MONTPELIER — By the end of this week, the
House HealthCare Committee will vote on a bill
that authorizes the building blocks for a future s
ingle-payer health care system.
The bill will largely follow the template provided
to the Legislature by Gov. Peter Shumlin, who set
transformation of health care as a priority for his
first term in the state’s top job.
“It is not a vote that we are jumping off a cliff to
a single-payer system,” Anya Rader Wallack,
Shumlin’s special assistant for health reform,
said to assure those worried the administration
and Legislature might be moving too fast. “This
is a multi-year process. We are proposing we
just get on the road toward a system.”
“Single payer we think is where you experience
the greatest cost savings and allow people to
have the simplest interaction with the health
system,” Wallack said. “We think it is worth
heading for.”
Shumlin is leading Vermont in the opposite
direction of many in Congress — especially in the
newly elected House of Representatives that
voted to repeal the more modest reforms of the
federal Accountable Care Act.
Although Democratic majorities in the Vermont
House and Senate are expected to be supportive
of the health care bill, it has plenty of opponents
inside and outside the Statehouse.
House Republicans, for example, are expected to
balk at the provisions that establish Green
Mountain Care, the entity that would eventually
become a healthinsurance program for all
Vermont residents.
“This drastic change to our healthcaresystem will
affect every Vermonter, every family, every
employer, and every health care provider in this
state,” House Republican Leader Turner of Milton
warned a week ago.
He appealed to Vermonters to press their
representatives to slow down the legislation so
dozens of questions could be answered now —
before the state commits to a single-payer
track.
“With the health care industry at 20 percent of
our economy, we have a responsibility to address
the details, crunch the numbers, and get it right,”
Turner said. “Setting a date of March 11 to get
this done is a little aggressive.”
House Health Care Chairman Mark Larson, D-
Burlington, countered that “slowing down just
subjects Vermonters to rapidly increasing costs.”
“If we lose sight of the crisis in our current
system, that can make us think it isn’t essential
to act swiftly,” Larson said. He cited the
skyrocketing growth in health care spending in
recent years. It jumped from $3.9 billion in 2006
to $4.7 billion in 2009 and is projected to hit $5.9
billion in 2010 — a jump of $2 billion in five
years.
Advertisement
Larson acknowledged people’s worries about
making big changes, but offered his assessment
that “Scary is doing nothing.”
Rep. George Till of Jericho is a doctor and a
Democrat who, unlike many in his party, has
many questions about the pending legislation —
starting with the fundamental assertion that
health care is too expensive.
As a member of the House Health Care
Committee, he will be one of those casting a
vote Friday.
“If we had a different industry growing at the
rate health care is, that would be really
celebrated in the Statehouse,” Till said.
“Nonetheless, the general consensus is we can’t
afford it. I do want people to just consider that it
isn’t like the money is headed off to China or
India. That money stays here.”
Wallack, Shumlin’s health reform assistant,
countered, “There is a lot of evidence that the
cost growth isn’t getting us any benefit.” By
benefit, she said she means better health
outcomes.
She noted, too, that the growing cost of health
care crowds out other spending priorities — at
businesses faced with escalating insurance
expenses, for individuals socked with bigger
premiums and co-payments or in government as
it juggles multi-million dollars increases in its
subsidized health expenditures and the impact
of a recession.
Till worries proposed legislation banks too much
on administrative savings from consolidating
claims processing and payments, and doesn’t
tackle the real cost drivers.
“The administrative savings, I think, are terribly
overstated,” he said. A single-payer system in a
single state “can’t be a true single-payer
system,” he argued.
“The focus on who writes the check is a
distraction from the real issues,” he continued.
He listed four big drivers of health costs:
• The spike in spending at the end of life.
• Increased care for people who now live longer
with chronic diseases.
• Spending on new medical technology.
• Increased use of drugs to treat and cure.
“What can we do about these?” Till asked.
Larson said the ideal solution to the healthcost
crisis would curb costs, provide universal access
and improve quality.
