By Kurt Staudter
While the presidential cycle swirls around us like an angry tornado, now finally showing signs that it’s coming to an end (the ballots have arrived), let’s take on a subject that should be on the minds of all wannabe state lawmakers: Systemic healthcare reform. Last week, yet another report was made to the Green Mountain Care Board (GMCB) on the future of hospitals in the state. The report is in the form of a 140+ page PowerPoint, and there is something in here for everyone to hate. However, will this bitter medicine be just what the doctor ordered to save our ailing hospitals, or will we once again let state bureaucrats make draconian decisions that amount to just rearranging the deck chairs of a sinking ship? Or worse, will they just ignore the financial realities until it’s too late?
What comes to mind for me is the recent effort to consolidate our public schools. After the angst and bad blood that the state caused in communities all over Vermont, now bussing children to schools over an hour away, and towns having lost that shared community space, we are still seeing record levels of school spending. The lesson to be learned here is that we can’t just tinker around the edges and expect systemic-sized changes.
Healthcare is a mess in the United States; we spend something like five times what other countries do, and have worse outcomes. Another difference is that they cover everyone, and after the advances of Obamacare we are once again seeing the rise in the uninsured. Now remember, this is happening in the richest nation on the planet.
As a small state, we have a number of small hospitals, and because of our convoluted multi-payer system there are winners and losers. I live in Springfield, where we have what used to be a full-service hospital run by our friends and neighbors.
Today it’s not the same. There’s no babies born in Springfield anymore; Babies now come from Brattleboro. You’d think prenatal care and OB/GYN care would be at any hospital. Theproblem with funding at the hospital has to do with the large number of payers that have business models where the desired case is when they don’t pay. Add to that mix ACO Reach (into my pocket), One (we don’t) Care Vermont, Medicare (Dis)Advantage, and any number of other leeches and for-profit jackals, and you have the recipe for insolvency. Their recommendation for Springfield: Adult mental health beds and memory care. I drive by that hospital every day, and can’t believe that wonderful facility would be turned into a building with such a narrow focus. With an aging population in the Springfield area, perhaps other specialties for elders beyond memory care. Just an idea… According to the report, we would save almost half a billion dollars if we instituted the recommendation in the report that cost taxpayers around $1 million. Another report, and I can’t think of an issue that has been studied more often, that was produced in the days of the Shumlin administration said we’d save around the same money by going single payer. If we’d only had the resolve, along with lawmakers with backbones to sell it back then.
The problem with healthcare is it’s become just another item in the marketplace that’s bought and sold in 50 different states. Healthcare is not a commodity. For too many years, our hospitals have become a place where healthcare is for sale. While most hospitals are non-profit there are without a doubt people who are well taken care of financially. In a recent response to the report where UVM medical executives warned,
“The state regulator’s decisions about our nonprofit safety net hospitals are significant enough that we have no choice but to make some reductions in the care we deliver in Vermont, in addition to further increasing behind-the-scenes expense cuts.”
Have you noticed: We’re no longer patients, but now healthcare customers? From the files of complaining with your mouth full, I imagine that the four UVM executives that signed the letter collectively make over a million bucks.
We need to stop thinking of healthcare as a business. You’ve heard it before, “Healthcare is a human right!” If we learned nothing else from COVID, it should be that our hospitals provide for our day-to-day needs, but also be prepared for catastrophic events like the pandemic. We can’t get caught as flatfooted again, our hospitals need to be prepared for the worst, and we need to pay for that service even if we never use it. Kind of like the fire department.
We should expect certain services from all of our hospitals: Emergency room care, specialties that serve the community, beds for short- and long-term care, no delays in care, quality care, and the best doctors. Anything less and we’re just not getting any bang for our buck. Community based hospitals should be the cornerstone of our healthcare system, and a failure to recognize this, to turn these wonderful hometown institutions into something based on a consultants for-profit model is a disservice to all of us, but more importantly, it further diminishes the questionable care we get now. How is that progress?
Lawmakers take notice; you cannot ignore this any longer.