Dear Mr. Hester:

Thank you for the opportunity to comment. The process to select experts to design three versions of a health care system for all of Vermont has been exceptionally open and accessible and is most appreciated.

I support Dr William Hsiao and his team to do the system design work.

First of all, his team meets all of the criteria spelled out in the RFP. I am sure you have his CV so I do not need to list all of his accomplishments in designing systems throughout the world – some single payer and some multi-payer. I am sure you are also aware that Professor Hsiao has written several books on designing health care systems, the most recent due out this August. His experience in designing real-world health systems could not be clearer.

The requirements (RFP) demand that whoever is selected must have experience in designing systems that have expanded coverage and contained costs. There is an important distinction between overall costs of a system itself and program costs within a system. Vermont has had programs designed to extend coverage to groups within a system. Some of these programs have lowered, or have promised to lower, costs to payers within a system. But none has translated into lower costs for the system itself. Dr. Hsiao, however, achieved exactly this when, for example, he designed Taiwan’s health care system.

Another very good reason for supporting Dr. Hsiao over other candidates (none of which has actually designed a system, only programs) is the inclusion of Steve Kappel. Kappel lives and works in Vermont. His depth of knowledge about Vermont’s health care data needed for any design has few if any equals.

Once again, thank you for allowing Vermonters the opportunity to participate in the process.

Sincerely, Deborah Richter, MD