“We are moving in the direction of the governor’s
proposal because it has the most potential for s
uccess in all these areas,” Larson said. “I haven’
t heard anybody propose anything that would
accomplish close to what Gov. Shumlin
proposes.”
Wallack said the bill has three components:
• It sets up a mechanism for cost control — the
Vermont Health Reform Board.
• It creates a health benefit exchange or
marketplace for health insurance as required by
Advertisement
the federal health reform law.
• It sets out a work plan to lead the state to a
single-payer system that would be known as
Green Mountain Care.
House Republicans and other skeptics writing in
the blogosphere aren’t ready to make the same
leap of faith as Larson.
Republican leader Turner isn’t persuaded to
throw out the current system yet. “We have very
good health care,” he said. “We don’t want to
lose that.”
Till complained that the bill “puts this stake in
the ground that we are going to single payer”
without spelling out how it would be financed or
what the insurance benefit would be. The bill
gives the administration until January 2013 to
provide the financing plan.
“You can’t have a rational discussion about that
right before it is going to happen,” Till said.
Wallack said the administration needed more
time to research financing.
Larson said the bill will state that Green
Mountain Care won’t be implemented until the
new board has approved a benefit package, the
Legislature and the governor have approved a
financing plan and the federal government has
granted a waiver.
Vermont’s congressional delegation introduced
bills in the U.S. House and Senate to move up the
date when waivers could be granted from 2017
as set out in the federal health reform law to
2014. President Barack Obama signaled his
support for the date change a week ago during
remarks to the National Governors Association.
John O’Kane, manager of governor programs
with IBM, spoke for many in the business
community when he advised the House Health
Care Committee on a recent afternoon to pay
attention to the employers’ worries about the
potential impacts of “an unfavorable design of a
reformed health care system.”
“Private sector for-profit companies operate in
highly competitive, global markets where the l
ack of cost competitiveness can mean
extinction,” O’Kane said.
Companies that operate in multiple states want
to offer uniform health packages to their
workers, O’Kane said. They shouldn’t be forced
to abandon company-wide health insurance
programs by rules or coercive taxation, he said.
Some providers of health care — doctors and
hospitals — worry about the track record of
government medical care programs. Medicaid
and Medicare both pay less than care costs.
“Within the health care community there is a not
a lot of trust government can run things well,”
Till said.
Melinda Estes, president and CEO of Fletcher
Allen Health Care in Burlington, has lots of
questions about how the health care reform
board would work. This board will make
decisions affecting hospital budgets and provider
reimbursements.
Estes rattled off a list of concerns such as
whether the board would have staff with
expertise on technical topics? What would its
Advertisement
relationship be to the Legislature which would
have authority over the dollars for a
government-financed health care system?
She also voiced concerns about the effect of the
big change on the state’s ability to recruit and
retain physicians. “Physicians are a notoriously
risk averse lot,” she said.
She also wondered whether a single-payer
system would result in “an in-migration of the
sickest of the sick. I don’t know the answer, but
it is something we have thought about.”
Despite concerns, Estes said, “both the
administration and the Legislature have been
very open and willing to listen.”
There are lots of reasons why a single-payer
health care initiative would be on a fast-track
this year.
The obvious political explanation is the election
of a governor who made the issue a priority and
sympathetic majorities in the House and Senate.
There are the bundles of federal dollars that
come with the federal health care reform law —
money that Wallack acknowledged would make
it easier to carry out reforms. For example, the
state will be eligible for a 90 percent federal
match on money used to upgrade its Medicaid
systems. “That will be hundreds of millions of
dollars,” Wallack said.
Vermont’s community sensibility makes the
tough discussions easier, Wallack said. “There
are other opportunities because Vermont is
Vermont and we have a health care system that
isn’t highly competitive and isn’t influenced by
the kind of money in other states.”
Many interest groups “are working with us. They
are making suggestions,” Wallack said.
Although the bill still has many hurdles yet to
clear in the Legislature, Wallack said she was
optimistic. “I think we will get something good
out of this.”
Contact Nancy Remsen at 578-5685 or
nremsen@bfp.burlingtonfreepress.comNancy
RemsenBurlington Free Press
Advertisement