Double Trouble for Vermonters

by Alice Dubenetsky

Today, Vermonters face two health care “reform” behemoths bearing down on them from both federal and state government. The Affordable Care Act, passed by Congress on March 23, 2010, will essentially change the entire health care delivery system as Americans currently know it.

According to the website HealthReform.gov, the plan will “put American consumers back in charge of their health coverage and care.” However, many believe it will do exactly the opposite, leading inevitably to a single payer system and a whole new bureaucracy to control costs and institute “efficiencies”.

Republicans are on record saying that the new health care law kills jobs, raises taxes and increases the cost of health care. The GOP is calling for a repeal of the law and the enactment of “common sense” reforms that work with the free market system.

Even if the national law is repealed and replaced, Vermonters still face the prospect of Green Mountain Care, a single payer health care delivery system signed into law by Governor Peter Shumlin earlier this year. The Democratic majority passed the bill and the governor signed it into law without a framework for implementation and without identifying any funding sources for this massive government undertaking. It is now in the hands of a five-member board of appointees to decide how to fund and implement the plan. On October 5th, the Green Mountain Health Board met for the first time to be briefed on their duties.

To say the task at handing is daunting would be an understatement. Basically, these five people are being asked to completely recreate the health care system, make it affordable, fair, efficient and legal. They must also figure out how to fund it. As of now, there are plenty of questions but only vague ideas and no answers.

Vermonters for Single Payer (“Everybody In, Nobody Out”) sees only advantages to the plan, asserting that it controls costs by creating a universal health care system and establishes uniform rules of reimbursement. However, doctors and opponents see it differently. Dr. Dan McCauliffe of Rutland sees medical disaster right around the corner if the state establishes this massive new program to control every aspect of the patient-doctor relationship, including reimbursement and treatment options.

Dr. McCauliffe is one of the people who are calling for more common sense reforms. He asserts that there are a number of things that can be done right now to “cure what ails our health care system” besides dismantling the present system entirely and replacing it with a top-down government controlled system.

According to the National Institute for Health Care Management’s website, health care spending is highly concentrated among about 5 percent of the U.S. population, which is responsible for 50 percent of all health care spending. Finding more efficient ways to manage their care would go a long way toward lowering health care costs.  Other ways to reduce costs and rein in out of control health care spending include:

Encouraging Health Savings Accounts, which are tax-advantaged medical savings accounts that can be used to pay for qualified medical expenses without federal tax liability. (Currently, the Affordable Care Act as written will prohibit these dollars from being used for over the counter medication)

Tort Reform, limiting payouts in malpractice awards.  A government mandate that the U.S. does not pay more for medications than the average world-wide price, ending subsidization for the rest of the world.

Outlaw direct prescription drug ads targeted to consumers. The United States and New Zealand are the only countries that allow such ads to be broadcast.

Providing incentives for healthy living to combat high rates of obesity and related illnesses. A 2009 study by the Centers for Disease Control and Prevention found that the direct and indirect cost of obesity “is as high as $147 billion annually.”

Minimize governmental and insurance company interference in outpatient care. Third party rules and regulations require legions of “paper pushers” to handle the resultant “morass”, as Dr. McCauliffe puts it. Health Savings Accounts would be a good first step.

Finally, address waste, fraud and abuse, including means testing, opening billing databases to investigate for fraud and billing abuses, better tracking of those who receive government assistance, and setting up an email site and 800 phone number – both widely publicized – where suspected fraud can be reported.

“There is no one silver bullet to cure what ails our health care system,” said Dr. McCauliffe. “However there are a number of things that could be done that collectively could significantly lower the cost of health care.”