using health care claim data to quantify the total healthcare and lost productivity cost attributable to depression prior to its diagnosis. To do so, we studied a depressed sample as compared to a non-depressed sample that was similar to the depressed sample in terms of age, gender, state of residence and health status. We hypothesized that given the average amount of time between onset and diagnosis of depression, elevated cost levels likely emerge in the depressed group prior to the depression diagnosis.

Our analysis revealed that our hypothesis was correct: the costs over the two year study period prior to depression diagnosis were significantly higher for those eventually diagnosed with depression. The increased levels of health care services and the lost productivity are both important contributors to the excess costs attributable to undiagnosed depression. We are in the final stages of this study and will be releasing the research results in the next couple of months.

Given the significantly increased costs for the depressed cohort, a logical next question is what can be done to control these pre-diagnosis depression-related costs. We have embarked upon a follow-up study to understand the characteristics of people prior to their depression diagnosis that could allow care managers to identify them sooner for intervention.

Care managers have limited resources to spend on screening and identifying depressed members. If they use those resources to screen patients at random, they are likely to find that 5-to-8 percent of the members are depressed, which is consistent with the prevalence of treated depression in a commercially insured population. We are investigating models that can help case managers more selectively target resources on screening, in an effort to identify a larger number of depressed patients. We are targeting the release of these results later this year.

We look forward to sharing the report on the excess costs of undiagnosed depression.

Steve Melek is a principal and consulting actuary with the Denver office of Milliman. He specializes in financial analysis of health issues and has worked extensively in the behavioral health specialty. This opinion piece is reprinted with permission from Milliman’s Behavioral Health Advisor.

By Katie Kerwin McCrimmon

Despite vehement opposition from prosecutors and sheriffs, a bill that would reduce possession of small amounts of drugs from felony offenses to misdemeanors advanced in the Colorado legislature this week.

Denver District Attorney Mitch Morrissey told members of the Senate Finance Committee on Tuesday that SB12-163 would destroy Denver’s drug court and undermine his ability to entice addicts into drug treatment because he could no longer threaten them with felonies.

A representative for Colorado sheriffs also questioned the costs of the bill. The fiscal note predicts that it will save the state nearly $1 million next year and $2.2 million the year after that. Backers contend that fewer people would wind up in courts and in prison, thus saving the state money. Savings from the bipartisan measure must be spent on drug treatment programs. But, county officials say the cost of dealing with a flood of drug cases would merely shift from state courts and prisons to county courts and jails, where misdemeanor cases are handled.  Lawmakers supported an amendment Tuesday aimed at preserving Denver’s Drug Court and analysts will now revise the bill’s fiscal note, so cost estimates could change.

Regardless of the amendment, Morrissey opposes the bill. He said people caught with drugs almost never go to prison on the first or second offense. He said the system isn’t broken.

“I don’t know what you’re trying to fix,” he said.

He said addicts commit 60 to 100 crimes a year to feed their habits and predicted that crime and drug use will go up if the bill passes. Furthermore, he said drug dealers would use the bill to safely carry small amounts of drugs from their supply caches to customers.

“These guys got you guys figured out,” Morrissey said.

Estimated state savings for reducing drug possession from a felony to a misdemeanor. County officials say the bill merely shifts costs to local courts and jails where misdemeanor cases are handled. A revised fiscal note is expected in about a week. Click on image to enlarge.

He implied that lawmakers were naïve, saying their estimates for amounts of drugs that constituted personal use were way off.

“If there is a person out in Civic Center Park now with four grams of crack or heroin or two grams of meth, they are distributing those narcotics. The use amount is far, far less than those amounts you’re talking about. That’s the reality. You can change these numbers however you want. These guys will still carry the amount that gives them the lowest (criminal penalty).”

Advocates for the bill, however, said Morrissey and others are simply wrong in thinking that threats work with drug addicts.

“The truth is there is no research that says (we should) make the stick bigger than it needs to be,” said Maureen Cain, a criminal defense attorney and legislative policy director for the Colorado Criminal Defense Bar.

An unconventional mix of advocates including liberal Democrats and libertarians from the conservative Independence Institute have been working for the last couple of years to alter Colorado’s drug policies.

Cain said Colorado is among the top six states for drug use in the country while being among the bottom six nationally in funding drug treatment.

She said the move to make more and more crimes felonies has simply boosted prison populations without solving the real problem of addiction.

“We’ve just created a society of felons,” Cain said.

A bipartisan coalition of lawmakers is sponsoring a bill to reduce drug possession from a felony to a misdemeanor in Colorado.

