Newsletter – June 15, 2012

Vermonters for Health Care Freedom

Supreme Court Decision on the ACA Expected Soon

The U.S. Supreme Court is expected to rule on the constitutionality of the Affordable Care Act – ObamaCare – sometime within the next two weeks. The decision is expected to be close based upon the Justices’ comments and questions during oral arguments held in March. Those interested in reviewing the legal history of this case and the historical precedents that will inform the final decision are encouraged to read “ObamaCare on Trial,” published by Reason.com. This article is long but comprehensive and will serve as a refresher course for court watchers interested in the pending decision.

The Reason.com article is here: http://reason.com/archives/2012/06/11/obamacare-on-trial

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What will the Decision Mean to Vermont?

Vermontbiz.com has published a good article summarizing what various rulings on ObamaCare would mean for the progress of this state’s transition to a single payer government monopoly system. To summarize, if the court upholds the law “it’s full speed ahead with the current plan,” according to Robin Lunge; If the court shoots down the individual mandate but leaves most of the rest intact it will have a minor impact (indeed, it might allow the Administration to accelerate implementation of single payer), and if the whole law gets shot down, according to Anya Rader-Wallack,

“If the court was to strike down the entire law, that’s much more significant for us,” Wallack said.

“We are looking to maximize the use of federal tax credits. Without those we would have to cover Vermonters without adding new resources to the system or raise taxes at the state level. Both of those are difficult for a little state all on its own.”

The full article can be read here: http://www.vermontbiz.com/news/june/state-braces-supreme-court-decision-health-care-law

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VHCF Responds to Davis on VTDigger

Hamilton Davis, a longtime student of health issues in Vermont and single payer advocate prepared a series of three articles published by VTDigger. The second of the 3-part series dealt with the challenges of funding the system and is particularly thoughtful and informative. The first installment repeated some of the Administration’s ‘sales pitch’ and as such deserved a response, as did the third installment in which Davis analyzed the arguments against the plan. VHCF’s Jeff Wennberg prepared a response which is now available on VTDigger.

Hamilton Davis’ Series:

http://vtdigger.org/2012/06/05/the-single-payer-framework-how-vermont-is-using-the-aca-exchange-as-a-vehicle-for-reform/

http://vtdigger.org/2012/06/06/the-single-payer-framework-cost-containment-is-the-shumlin-administrations-biggest-conundrum/

http://vtdigger.org/2012/06/08/the-single-payer-framework-an-analysis-of-the-opponents-arguments/

Jeff Wennberg’s Response:

http://vtdigger.org/2012/06/14/wennberg-comments-on-the-single-payer-framework-series/

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MA Study Shows Global Budgets don’t Influence Hospital Costs

In their June 14 meeting the Green Mountain Care Board received a presentation from Anna Gosline of the Blue Cross Blue Shield Foundation of Massachusetts. Gosline has analyzed data from Bay State hospitals to determine the cause of the wide disparity in hospital charges for the same procedures, tests and treatments. The analysis aggregated a large cross section of services so the results are not reflective of differences in any particular service, and adjustments were made for regional demographic differences.

Notable among the results are slides 26 and 27. Since some Massachusetts hospitals are currently operating under global budgets and others are not, Gosline could test whether global budgeted hospitals responded to capitated funding by reducing the cost of services provided. The answer was “no”. There is no correlation between the way the hospital is paid and the prices it charges for services.

So if the payment system isn’t the reason for the difference what is? Quality of outcomes, i.e., “you get what you pay for?” Nope; health outcomes and other measures of quality were not statistically different between high charging and low charging hospitals.

The answer was on slide 27. It appears the larger the hospital the more they can charge. Gosline speculated that institutions that serve a great many people have significantly more clout when dealing with regulators and insurers and use that power to increase payment rates. As noted in the GMC Board discussion, the direction of Vermont’s reform is to move toward Affordable Care Organizations and encourage centralization of many services. Will this effort designed to improve efficiency actually increase costs by empowering much larger provider entities?

Equally interesting is the finding that global budgets do not affect service cost. So if global budgets don’t reduce the cost of services, how do they constrain the overall spending? By limiting the number of services provided, i.e., rationing.

It will be interesting to see what the board does with this information.

Gosline’s presentation should soon be posted here: http://gmcboard.vermont.gov/reports/presentations

A video of the GMC Board meeting will be posted here: http://www.youtube.com/user/CAMavtTV/videos

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Report: Health Care Spending to Increase Under ObamaCare

Multiple media outlets covered a report from the Center for Medicare and Medicaid Services that ObamaCare will increase the overall cost of health care over the next few years. Overall health care spending is expected to grow about 1% faster than inflation but a large bump of 7.4% in 2014 includes a 4% increase as a result of ObamaCare’s expansion of Medicaid.

Coverage in The Hill is available here: http://thehill.com/blogs/healthwatch/health-reform-implementation/232529-house-gop-blasts-obama-health-law-over-spending-projections

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McClaughry’s Decoder Ring Still Working

Ethan Allen Institute’s John McClaughry has provided Vermonters with another insightful commentary on what is really happening within the Vermont race toward government monopoly health care. Published widely, his “Decoding Green Mountain Care language” is a must read for those in need of translation.

The Times Argus published it here: http://www.timesargus.com/article/20120611/OPINION02/706119951

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Seven Days Profiles VHCF

Seven Days newspaper contains a profile of Vermonters for Health Care Freedom in this week’s edition. The profile focuses more on the organization and less on the issue of health reform in Vermont. The reporter paints single payer critics with a “Tea Party-esque” brush, equates health care reform with single payer and mischaracterizes VHCF as being opposed to reform. In other words, if you support any reform other than single payer, you are opposed to all reform. As regular readers of Newsletter are well aware this is not the case; but one can appreciate the fact that opposing single payer must be the first objective if Vermont is ever to consider more rational and humane alternatives. The article correctly quotes VHCF’s Jeff Wennberg warning readers not to fall into this trap:

[Single payer critics] accuse the [advocates] of convincing the public “that single payer is the only alternative to the current system,” Wennberg says. “A lot of people buy it, but it’s just not true.” 

Read the full Seven Days profile piece here: http://www.7dvt.com/2012some-vermonters-are-trying-stop-health-care-reform-8212-one-metaphor-time

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True North Reports TV Discusses Health Care

True North Reports TV, broadcast through Channel 17 in Burlington, included a discussion of Vermont’s health care reform and the questions and issues it raises. VHCF’s Jeff Wennberg was host Rob Roper’s guest for this 30 minute interview. The streaming video was not available at press time but should be within the next 36 hours.

Link to True North Reports TV interview: http://www.cctv.org/watch-tv/programs/jeff-wennberg-vermonters-health-care-freedom