The Health Care Proposal Only the Beginning of a Process

By Anthony Pollina, Senator & member of Senate Health and Wellfare Committee

Despite the politics and war of words, the health care proposal now before the Senate makes relatively modest steps towards a single payer health care system, while also taking steps to start controlling costs.

It is true that many questions about costs and financing are still unanswered. That is because the “plan” is not yet determined. I support a single payer system. It works in many places and can work here. But, I do not see this proposal locking us into a single payer at all. (Some will like this, others will not). Instead, the bill is designed to start controlling costs, to answer the questions we all have and to bring a plan to the Legislature, which we will accept or not. Here is what it does.

It establishes a Board to answer questions about what Green Mountain Care (the single payer) may look like. So, over the next few years a benefits package will be designed, costs and provider payments determined and a financing plan recommended. The Legislature will then vote to approve or disapprove it. This is expected in 2013 but may not happen until 2017, leaving much time for questions, answers and debate on the issues.

While this is a path to a possible single payer, it can only happen if certain requirements are met: there must be a comprehensive coverage plan, we must know the cost and how we will pay for it; the federal government must provide waivers and our Legislature must vote to approve it.

Certain values will guide the plan. It must cost less; with significant savings in the initial stages, followed over time by slower and lower cost increases than in our current system. It must include comprehensive benefits, including mental health and wellness; fair reimbursement for providers and protections for consumers. And, those on Medicare and other federal health care and retiree benefit programs (i.e. military programs) will keep their benefits. They will not see lower benefits.

It establishes a health insurance exchange as required by the federal government. The exchange is a way to help us comparison shop for health insurance and for some to receive subsidies to help pay. A variety of plans will be in it, including two new multistate plans required by federal law. Other plans will be available outside the exchange. It does allow us to move towards common administrative forms and other efficiencies. It should be operational in 2014 for individuals and small employers and for others in 2017.

And, it establishes pilot projects to start controlling costs by changing how health care is paid for and delivered. Costs will be lowered and outcomes improved by having physicians work with a team of others (i.e. prevention, mental health). They will be paid on a per-person – per month basis not the current fee for service method. And, be rewarded financially for keeping us healthier. This is already underway in our Blueprint for Health program.  Finally it makes better use of technology and electronic data to further cut costs.

The bottom line: there are a lot of questions to be answered. This bill only gets the process started.

9 Responses to “The Health Care Proposal Only the Beginning of a Process”

  1. John & Susan Tavela says:

    We hope a strong universal healthcare bill comes out of the Vermont State Senate Health and Welfare Committee. We hope to see single payer health insurance come to Vermont and eventually the whole country (our grandchildren live in other states). We are both retired and are on medicare. We would like to have uniform benefits available to all. We would like everyone to pay fairly for it. We both worked while raising our children. Every year when different insurance plans were offered, it was a source of stress demanding some of the limited time we had to devote to our family. Now we find the medicare drug options frustrating. As with insurance plans in the past we are bombarded with things to read and decisions to make. We have no crystal ball to know what will happen to us. In the past we couldn’t predict our children’s health Why can’t there be some standard reasonable care provided for all. Fortunately we’ve been relatively healthy, but if we’d had some standard guaranteed healthcare for all, we would have had much greater peace of mind, Please work for a strong bill – maybe fewer options but something universal.
    Thanks for your work and consideration,
    John & Sue Tavela

  2. Hi Anthony,
    Please do whatever you can to be sure IBM and other ERISA companies are not allowed to opt out. These 4 amendments are only meant to weaken the bill. We have all waited far too long to have the whole thing fall apart now because the insurance industry and big business are afraid this would affect their bottom line. If we finance it with a broad based income tax rather than “requiring” payment, as Bill Doyle put in his survey question, we can make this an equitable health care for all bill that does not call it “insurance” at all.
    Feel free to circulate this to your other committee members. I also have written a Letter to the Editor that I hope your committee members will see prior to their vote.
    Thanks for all you are doing.
    Mary Alice Bisbee

  3. There are so many things happening in the world right now. Ever since I’ve began working for a process outsourcing firm, I have not been updated much on a lot of social issues.