Sen. Pat Steadman, D-Denver, one of the co-sponsors of the bill, said the measure focuses strictly on possession, not on drug dealers.

“What this bill tries to do is chip away at the customers of that man (in Civic Center Park) who is trying to peddle drugs,” Steadman said.

“There’s a lot you can say about the war on drugs,” Steadman said. “We’ve also declared a war on young men of color, the mentally ill and victims of trauma. Rather than waging that same old war, we’re trying to wage a war on addiction.”

By Katie Kerwin McCrimmon

Donations for breast cancer took at hit in Colorado last year and the public battle between national Komen leaders and Planned Parenthood could further reduce fundraising this year, leaving breast cancer survivors without critical help.

Already groups like Sense of Security, a small Denver nonprofit that serves low-income breast cancer patients throughout Colorado, have lost thousands of dollars. Sense of Security did not receive funding this year from the Denver affiliate of Susan G. Komen for the Cure, leaving a $60,000 gap in its $400,000 annual budget. Another nonprofit, Rocky Mountain Cancer Assistance, lost $70,000 of its $425,000 annual budget after two Komen grants failed to come through. Sense of Security has launched a “Restoring Hope Campaign” to raise emergency funds and is putting needy breast cancer patients on waiting lists rather than giving them cash assistance to help them afford housing, utilities and food during cancer treatments.

“I don’t like saying ‘No.’ Then you’re destroying hope,” said Rita McCoy, executive director of Sense of Security.

The Denver Komen affiliate, which serves 19 Colorado counties, had to cut grants from $2.98 million the previous year to $2.5 million effective April 1. Several small nonprofits including Sense of Security, Rocky Mountain Cancer Assistance, Native American Cancer Research and Project Angel Heart recently learned that they did not receive Denver Komen funding. The Komen affiliate in southeastern Colorado also had to cut its grants by 15 percent. Local Komen directors blame the poor economy for decreased fundraising last year. But now they fear that they will pay a hefty price for a controversy that had nothing to do with them.

Denver Komen affiliate protested national move

Employees at the Denver Komen affiliate risked their jobs by publicly opposing the national move to cut funding to Planned Parenthood. The Denver affiliate is currently funding breast cancer screening and treatment for Planned Parenthood clinics in Aurora, Greeley and Fort Collins.

Michele Ostrander, executive director of the Denver affiliate of Susan G. Komen for the Cure, risked her job and those of her employees by protesting Komen's national decision to cut funding to Planned Parenthood. Now local Komen affiliates and nonprofits who rely on them fear they will lose funds over the flap.

“We’re concerned. What we want the community to know is that we did oppose this (national) decision. We had no say. Planned Parenthood is a critical part of breast health in our community,” said Michele Ostrander, executive director of the Denver Komen affiliate.

She said local Komen affiliates and the cancer care providers that count on them could experience “trickle-down effects” from the backlash over the national group’s attempt in December to halt funding to Planned Parenthood. Outrage over that decision prompted a reversal in February.

“I wish we had more money. That’s the concern,” Ostrander said. “If donations decrease to Komen, then our grant funds will decrease again.”

None of the Komen money raised in Colorado goes to pay salaries for national staffers, Ostrander said. Of the net proceeds, 75 percent stays in Colorado, while 25 percent goes to the national office to support research.

“We certainly are hoping that the community can refocus on our mission…to save lives and end breast cancer forever,” Ostrander said.

The southeastern Colorado Komen affiliate, which supports breast cancer programs in El Paso, Pueblo and Teller Counties, views Planned Parenthood as an ally in women’s health, but has not funded its programs since 1996.

“(The controversy) unfortunately has had an impact on what Susan G. Komen for the Cure of Southeastern Colorado does, which is to help people with breast cancer. We have only that focus,” said Paul Montville, who started as executive director for the group on April 1.

He said he’s fielded questions nonstop about the national flap and knows he’ll need to do some repair work in his community even though the relationship with Planned Parenthood is a “non-issue” in his region.

It’s unclear whether Komen fundraising will be down in Colorado, like it has been in some states that have had races this spring. Colorado’s races will take place in the fall.

“We’re really concerned, particularly because we didn’t have anything to do with it,” Montville said. “This whole thing became a public relations explosion.”

Cancer can wreck health and financies

For women on the ground, the loss in funding could make a dramatic difference.

Shelly Bordas was only 38 and had a 5-month-old son, Nathan, when she learned she had breast cancer in 2009. Her pregnancy had triggered a fast-growing cancer. Bordas’ doctors rushed her into treatment. She has since endured 26 rounds of chemotherapy and nine surgeries, including a double mastectomy. Bordas opted for the aggressive option hoping to keep cancer at bay. But, it returned in 2011.

