Green Mountain Care NOT Single Payer: GMC Board Member

by Vermonters for Health Care Freedom

Dr. Hein: “GMC is Not Single Payer at All.”

Last week Newsletter noted that Governor Shumlin appears to be avoiding the use of the term “single payer” in describing and defending his health care reform initiative. This week Newsletter attended a Vermont Ethics Network conference at which Green Mountain Care Board member Dr. Karen Hein made a presentation. Without any prodding from the audience she asserted in her prepared remarks that, “[Green Mountain Care] is not so much a single payer but a single pot . . . it is not single payer at all.”

This is a remarkable assertion given the long history of Act 48’s authors and supporters describing it as the first effort to implement a single payer health program in the U.S. Indeed, the act itself contains the following under Sec. 2, Strategic Plan:

“. . . all Vermont residents shall be eligible for Green Mountain Care, a universal health care program that will provide health benefits through a single payment system.” 

And in Section 3 we find the definition of Green Mountain Care:

““Green Mountain Care” means the public–private universal health care program designed to provide health benefits through a simplified, uniform, single administrative system . . .”

The Vermont Workers Center, VPIRG, Vermont Health Care for All, and VT Leads: Single Payer NOW! have been promoting Green Mountain Care as single payer, and a Google search of the phrase “Vermont single payer health care” turned up 3,130 results.

So if Green Mountain Care really is single payer, why are key Shumlin Administration officials denying it? Could it be that public support for ‘single payer’ is not as robust as they would have us believe?

Clearly, it is the intent of the governor and legislative leaders that a single administrator – either the state or a private entity under contract with the state – will administer a universal health insurance program applying to as many Vermonters as they can capture, and financed primarily by taxes. And it will be unlawful for any of these Vermonters or their employers to purchase insurance outside the state approved and controlled single administrative system.

If it walks like a duck . . .


Health Care Budget: It’s Worse than We Thought

Many of us who oppose the implementation of single payer health care in Vermont are concerned about the scope of the reform under Act 48. The legislature has granted the Green Mountain Care Board with unprecedented authority to regulate or otherwise control every aspect of the health care industry and assigned them the task of reforming all of it at once.

It is unlikely that a sweeping reform of health care finance could be successfully executed without implementing the reform in iterative steps, bit by bit, to make sure that each change is delivering the desired results. But the Board has been assigned this task and over a dozen others from workforce planning to setting doctors’ compensation levels, with nearly immediate deadlines for making it happen. The opportunities for undesirable and unintended results are almost limitless.

Well, it’s worse than we thought. In Dr. Karen Hein’s presentation to the Vermont Ethics Network conference, she provided a definition of what the Board considers the “Unified Health Care Budget.”

Historically this task has been performed by the Commissioner of Banking, Insurance, Securities and Health Care Administration, and dealt with public and private expenditures for delivery of health care services by providers. But Dr. Hein and the GMC Board now consider any expenditure that seeks to promote health, including line items in potentially every state agency budget. Agriculture, Public Safety, Transportation and Environmental Conservation were mentioned. Bike paths were noted several times as transportation expenditures that ought to be part of the “Unified Health Care Budget.”

Among other things, the budget is to:

“(A) Serve as a guideline within which health care costs are controlled, resources directed, and quality and access assured.

(B) Identify the total amount of money that has been and is projected to be expended annually for all health care services provided by health care facilities and providers in Vermont, and for all health care services provided to residents of this state.”

So when the GMC Board delivers their first Unified Health Care budget to the legislature and it adds a huge chunk of General Fund and Transportation Fund items to the current $5.3 billion total, and starts ‘managing’ these resources through their unprecedented authority, you can say you read it here first.


Rasmussen: Health Care Freedom Supported by Voters

Scott Rasmussen, writing in, affirms that voters support the VHCF view that free market competition is the key to health care cost control, and that every individual should have the right to choose between expensive health care plans that cover almost everything and less expensive one that cover only major medical expenses.

“By a 3-to-1 margin, voters believe that free market competition will do more than additional government regulation to reduce health care costs. . . Seventy-six percent of voters think every individual should have the right to choose between expensive health care plans that cover just about everything and less expensive plans that cover only major medical expenses.

. . . As far as voters are concerned, good ideas are the ones that give individuals more control over their own health care decisions.”

Through Act 48, Vermont is moving in the opposite direction – giving government near total control over the whole health care system and through the single payer monopoly restricting or denying choice to individuals.

The article is here:


Government Control + Human Right = Rationing

Robert Maynard writing for True North Reports examines the recent GMC Board actions on hospital global budgets and explains why Vermont’s effort to use bureaucratic decree rather than patient choice to contain spending will not work:

“When well connected political forces wage a campaign insisting that health care is a human right, they send the message that cost is no object and that people are entitled to the care they desire regardless of the cost. This is especially so when they decry the fee for service model of health care and seek to replace it with a government run model. Now, instead of free market incentives to keep costs down by engaging in healthy behavior we have spending guidelines imposed by an unelected board of government bureaucrats.”

His True North Reports commentary is available here:


Hospitals Respond to GMC with ACO

“One Care Vermont” was announced last week as a cooperative effort to unite Fletcher Allen and Dartmouth Hitchcock to enroll the nearly 100,000 or so Medicare patients in the state on Jan. 1, 2013. OneCare would then coordinate the care being delivered not only at the two largest medical centers serving most Vermonters, but in all other hospitals across the state and in doctors’ offices.

This arrangement, which at first would only involve Medicare patients, is called an Accountable Care Organization (ACO) and is consistent with the goals of the Affordable Care Act and Vermont’s Green Mountain Care single payer program. The federal Centers for Medicaid and Medicare Services (CMS) must approve the plan before it can go into effect. An ACO is essentially an MCO operated by providers.

The idea is to streamline and better coordinate care, and to respond to global budget financing that allocates funding to the ACO on more of a block grant basis, and allows the ACO to retain some of the savings they may realize through improved efficiency. If the ACO overspends its budget it bears the responsibility. The concern is when government constrains the budgets, providers – through the ACO – will restrict access to services to avoid the financial consequences. In this way Medicare deficits are converted into waiting lists for treatment.

It is to be expected that providers will reorganize themselves in response to the assertion of vast new government control over their industry under the Affordable Care Act and Act 48. But it is not clear whether these trends will in fact better serve patients. Studies reported in prior Newsletters have demonstrated that the trend of private practice doctors selling their practices to hospitals is accelerating health care cost increases. And the Massachusetts Attorney General’s report on hospital prices concluded that the larger the hospital the more market leverage it had and the more it was allowed to charge for services.

The likely result of provider aggregation is therefore higher health care costs, and potentially rationing by waiting lists.

The VPR report on “One Care Vermont” is available here:


CALENDAR NOTE: The Department of Vermont Health Access (DVHA) is hosting a series of public forums this fall to educate Vermonters about the new Health Benefit Exchange, scheduled to launch in late 2013. On Monday, September 24, DVHA will present the information at the Rutland Free Library, 10 Court St., between 6:00 pm and 8:30 pm. Details and more information about upcoming events on health care reform can be found on the VHCF Calendar, available here: