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 (www.ethanallen.org).