The Vermont Political Observer

By John Walters

If there was an organizational chart outlining America’s process for supplying and paying for health care, it would look something like this. It’s not a “system” as much as a mare’s nest that grows more and more complicated — and less efficient and increasingly unjust — over time.

I’m guessing here, not a health care management expert or anything, but this mess has got to be costing us untold billions that might otherwise go to, I don’t know, making people healthier? There are inefficiencies, redundancies, and a massive amount of profit-skimming at every turn. That’s why other developed countries can provide much broader and more equitable coverage at a much lower cost. I have often thought that health care in America would be cheaper if we simply left big bags of cash everywhere.

Aside from the inadequacies and inequities of our “system,” there’s also the fact that it’s completely out of our control. Decisions made at high corporate levels trickle down like warm piss upon our heads, and damn but we’d better be grateful for the golden showers.

This line of thought was triggered by VTDigger’s story about likely reform efforts in the state Legislature. A story that could have been published, with alterations in the details, just about any time in the past. Yep, our health care “system” needs reform, and by God, our elected officials are gettin’ to work.

But the scope of that work will be limited indeed.

Rep. Lori Houghton, current vice chair of the Health Care Committee (and almost certainly its next chair), is focused on recent steps to get the “system” through pandemic times. “We need to review the programs that we created and funded over the past two years, with all the money that came in,” she said.

So everything was hunky dory before then?

I know, that’s unfair. Houghton’s remit will mean a lot of work for her committee and its counterpart in the Senate. But lawmakers and executives alike have shied away from any sort of comprehensive health care reform since Peter Shumlin’s single-payer plan went down the porcelain convenience. This year promises more of the same, as we continue to wait for an outbreak of courage in Montpelier.

Meanwhile, we’re at the mercy of health care behemoths like OneCare Vermont, the big and unproven solution to our problems, big insurers like Blue Cross Blue Shield, big institutions like the University of Vermont Medical Center, and the money-grubbers of Big Pharma. Former Canadian prime minister Pierre Trudeau compared the US/Canada relationship to a mouse sharing a bed with an elephant: “No matter how friendly and even-tempered is the beast, if I can call it that, one is affected by every twitch and grunt.”

That’s how I feel about my health care being in the hands of a bunch of cartels whose inner workings and relationships are a complete mystery to me. Jokes about bureaucrats notwithstanding, I would much rather depend on the government to manage my health care.

Let’s tot up some of the twitches and grunts, shall we?

OneCare remains a very costly experiment. We’ve committed so much time and money to the OneCare model that we’ve essentially made it too big to fail.

Sure hope it doesn’t.

But OneCare is looking shakier than ever, now that Blue Cross Blue Shield has opted to withdraw from it. The stated reason is about OneCare’s use of patient data, but the mouse gets extra nervous when a pair of behemoths start tussling.

Speaking of Blue Cross, it’s steadily crapifying its drug coverage. Every year, more medications are added to its pre-authorization list. That means doctors have to re-apply for coverage even in the most ridiculous of circumstances. (Example: A patient with a chronic condition that’s under control by medication. They’re going to need it for the rest of their lives, but BCBS just needs to make really sure you still need it every year or so.) Personally, BCBS has never rejected any of my prescription renewals, but every time I get a notice it’s another twitch from the elephant. And it’s a lot of pointless work for doctors.

Moving on to the teeth, my very capable dentist is withdrawing from Northeast Delta Dental. This means I’ll have to pay in full at time of service and wait for Delta to reimburse me to whatever extent it chooses to. My dentist has been struggling for quite a while with Delta’s requirements and mandates, and it just got to be too much. The dentist is offering some financing options, but still expects to lose clients who can’t afford to bear the float.

One more. My spouse and I have had long-term care insurance for a long time. For those unfamiliar, the policy covers assisted-living costs. It’s a bit of reassurance in case of disability or a long slow end-of-life dwindle.

The premiums aren’t cheap, but they’ve stayed the same for many, many years. But a little less than a year ago, our insurer notified me that it had applied with the Department of Financial Regulation for a massive rate increase that would have nearly quadrupled our premiums. I wrote a letter to DFR objecting to such a sudden and radical increase.

And then… crickets. My rate has stayed the same. I haven’t checked in with DFR (and I should), so I don’t know if they rejected the rate hike or have yet to pass judgment. The latter seems unlikely after so many months, so I’m cautiously optimistic that my premium isn’t going through the roof.

Well, not now, anyway. But the threat of future rate increases or limits on coverage hang over our heads, limiting the peace of mind that insurance is supposed to offer. It’s just another elephant I’m sharing a bed with.

All that said, we are among the lucky ones who actually have decent coverage and can afford it. Still, the health care systems’ frequent shivers and shakes impart little confidence that we’ll continue to be so fortunate.

Point is, the health care “system” is failing hordes of Americans and putting almost everyone else in a needless state of worry. And it’s wasting tons of money. The “system” doesn’t need tweaking or modest reform. It needs an overhaul. We got here through a combination of creeping corporatism and political inertia. If we were inventing health care from scratch, there’s no way on God’s green earth that we’d devise the dysfunctional Rube Goldberg machine (look it up, kids) we’re stuck with now.