by Rob Roper
Ludlow, VT – Six panelists – three for and three against single payer healthcare – gathered in the Ludlow Town Hall auditorium. The event revealed a growing list of real and detailed concerns in regard to the scheme, and the overall lack of substantive answers on the part of those pushing single payer.
Proponents of single payer, Senator John Campbell, Dr. Deb Richter and Steve Kappel, spoke largely in philosophical terms, about how we need to do something, we can’t continue on the path we’re on, etc. (a notion that the three opponents of single payer pretty much agreed with), but weren’t able to offer a clear picture of where they’re taking us.
In defense of the lack of answers at this time, Dr. Deb Richter offered the thought, “We need a political process where we figure out how much money we want to spend on health care, and how we’re going to raise that money. And that is part of the process that Act 48 lays out.” In other words, we’re just getting started. Give us time.
But this raises another question: do we really want our health care subjected to a “political process?” Most people say healthcare is an issue that should be above politics, not intentionally mired in it.
Steve Kappel laid out some of the conundrums the legislature and the newly appointed Green Mountain Care Board have to solve. “What’s good about our healthcare system is what makes it so expensive,” said Kappel, citing examples of medical advances that have achieved miraculous results in treating heart attacks and other ailments. That’s good, but expensive. How to reconcile the numbers and morality is a matter for more philosophical debate, but Kappel did offer some thoughts about “rationing.”
“There are only two ways you can control people’s demand for things they want,” said Kappel. “One of them is to make them pay for it. That’s a market solution. The other is to ration. And, I’m one of the people who doesn’t automatically think rationing is a dirty word. It certainly can be. It doesn’t have to be….”
Regarding global budgets, he explained, “The most important thing that a [global] budget does is that it moves the financial focus away from utilization equals revenue. The way hospitals think now, the more people come through they make more money. Under a [global] budget, the incentive becomes volume equals costs. So, all of a sudden, your incentive is not to run a lot of people though your facility, your incentive is to keep your populations healthy as possible to run as little volume through to control your costs, rather than managing your revenues.” Or, what Kappel failed to mention, the incentive to simply deny some patients the care they need in order to meet the bottom line.
Opponents of the framework set out in Green Mountain Care were specific in their criticisms.
Rutland City Treasurer, Wendy Wilton, who has been crunching numbers on Green Mountain Care, laid out how huge the stakes in this policy gamble are. “Understand what’s happening here. [Green Mountain Care] means creating a new state fund that is $4 billion in size. Currently the general fund is $1.1 billion. The education fund is $1.3 billion. And the transportation fund is about $700 million. This thing will dwarf all three of those funds combined. It is huge.”
In addition, Wilton contends, “What I’ve discovered is that under the best of circumstances, matching the revenues and expenses,… that this has an excess of expenses over revenue of over $300,000,000 each year, and at the end of five years, it’s a $2 billion cumulative deficit to the state of Vermont. That’s disconcerting.”
Bob Gaydos of Digital Insurance, the nation’s leading employeebenefits agency specializing in insurance for small businesses and mid-sized companies, addressed the concern that Green Mountain Care will drive employers out of the state. “I sat in a room with an employer — a client, twenty-one states, based in Vermont, hundreds of employees in Vermont – to talk about this issue. These are the words that came out of the CFO’s mouth when the H[uman] R[esources] person was trying to figure out, what are we going to do [in response to Green Mountain Care]? He said, ‘Simple. We don’t hire Vermonters.’ You can ignore that all you want, it doesn’t make it go away.”
Of equal concern is the potential loss of doctors. On this point, Wilton offered a very specific example – her own. “I’m losing my primary care doc. We’ve lost seven primary care doctors in just three or four years in Rutland,” said Wilton. Questioned by Campbell about this number, Wilton attributed two directly to Green Mountain Care, including her own, and the rest to other policies regarding reimbursement. Wilton also raised a concern that a continued loss of specialists at Fletcher Allen Hospital in Burlington could cause Vermont to lose the only trauma center we have in the state.
Faced with a barrage of facts, figures and anecdotes about the real and potential pitfalls of Green Mountain Care, Senator Campbell said, “You know, what’s really unfortunate is that this debate – not just here tonight – this debate has almost become one of let’s spread fear, stress….”
This is not an acceptable response to people who are genuinely concerned about how the state is plans to spend over $5 billion of our money on programs that are supposed to keep us alive and healthy.
The other bone Senator Campbell threw to the skeptics is one the Governor and the Speaker of the House have thrown as well, “We’re going to have to determine whether or not we can pull this off…. And, if we can, great! If all of a sudden we get through a and we find that the cost savings that we expected are not there… we pull the plug.”
However, answering questions after the program was over, Campbell was less strident about pulling the plug.
During the debate he stated, “The determination has not been made on how this will be financed, because we have to find out how much it’s going to cost first, overall.” However, if Green Mountain Care is going to contain costs as promised, that means it will necessarily cost less that the current $5.3 billion we currently spend on healthcare, plus some predetermined rate of growth. If proponents are being honest, that’s the maximum amount the program can cost, or there won’t be a program.
But, when asked if Green Mountain Care was shown to cost more than that amount, would the proverbial plug be pulled, Campbell wouldn’t say for sure.
Just one more thing to be uncertain about.