Dr. Ben Vernon is no fan of the Affordable Care Act.
The Denver-area surgeon thinks the health-reform law amounts to a Band-Aid when it comes to health care's biggest problems: inefficiency and waste.
"I don't see how the current system has the economics that can support prevention," said Dr. Vernon, the former president of the Colorado Medical Society. "We haven't figured out if we save a half a million dollars from a patient having a heart attack, who has that half a million dollars, and what does it mean."
Vernon has been a vocal supporter of Colorado's Amendment 69, a referendum that would create a first-in-the-nation single-payer health system called Coloradocare, which would replace Obamacare in the state.
"When there's one payment authority looking at all of what's happening across the board, we're going to have a much better handle on our providers' quality (and) we're going to have a much better handle on what it costs to get that quality," said Dr. Vernon.
But Dr. Vernon may not be in the majority. Support for Amendment 69 has slipped from 43 percent in January to 27 percent this fall, according to state pollsters Magellan Strategies.
Amendment 69 would fund Coloradocare with a 10 percent state income and payroll tax. Employers would pay two-thirds of the tax for their workers, with employees picking up the remaining third. (Those below the poverty level, or unemployed, would be covered but exempt from the tax.)
Business groups are among those opposing the measure, arguing that it would hurt competition in the state.
"Being the only state in the union who would have a system like this makes it very hard for Colorado to compete economically," said Kelly Brough, president and CEO of the Denver Metro Chamber of Commerce. "We'd have the largest income tax and payroll tax in the country and it hits our small businesses the hardest."
The measure has also drawn bipartisan opposition from political leaders, who have expressed concern about long-term funding for the single-payer system.
A Colorado Health Institute analysis concluded that Coloradocare would break even in its first year, but would "slide into ever-increasing deficits" longer-term without tax increases.
State Senator Irene Aguilar, a practicing physician who has been a key backer of Amendment 69, takes issue with CHI's findings. She said the study underestimates the impact of the savings that would derived from the single-payer system.
"What I think is important for consumers and everyday voters to look at is how does this compare to what we are doing right now and overall that's win-win even in their assumptions," Dr. Aguilar said.
The single payer referendum made it onto the ballot after advocates raised the money for a signature drive. Under Colorado's state bylaws, a constitutional amendment can be put on the ballot if supporters gather signatures from 5 percent of voters. It was through a similar referendum that the state became the first in the nation to legalize recreational use of marijuana in 2012.
The ACA offers states the option of setting up their own form of universal healthcare, though the legislation also stipulates that the Department of Health and Human Services would have to certify the state health-care proposal.
Yet, even if the measure fails, Coloradocare advocates think they are on the right track. With the impasse over Obamacare in Washington, they say the answer to fixing problems with the nation's health-care costs has to come from the state and local level.
"I don't think we can wait on them to fix it," said Dr. Aguilar. "I think that states are laboratories of invention."