Leading up to the elections, I’ve become increasingly frustrated there hasn’t been a spirited discussion on any number of important issues. Forget for a moment the foolishness happening on the top of the tickets in November, and instead let’s revisit some of those challenges we face as a state and a nation. I sound like a broken record, but between now and the election I plan on beating the healthcare reform drum. So, here we go again.
Did you know that, in 2023, nine of the fourteen hospitals in Vermont ended the fiscal year in the red? This has been a growing problem, and the Green Mountain Care Board (GMCB), which regulates the hospitals and sets their budgets, has been ineffective at controlling costs. By setting unsustainable budgets, the GMCB has been slowly pushing our hospitals to insolvency. And don’t get me started on ACO Reach or OneCare VT, and other leach-like middlemen that do nothing to improve our healthcare for the millions they suck out of the system.
Here’s the rub on this: What if I told you that hospitals shouldn’t make a profit, and at best should break even? Do we expect courts to make a profit or pay their own way? The cops, the army, public transit, there are all sorts of examples of where the private sector won’t go. Right here in Woodstock the powers that be are considering purchasing a privately held water system for the community. Why is it for sale? When it was held privately there’s no incentive to make the capital investment in the infrastructure; in the electric industry we called it “explosion maintenance.” The public sector may not be more responsible in equipment upgrades, but at least elected officials are more accountable than corporate owners.
Since the 1970s and ‘80s, for-profit players have been entering the healthcare industry, and today have succeeded in blending for-profit elements into the non-profit hospital environment. Many unprofitable departments, like the maternity ward, have been removed from the hospital, while lucrative practices, like the emergency room, are quietly bought up by for profit players. I’d always heard that 25 cents on every healthcare dollar went to administration, but now it’s closer to 30% according to the American Medical Association. Compared to national healthcare plans in other countries where administrative costs are rarely higher than three cents on a dollar, today U.S. hospitals employ hundreds to deal with the insurance paperwork. Wouldn’t it be nice if they all worked in patient care?
It’s not just the hospitals either; the insurance companies like Blue Cross Blue Shield of Vermont (BCBS) are swimming forOlympic gold in a sea of red ink. A growing trend now puts healthcare costs above what the insurance companies collect in premiums. These companies have three choices and none of them are good: With the permission of the GMCB they can raise rates, reduce payments to providers, or find more patients. One study, and there have been an awful lot of them, says that over the course of the next five years, our hospitals need $2.4 billion in additional revenue, and in order to give them a 3% operating margin they will need $3.1 billion. That’s in the next five years, or they go belly up by 2030. Crisis! You be the judge. I live a couple of miles away from Springfield Hospital, and as I grow older it is a comfort having it there, but what if it wasn’t? Other hospitals nearby include Ascutney, Claremont, Alice Peck Day (APD) in Lebanon and Dartmouth/Hitchcock, but all would be an inconvenience for our elders in Springfield. I stubbornly stick to a primary care physician that I met working in Lebanon, N.H., but even APD has bought into the Accountable Care Organization snake oil.
While we wait for yet another report on the sad state of affairs in our healthcare system, perhaps the answer to our problems has been right in front of us all along. I’m not totally concerned with bankruptcies at the hospitals and BCBS; in fact, it might even be a good thing. Perhaps if we were able to take over the hospitals and make them public assets they could be run for the public good and not for profit. As far as BCBS goes, one healthcare activist pointed out that they had exactly the skill sets needed to run our first-in-the-nation single payer, universal coverage healthcare system.
As we wade into the muck of another election cycle, statewide races and local elections, we should expect to hear from the candidates on the healthcare issue. With the money running out in a few years, it would seem that this issue is in need of some immediate attention. Tell me, what’s your plan, or tell me why we haven’t socialized these vital public services. Honestly, should anyone be profiting off the sick and those in hospice? How is this not a crime? Kicking the can is over! Either lawmakers deal with healthcare, or get out of the way of those that will.
Contact Kurt Staudter at staudter@sover.net.