Decoding the Language of Green Mountain Care

by John McClaughry

The Shumlin Administration is proceeding at flank speed to realize its breathtakingly ambitious promise of “comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless manner regardless of income, assets, health status, or availability of other health coverage” – Green Mountain Care.

The Administration advocates –including Gov. Shumlin himself – deserve credit for openly describing GMC as a “single payer” system. Ideally, every health care dollar spent, aside from modest copays and over the counter remedies, would first be taken from everyone via taxation.

Then the government – the single payer – would distribute the money to health care providers in payment for their approved services to everyone, less, of course, the usual government handling charge. The funds must be spent so that all covered Vermonters receive “affordable and appropriate health care at the appropriate time in the appropriate setting,” at least until the money runs out.

The less forthright GMC advocates shy away from the term “single payer”. They prefer terms like “unified and universal health care system”. That’s because “single payer” invites a comparison with the 40 year old government-run system operating just across our northern border.

This is a comparison the GMC advocates earnestly want to avoid, since an examination of the Quebec system can quickly lead to the conclusion – largely justified – that single payer health care will unavoidably result in rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and of course much higher taxation.

The advocates have an interesting twist on the word “choice.” In a Vermont Digger interview, GMC Chair Anya Rader Wallack observed “[the present] system [is] too complicated and convoluted for anyone to understand, it’s hard to make rational choices.”

It’s certainly true that the present health care system can be difficult to understand, and sometimes people and even doctors make poor choices. But when Rader Wallack touts the role of government in replacing your confused choices with her Board’s expert choices, all of a sudden you realize that you won’t have many choices left. Anya and her board are making them for you.

And why not?, they would say. The Board can’t afford to squander the few billions of dollars they control on unnecessary treatments that you and your doctor might find most suitable. So if the Board’s finds that its choice of treatment for you fits into its mandate for delivering “appropriate health care at the appropriate time in the appropriate setting”, you’ll get it, if there’s any money left.

If your and your doctor’s choice doesn’t square with the Board’s choice, you won’t get it – unless of course you care to pay for it out of your own pocket out of what’s left after paying your GMC tax bill.

“Choice” also appears in another context. Act 48 says “every Vermonter should be able to choose his or her health care providers.” A Quebecker would scoff and reply, “very well, but just how am I supposed to find a provider, eh?”

What Quebec has done is this: “We can only extract so much money from the taxpayers. Money pays bills submitted by providers. The more providers there are, the more bills we’ll have to pay. So let’s reduce the number of providers (by limiting medical school graduates and paying doctors to retire), and limit how much doctors can bill (by capping their payments each quarter). Presto! Problem solved!”

Since the GMC Board has the power to determine “reasonable rates for health care professionals”, in view of “health care professional cost-containment targets”, scarce revenues will force the Board to drive down doctor compensation until, as in Quebec, enough doctors emigrate or retire to achieve the Board’s cost containment target. Again, the Board makes the choices, and good luck to you in finding a doctor who will take you as a patient.

Another term rich in implications is “global budget”. What that term actually means is this: the Board sets the coming year budget for all (thus “global”) providers. When the providers draw down their allotted funds, that’s it. Presto! Cost containment!

There are more examples of Green Mountain Care’s special uses of language, but these should serve to make the point. The advocates of a taxpayer-financed remake of our $5 billion health care landscape need to candidly explain to Vermonters, in plain language, the challenges, contradictions, consequences, and costs unavoidable in this mega-project.

John McClaughry is vice president of the Ethan Allen Institute (

One thought on “Decoding the Language of Green Mountain Care

  1. I have grave concerns regarding Green Mountain Care, and our legislators detirmination that the cost of health must be cheapened here in Vermont. I believe they have a “short sighted” perspective when they place cost reduction as their primary goal in order to make care more available to all Vermonters.

    Because of the emphasis on “cost containment” instead BETTER care for ALL, the new Green Mountain Care must limit access to care by limiting payments to physicians and reduce the budgets of health care facillities, while placing more people into the system.

    Cost containment will also be acheived by adding oodles of red tape for providers in order to justify the cost of the care they provide. A board will detirmine the apropriateness (aka: cheepness) of the care a physician wants to provide because cost reduction and not “best outcome” is the driver in the Green Mountain Care Model.

    Because medical providers will have to provide care to more people for less money without the ability to ALWAYS perscribe what they believe is the best treatment for their patient, many doctors will look for other alternatives for their skills. Options such as changing their parctice to a concierge practice will cut out Green Mountain Care by accepting cash payments for service only, or they may retire, or they may relocate their practice to another state or country like many Canadian doctors have done. How many will consider these opitions? Who knows? There will be those who feel they can not practice good medicine under such a restrictive governmental system and they will not participate. This will leave fewer doctors practicing medicine in Vermont when more people have been promised free/inexpensive access to health care.

    A cost driven health care system means less innovation, longer access times and the limiting of care options due to their cost. Has anyone asked the question “What will happen to patients needing care when Green Mountain Care’s global budget has been spent for the year and there is still 2 months to go until the next budgeting year?” Do the facilities shut down and doctors refuse care for all but the extreemly ill? Who knows? These things do happen in other contries, where cost is the driver in their health care systems. Unless Green Mountain Care changes the perspective with which it looks at patients and the care they need, better care for most Vermonters will be just a pipe dream.

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