  4. David Galland says:

    Speaking as a small, but significant, employer in Vermont, I must toss a little cold water on this discussion. The fact is that Vermont is already one of the highest tax states in the United States (fact, look it up). Raising taxes will, therefore, only discourage new businesses from setting up and will, in all likelihood, cause businesses to actually leave the state. Even, perhaps, IBM and other “big businesses” (boo, hiss).

    What then? Will the state then have to tax more to make up for the exodus? Could an economic death spiral begin? Now, I know that I am not writing this post for an audience that is likely to agree with me, but it is important, as Vermonters, to understand that actions actually have consequences. When society begins to adopt what is called “positive rights” — to wit, the right to low or no cost health care for those who can’t afford it, it is a slippery slope. Why not a comfortable house, or three square meals? Surely those are as important? The problem is that we as a nation are broke (again, check the facts). Can we as a people come together to make sure that the truly needy are looked after? Sure. But chasing the productive members of this society out by taking an ever increasing amount of their wealth will have predictable consequences.

    Don’t get me wrong. I am happy to pay my fair share (which, at this point, is about 46%, all in, by a conservative calculation) – but when it gets over 50%, then I become a slave to the state and, well, that’s just not going to happen.

    Now, fire away, unleash whatever invective you might – but the truth is, raise my taxes significantly and I’ll be corresponding from another state. Actually, I rather like Hanover, N.H.

  5. Living in NH says:

    Mr. Gallard.

    You are welcome to live in the “Live Poor and Die Poor” state of NH. Since you are considering Hanover, obviously you are all set financially. Me, I will move my business and open up new businesses in VT when single payer becomes reality. As a dual Euro/US citizen, I can tell you that the European system of addressing health care works. Germany is second in exports behind China.
    The US health care system is broken. No matter how much money you have, in many medical instances it will make no difference. I now wait three months or more to see one of my doctors. Accessing my health records is a nightmare. And the “for profit” motivation of doctors must constantly be considered each and every time I seek medical help.
    In my business, and any business in the US, it is difficult to attract new hires because of the convoluted nature of health benefit offerings. Good employees won’t go to work elsewhere if they have decent benefits so I don’t get the best employees because of this wall.

  6. James Duncan says:

    @David Galland A lot of new expenses from this system would be covered by more efficient payment systems as well as greatly reduced administrative costs. As well, there is much less expensive waste in the form of unneeded emergency room visits.

    For me as a self-employed person, the $9K – 12K annual cost for health insurance is in effect a tax, plain and simple. It’s something that I can’t escape – like death and taxes. I pay for that along with federal and state income taxes. If this health insurance cost suddenly went away, my taxes would have to go up about 30% in my current scenario before I’d lose ground in this single payer system.

    I don’t think the single payer people have adequately explained the real world favorable financial tradeoffs as I describe them here.

    I’m nearing Medicare – fortunately – getting and maintaining health insurance has been a huge life hassle. There’s no excuse for this in the “world’s best country”. Fortunately I’ve had the means and brains to keep health insurance. Too many other people don’t, and that’s a socially costly problem which after many decades the health insurance industry cannot solve and never will.

  7. Carl says:

    As someone who recently lost a job, and a nice benefit package, I now understand the need for lower cost health benefits and more options.
    @Mr. Gallard, I agree that ” Good employees won’t go to work elsewhere if they have decent benefits”, as I was one of these good employees. But I also understand that employers are paying out a lot for these types of “good benefits”.
    It can be a benefit to employers and employees to offer more benefit options with Limited Medical Plans, than just a standard high cost package.

  8. john says:

    my wife and i have no health insurance coverage. never have. we are in our early sixties. let’s see: $20k times forty years equals $800,000. subtract $6000 per year or so for medical over the years is a net of approximately $600k. oh, did i mention that i have been retired since i was 55. not paying for health insurance is why. plain and simple. no booze, no drugs, no mcdonalds, no stress, etc. we are at the top of the food chain. where in the vermont constitution does it delegate the authority to the state to manage the health of its citizens? the fact that doctors from around the country would be willing to relocate to a “single payer” state speaks volumes to what’s really behind the concept. welfare for the medical profession.

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