Doctors speak out against rate setting by the Green Mountain Care Board

by Robert Maynard

In a Press Conference held by Vermonters for Health Care Freedom, a bipartisan group of doctors spoke out against a provision in Act 48, which gives the Green Mountain Care Board the authority to set the rate that doctors may charge.  The event was covered by the Vermont Digger and reported on here.  One of the doctors speaking out at the event was Dr. Dan McCauliffe of Rutland.  Here is a commentary by Dr. McCauliffe explaining his concerns:

The part that I take issue with, is blocking the right of a patient to obtain care in Vermont, outside of the single payer system with their provider of choice. This pertains to doctors, podiatrists, chiropractors, physical therapists, dentists, optometrist and other health care providers. These providers should have the right to decide whether of not to participate in the single payer system, as they currently have the right to choose to participate with Medicare, Medicaid, and private health insurers. Prohibiting patients from receiving health care services outside of the single payer system can lead to patient harm as it has in Canada. The following is what I discussed at yesterday’s press conference.

There is no doubt that we need to change our health care system to better control costs while guaranteeing universal access.

Abolishing the right of a patient to obtain care from an independent health care provider with private funding, outside of the governance of the single payer system, is a step in the wrong direction.

Canada similarly abolished a patient’s right to privately contract with a physician outside the Canadian single payer system. In 2005 the Canadian Supreme Court ruled on a case in the province of Quebec, and determined that outlawing a patient’s right to obtain care outside the single payer system was a violation of a person’s right to life, liberty and security. The court felt that the inadequacies of the single payer system to deliver care to patients in a timely fashion was causing patient harm.

Other Canadian provinces have pending court cases to also overturn the law that outlaws a patient’s ability to seek care from a health care provider outside the single payer system.

One of the plaintiffs in a court case in the Canadian province of British Columbia is a 36 year old woman who wanted to legally be allowed to get a colonoscopy sooner than the 9 months that she would have to wait, to determine if the blood in her stool was caused by colon cancer. She felt that she should have the right to pay a private doctor to get a colonoscopy sooner than the 9 months she would have to wait in the single payer system. She was worried that delaying the diagnosis would delay her treatment and could allow her cancer to spread and become incurable. Colonoscopy confirmed that she did indeed have colon cancer.

Canada is unique among the 34 countries in the Organization for Economic Cooperation and Development (OECD) in prohibiting private insurance coverage of publicly financed services. Canada also has the distinction of excessively long waiting times to receive health care services because of this prohibition.

Virtually all the health care systems in Europe allow a patient to obtain health care outside of their publicly funded system, through private funds.

The Swiss and Dutch health care systems are two of the highest rated health care systems in the world. They spend approximately the same amount on health care per capita as does Canada, yet neither the Dutch or Swiss system outlaws the private funding of health care. In these two systems patients have many choices to best suit their health care needs, and they do not have the long waiting times as found in the Canadian single payer system. It should come at no surprise that the Canadian single payer system has ranked poorly compared to the better European systems in both quality of care and timeliness of care.

In conclusion, we should learn from the Canadian experience and preserve the right for every patient to privately contract with independent health care providers, when the patient feels that is in their best interest.

Experiences in other countries have shown that outlawing a patient’s ability to obtain health care services outside of a government funded health care system is terribly misguided, leads to long waiting times and violates a person’s right to life, liberty and security – and could do patients harm. This issue needs to be readdressed by the Vermont legislature with more prudent consideration.

A few of us spoke to Representative Dr. George Till yesterday and he stated that he hoped to revisit this issue during this legislative session and would like providers to provide testimony.