Restoring Accountability to “Green Mountain Care”

by John McClaughry

John McClaughry

The 85 page Green Mountain Health Care bill now before the Vermont Senate is quite possibly the most ambitious, complicated, and portentous piece of legislation ever to come before that body. A trip through the lengthy bill reveals not only enormous tasks assigned to bureaucrats to make the plan move forward, but also an astonishing collection of boards and advisory committees obviously designed to keep all the “stakeholders” on board for what could be a long, bumpy and expensive ride.

As passed by the House, the bill declares that Vermont shall have a fully government controlled and taxpayer financed “health delivery system”. This was formerly known as “single payer”, until that term became a political liability as more and more Vermonters discovered what it stood for. Now we’ll get a “public-private universal health care program” making “single payments” and enforcing its “global budgets” on health care providers.

The creation and management of this megasystem will be directed by a five member Green Mountain Care Board appointed by Gov. Shumlin. Once the Board establishes the roster of eligible patients, the package of approved benefits, and the schedule for what all medical providers will be paid, the cost of the plan can be calculated. The state will then call upon the taxpayers to foot the bill.

This bill of course doesn’t specify how the state is going to extract the billions of tax dollars needed to pay those bills. The legislature’s consultant Dr. Hsaio strongly advocated a new state payroll tax – at least 9.4% on employers and 3.1% on employees – to finance his plan, but higher income and sales taxes are still on the table.

The 2013 legislature will presumably have a say over which taxes are to be raised for Green Mountain Care. They will not, however, have any vote on the benefits or the eligibility or the costs of the grand plan. A major sales pitch for the Green Mountain Care Board – now being called the “Jedi Council” – is that it is “independent” of such annoying political considerations.

It’s useful here to contrast Green Mountain Health Care with the state’s land use and development law, Act 250 of 1970. That act (14 pages as enacted) established a nine member Environmental Board appointed by the governor. It supervised enforcement of the permit criteria (air, water, traffic, etc.) applied by district environmental commissions. Only people engaged in “development” were directly affected, a very small percentage of the population.

But the Board was also directed to develop a state Land Use Plan to designate the appropriate and allowable uses for every square inch of Vermont. The legislature directed that the Environmental Board bring its proposed Land Use Plan back for legislative approval. That proved to be a death sentence. Three times the legislature rejected increasingly weaker Land Use Plans. The by then embarrassing requirement that there be a Land Use Plan was quietly repealed in 1984.

Compare this experience with Green Mountain Care. Same appointed board, similar sweeping mandate. But the all-powerful Green Mountain Care Board will be completely unaccountable to the people once its five members are confirmed by the Senate. After that, elected legislators can only vote in which taxes to raise to finance its ambitions.

The Land Use Plan would have affected the rights and economic interests of every property owner in the state. The Green Mountain Care plan will affect everyone who lives and breathes in the state (plus whatever new “residents” suddenly appear to enjoy “free” health care).

If Vermonters believe that the officers of government are “the trustees and servants” of the people and “in a legal way accountable to them” (Ch. I Art 6th Vermont Constitution), they should now insist that their representatives require that the far reaching and costly plans of the Green Mountain Care Board go forward only after majorities in the House and Senate have voted to approve them.

John McClaughry is vice president of the Ethan Allen Institute.