by Rob Roper
Morrisville – Tuesday evening, about thirty-five citizens turned out to take part in forum on Green Mountain Care. The event was sponsored by VPRIG along with Speaker of the House Shap Smith (D-Morrisville) and his seat-mate Representative Peter Peltz (D-Woodbury). Panelists included BISHCA commissioner Steve Kimbell, House Healthcare Committee chairman Mike Fisher (D-Lincoln), and Senate Appropriations chair, Jane Kitchel (D-Caledoia). This was one of several similar events held throughout the fall.
Participants submitted questions to the panel either on paper or by raising their hands and asking directly. Speaker Smith said at one point, they were not trying to dodge the hard questions (a fair statement as mine, anonymously submitted on paper, was the first one he read). However, many questions still remain about the future of healthcare in Vermont, even among the movement’s supporters.
Governor Shumlin has often repeated that if this reform does not contain costs, we will “take our marbles and go home.” What does that mean?
According to Steve Kimbell, “We are not saying reduce costs. We are saying slow the rate of growth. Health expenditures have been growing at 6 to 8 percent a year on average, we’re talking about getting it down to three to four. That would be a huge success. If you understand the concept of a base – we’re talking about a $5 billion base with a three percent growth rate.”
Rep. Fisher seemed to agree, stating, “It would be dishonest to ever say that we will ever reduce the cost of healthcare. The rate of inflation is quite literally killing all of us who are paying healthcare bills.”
So, this would mean that the cost of Green Mountain Care is $5.3 billion with a 3% growth rate. The task of the Green Mountain Care board is, therefore, to create a benefits package that can cover 622,000 people within that budget, and a tax collection scheme to cover that tab. But, supporters of Green Mountain Care still repeat that they don’t know how much Green Mountain Care will cost, and use it as an excuse for not answering critical questions about the program.
Kimbell was also emphatic that if the federal Affordable Care Act (AKA Obamacare) is overturned by the Supreme Court or repealed by a new president, Green Mountain Care was dead. “What if the federal law goes away? We’re in real trouble. The truth is, with this $5 billion system,… we need to make some investments to make the changes we need to make…. The federal money is the bridge, the investment money to let us get from where we are now to a new system. And, if the federal money goes away -unless the taxpayers of Vermont want to come up with $4 or $500 million dollars extra per year – we’re not going to do this. It’s that simple.”
Fisher wasn’t so emphatic, stating, “If the Affordable Care Act gets struck down, we still have unsustainable growth in healthcare spending…. It doesn’t mean we’re going to turn around and say, oh well, we tried. It means we’re going to have to look at what we have and address it as best we can.”
Another point of dissonance asserted itself over the issue of the “exchange.” The Affordable Care Act mandates that states create a health care exchange by 2014. The intent of the federal law was well described by VPIRG’s Cassandra Gekas, “This is really a virtual marketplace for buying insurance. It’s like the Orbits — if you’ve ever bought plane tickets — like the Orbits of healthcare. It’s designed to help people compare insurance plans based on price as well as all of the different details that are in the plan.”
Gekas’ excited explanation was actually misleading to the audience, however, as this is not how the Vermont “exchange” is going to operate. The Vermont exchange will not make competition transparent, it will eliminate competition altogether to create a “single payer” system. It would be as if Orbits said, “we have all the best fares on flights — so long as they’re on American Airlines and you pay $500 a seat.”
Steve Kimbell said, “The exchange is the bridge to our single payment mechanism. It’s that simple.” Speaker Smith confirmed in a conversation after the event that this was the intent for the exchange. Orbits it is not.
One citizen asked about the controversial policy of “end of life” choices, or, as opponents call it, Doctor Assisted Death, and it’s role in Green Mountain Care. “Will it be a part of the discussion?”
“End of life care will definitely be part of the discussion because whether you’re a newborn or at the end of life you’re a human being and we’re talking about covering everybody,” responded Commissioner Kimbell. “The real answer here is in the work the provider community is doing around end of life care to not say either or, but to say to the family and the person who’s dying, here are your choices. What do you want. And, amazingly, most people choose the more humane way out.”
On the equally controversial question of “rationing” healthcare, Kimbell said, “The system we grew up with where you could have everything you wanted – if you didn’t like an opinion you go get another one, you go get a third one, if the surgery didn’t work, so go get another surgery – I think we’re going to have to back off on that a little. And if you call it rationing, I disagree with you because we’ve got five billion dollars we’re spending. We ought to be able to buy effective care for $5 billion.”
Many questions simply can’t be answered about Green Mountain Care at this time. Rep. Fisher candidly acknowledged that there are obstacles in the road for which answers do not yet exist, but he is optimistic. “This is a puzzle…. I am recognize that there are groups of people we’re going to have to figure out how to build a universal healthcare system around, and I’ll just label a few of them. We know that there are federal employees in this state. We know that there are federal retirees in this state. We know there are people in this state who are employed by companies that are out of state and get their insurance through them. So, we know that it’s complex…. I believe there are answers to these problems, but we need to work on it.”
However, some of these obstacles seem to be completely incompatible with a single payer system. If solutions, both practical and political cannot be found to some or any of these problems, what does that mean for Vermont?
Speaker Smith opened the evening with these remarks, “We have a system that creates a lot of incentives to gamble, and when it goes wrong, it’s not a good thing. I would like to see a system that deemphasizes people’s ability to take those gambles.”
But, isn’t he and the legislature now gambling our entire healthcare system on an “all in” $5 billion bet on a single payer system that has, by the governor’s own admission, never succeeded anywhere its been tried, for which the legal future is cloudy at best, political support among the people is shaky, and for which key answers on key questions – like how to pay for all this — remain unanswered.
Perhaps we should deemphasize government’s ability to take these gambles with our lives and treasure.