Editor’s note: This commentary is by Ethan Parke, of Monpelier, who is a member of Vermont Health Care for All. A version of this commentary was submitted to the Green Mountain Care Board.

Structural and functional problems with the OneCare/All Payer Model are beginning to become evident; the Green Mountain Care Board should take these problems into consideration in the OneCare 2020 budget review.

Halfway into the OneCare pilot there is no indication that OneCare has the means to make a significant positive impact on the pressing health care needs of Vermonters. A recent article in the Journal of the American Medical Association put Vermont among the states with the greatest increase in death rate between 2010 and 2017 of people aged 25–64. Vermont’s suicide rate is higher than average and is increasing faster than most other states, according to a recent study by SeniorLiving based on census data. Changing how providers are paid does not get at the root causes of these issues, which are mostly about affordable access and provider capacity. Given the emerging doubts about the OneCare and its all-payer model, and given that the pilot will expire in 2022, the Green Mountain Care Board should begin planning now for the post-OneCare era. continue reading