Editorial, Rutland Herald
The Shumlin administration is energetically selling its health care plan even before it has drawn up its details, which often means fielding questions from the public that still have no answers.
Gov. Peter Shumlin and others were in Rutland this week for a forum to talk about the health care reforms that are taking shape following passage of Shumlin’s health care bill earlier this year. At this point the most that Shumlin and his top health aide, Anya Rader Wallack, could do was sketch the general outlines of their plan and offer assurances that they intend for it to work.
The big questions that dominate public discussion of health care reform are how much it is going to cost and how we are going to pay for it. These are critical questions on which the success of health care reform will depend, and it is good that Shumlin does not pretend at this point that he has the answers.
Instead, he is beginning the process of appointing the five-member health care board that will have the responsibility of crafting the plan in detail. There are upwards of 100 applicants for membership on the board; after Shumlin makes his choices, the board will get to work on the two-year process of designing a health care system that will cover all Vermonters in a comprehensive, universal, public system that will contain costs and guarantee a high quality of care.
That’s a tall order. Fundamental to the transition to a new system will be the Great Switch. At present people are covered either by private insurance obtained through their employers, for which they pay ever-escalating premiums, or by government programs, such as Medicare, Medicaid or veterans’ programs. The aim of Vermont’s new program will be to replace private coverage with a public program and to fold in other government programs where possible to create one large risk pool that would be better able to contain costs. To pay for this new program, a major new tax will have to be enacted. For this Great Switch to work the public will have to have confidence that the new taxes they are required to pay will be offset — or more than offset — by no longer having to pay health care premiums.
The tough work of the new health care board will be in determining what taxes to use to pay for health care and how much the plan will cost. Selling the plan to the public and the Legislature will require clarity and confidence — clarity about the costs and confidence that replacing private insurance with a public program will lower or contain costs.
Cost-containment efforts are already under way in the state, and they are showing results. Some of the state’s hospitals have already switched to electronic medical records, which are a great boon to practice, and the rest of the practices and hospitals are heading in that direction. Also the state’s Blueprint for Health program is making inroads in containing the costs of care for chronic diseases, such as diabetes and heart disease.
Shumlin has consistently sought to calm fears about the switch to a public system by saying he would not support a single-payer plan that wasn’t more affordable than the present system. He offered that assurance again this week. He noted that the present system is unsustainable; its costs doubled over the past decade.
There are many other question marks associated with the move to a single-payer system, such as whether waivers will be forthcoming from the federal government allowing Vermont to direct federal money toward the new system and how the state will treat companies that self-insure and thus cannot be regulated by the state.
Shumlin is enthusiastic about the state’s potential role as a pioneer in health care reform. Other governors, he says, are curious about Vermont’s plans. They are not ready yet to follow, but they are watching.