by Robert Maynard and Gerhard Meyer
What has been billed as a listening tour by the Agency of Administration to help inform the design of future health care reform financing plans, came to the Sheraton’s Diamond Ballroom in South Burlington this past Wednesday. This followed similar meetings in Brattleboro, and Rutland. A fourth meeting will take place in St. Johnsbury in January.
Besides the a number of red shirted advocates from the Vermont Worker’s Center, a special interest advocacy group that lobbies for “healthcare is a human right”, a few people representing local small businesses and at least one person from the health service provider profession attended. These individuals, who did not want their identities revealed, were disappointed that all the “listening” was intended to be one way, and one way only.
These participants arrived at the Sheraton hoping to bring up concerns relating to the business community and health care providers. They hoped the administration would listen, and perhaps address their concerns. What they were treated to was an exercise appeared to be designed to illicit a consensus in support of a predetermined outcome.
After expressing their disappointment, at least two representatives of the business community left early. As the health service provider left, she let one of the organizers know that she would be among those providers who would leave the state if this plan passed. The response from one of the red shirted Vermont Worker’s Center advocate was, “Good, we do not need you anyway.”
What really annoyed the non-advocate participants was the format of the event that allowed for no challenge to the general outline of what was being presented.
The event started with the Commissioner of the Department of Taxes, Mary Peterson, informing the audience that the question to be discussed, “was not whether we were going to have this reform, but how.” She then went on to encourage all to participate in this exciting chance to enact the reform. Contrast this assertion with what Governor Shumlin said this summer at a forum on healthcare in Rutland: “We will only go ahead with Green Mountain Care if we’re convinced together as a state, that the system is better than what we have, that it costs less, it’s going to help create jobs, and we’ve got the cost containment system right. If we can’t do that, we’ll take our marbles and go home.”
Right off the bat, those advocating for reform gave the distinct impression that the government knows best about the right path to reform, and were backing off from the promise that they would not push it through if it did not represent an improvement over what we already have.
The next presentation was given by the recently appointed Head of Department of Vermont Health Access, Mark Larson. He focused on the need for reform because the costs of health care were rising faster than personal income and the ability to pay.
After making the case that reform was a matter of how and not if, the group was then told to break into smaller groups for the first of two “exercises”. In the first exercise, the groups were to discuss a series of 14 pre-determined principles that were provided to guide the health care reform effort.
For example, the first four principles fell under the category of “equity”:
1. universal in paying for the health care coverage of all Vermonters
2. universal in participation of all Vermonters
3. progressive by taking into account the ability to pay for cover
4. uniform in placing similar burdens on people in similar circumstances.
Looked at closely, these “choices” mean essentially the same thing. Do you want a progressive cost structure, or one that places burdens on individuals in similar circumstances – which is the definition of a progressive cost structure. Do you want pay for the health care coverage of all Vermonters, or a system where everyone participates? Good grief!
Strangely, one principle conspicuously absent from the list was “cost containment.” This is extremely odd in that cost containment is supposedly the primary goal — the leading principle – of the administration in this reform effort. Steve Kimbell, Commissioner of BISHCA said the night before, “The Shumlin administration’s number one priority is cost containment because we believe there’s enough money in the system now.”
Other principles not listed included patient choice, doctor-patient confidentiality and the impact on businesses who already provide insurance coverage covered under ERISA. A good a number more could be thought of regarding favoring a free market approach to reform, but the groups were instructed to discuss only the 14 principles provided – leading to the pre-determined outcome of support for a single payer system.
In one group brought up the point that – Principle number 8 says, “predictable with certainty for payers, patients, and providers”. Notice how they do not mention businesses. One gentleman at the discussion brought this up tone of the coordinators, who could not provide much of an answer.
After discussing the principles listed, the participants were told to list the principles most important to them on a green sheet of paper and those of lesser importance on a yellow sheet of paper. The coordinators then collected the papers.
Preceding the next exercise was a discussion of the total amount of money now being spent on health care and the revenue sources used to pay for it. The participants were then broken into smaller group to discuss what revenue sources they preferred to use to pay for the reform effort. Each received a small envelope with miniature, play $100 bills, which they were told to divide up among various boxes representing different revenue sources.
The choices of revenue sources were: Individuals: Beneficiary Premiums, Individuals: Out of Pocket Spending for Services, General Tax/Tax on Businesses, Payroll Tax for Both Businesses and Individuals, Income Tax, Property Tax, Consumption Taxes, Other.
There was no option to stimulate Vermont’s economy so that people’s income was sufficient to meet health care costs. There also was no mention of fixing the mess made of our health insurance market by previous reforms like Guaranteed Issue and Community Rating. Both of these approaches would address the issue brought up by Mark Larson of incomes not rising as fast as health care costs. That is the whole point of those who favor a free market approach to reform. We can address these concerns without getting the government even more involved in the health care market. The tragedy is that there was no way to have such a much need discussion at these stops on the “listening” tour.