A single mother, actor and acting teacher, Bordas had always paid for health insurance, but she has a hefty $5,000 annual deductible.  During her cancer treatments and between surgeries, she has tried to keep working as a daycare aide and acting teacher, but is sometimes too sick. She applied for help from Sense of Security and will receive $500 a month for six months, crucial assistance that pays for housing and allows her to buy other essentials from diapers to food.

“I started screaming and crying,” Bordas said of the day when she learned she would receive a Sense of Security grant. “It’s really helped. I’m struggling to get back on my feet. I will be in chemo for the rest of my life. I will be having to pay a $5,000 (deductible) every year. It could be worse. I could be uninsured.

“I feel sad that there are a lot of people like me who need help. Cancer is expensive,” she said. “My only goal right now is to see my son grow up. That’s all I want.”

Dottie Marburger, 65, a nursing assistant from Fort Collins, was praying for help handling her cancer and her bills the very day that she learned she would get help.

“They’re my angels. I was asking the Lord to please help me.…The phone rang and I knew it was Sense of Security,” Marburger said.

She received a grant that covered $200 for groceries and $300 toward utilities a month for six months.

“It was a lifesaver. I was getting to the point that I couldn’t work.”

In addition to money, Marburger also said she received emotional support.

“They take an interest in you. You’re not just a number on a checklist.”

At Rocky Mountain Cancer Assistance, board president Edna Diament is determined that the group will find a way to make up for the lost Komen funding this year. Already the group had seen such a rise in demand for help that it had to cut its grants from $750 per person to $500 each. They also had to decrease income limits.

“Last year demand was so high. We just had to change our criteria,” Diament said.

Altogether the 11-year-old nonprofit has paid $2.8 million in bills for 4,551 cancer patients. Last year, 64 percent of the grants went toward rent.

“Cancer treatment is very expensive,” Diament said. We’ve bought bus passes and paid utilities. But our primary focus is housing. There are a lot of people who are the working poor. Once they stop working to get cancer treatments, they need help.

“I hope that people will not stop supporting Komen and all cancer foundations,” Diament said. “That’s my hope. We’re trying to help.”

By State Rep. Cherylin Peniston

These “personhood” zealots will not give up.

Not once but twice Colorado voters have overwhelmingly rejected proposed constitutional amendments that would confer “personhood” rights on fetuses.

But instead of respecting what the voters have said, Rep. Janak Joshi, R-Colorado Springs, is trying to circumvent the will of the people and impose “personhood” by legislation.

House Bill 12-1130, sponsored by Rep. Joshi, would create a new class of crime victim – “an unborn member of the species homo sapiens.”

In an essay posted in this space, Rep. Joshi claims it “does not confer the status of ‘person’ upon a human embryo, fetus or unborn child at any stage of development prior to live birth.” Yet it would allow homicide charges to be filed against someone who causes a woman to have a miscarriage.

Colorado law defines homicide as “the killing of a person by another.” In other words, you can’t have a homicide unless the victim is a person. And you can’t have a homicide of a fetus unless the fetus is defined as a person.

HB12-1130 passed the state House of Representatives with the solid backing of the Republicans who hold the slimmest 33-32 advantage in the chamber.

This bill goes way beyond protecting women from domestic violence. As my colleague, Rep. Claire Levy, D-Boulder, noted when the bill was debated on the House floor: “You could be involved in an ordinary, plain old fender-bender with somebody you’ve never laid eyes on, and that accident could cause the woman to lose the child and you are thereby at risk of being charged with homicide.”

Statutes already exist in Colorado imposing additional penalties on perpetrators who knew, or should have known, that their victims were pregnant women. If this bill is to protect women, it is completely unnecessary.

But we all know protecting women is not Rep. Joshi’s goal here. He’s trying to get the nose of the “personhood” camel under the tent, denying all the while that he’s doing what he’s doing.

If “personhood” gains any legal standing, Rep. Joshi and other right-wing zealots will have taken a huge step toward their goal of outlawing abortion and maybe even contraception. HB12-1130 would be a step toward interposing the state between a woman and her doctor and taking away a woman’s right to control her own body.

Even the bill’s sponsor in the state Senate, another conservative Republican, Shawn Mitchell of Broomfield, understands the personhood problems it presents. Last week, he yanked the bill off the Senate calendar and said he was trying to “fix” it.

I don’t know if it’s possible to fix Rep. Joshi’s bill, except to kill it.

State Rep. Cherylin Peniston’s House District 35 includes Westminster.