Health Care Report Ignores Some Big Questions
by Pat McDonald, VT GOP Chair
As Governor Shumlin and the Democratic leadership of the Vermont Legislature continue their efforts to transform our state’s health care system into a centrally-planned and government-managed system, it has become clear that they would like us to focus exclusively on the potential upsides of their new system while ignoring the downsides.
We all agree that health care costs are unsustainable and that something needs to be done to bend the cost curve. Bending that curve will require government to make smart and rational decisions, and be cognizant of the impacts those decisions will have on health care consumers and providers and Vermont’s employers.
In response to a 2011 legislative mandate, the Legislature’s Joint Fiscal Office and the Department of Banking, Insurance, Securities and Health Care Administration recently issued a Report that focused on the cost of Vermont’s health care system, and the potential savings that might accrue from the proposed system. The Report estimates that under a single-payer system, Vermont could reduce health care expenditures by nearly $2 billion by 2020.
The most stunning aspect of the Report, however, is what it ignores: there is no mention of how to fund such a system, and there is no discussion of how this system will affect Vermonters, Vermont businesses, and Vermont’s network of health care providers.
Curiously, the Report also includes savings that the State was already hoping to achieve from the Blueprint for Health Chronic Care Initiative. Those “Blueprint savings” should be in our health care spending baseline, and not counted as “single payer savings.”
Furthermore, no information is provided regarding coverage: that is, what medical and pharmaceutical benefits will be covered under the system, and what benefits will not be covered. For example, will there be limits on the quantity of services Vermonters receive, such as an annual maximum number of visits to a physical therapist? What portion of the cost of care must be paid by the patient? How will Vermonters access care from providers whose services are not covered under the new system, and how will we access care at out-of-state health care facilities?
Don’t we need to know the answers to these questions? Don’t we need to know where the revenues are coming from, what the benefits package will be and how much it will cost each of us? Right now we only have a “plan to plan” with few details – other than an incomplete financial model. A financing proposal is due to be reported by the Secretary of Administration in January 2013 – but that is more than a year away.
Another question which needs to be asked: Why aren’t we working to maintain and build on those best practices already in place? For example, Vermont has a strong fully-insured large group market, a strong and large self-insured (ERISA) group market, a strong state employee health care plan, and a unique “Choices for Care” waiver that stands out nationally and puts home health care and institutional care on an even footing with individuals needing long-term care. We also have the Medicaid “Global Commitment” waiver that has given Vermont the opportunity to use federal dollars more flexibly to help improve health care quality and outcomes for Vermonters.
Dr. Hsiao cautioned that there will be winners and losers with the implementation of a single-payer system – it’s important for us to know who they are. It’s important that we talk about solutions, consider all viable choices and build on what is good in Vermont’s health care system – with as much transparency as possible.
We need to ensure that we do not lose ground on Vermont’s legitimate advances to date in the public and private health care sectors. We need to broaden our thinking and not simply focus on a one-size-fits-all system to the benefit of all Vermonters.
