By Alice Dubenetsky
As the Vermont legislature struggles to fund and implement Green Mountain Care, worries abound regarding the laws potential impact. Regrettably, the proponents of socializing our medical system consistently turn a deaf ear to anyone who suggests that dismantling the current system without a clear assessment of the potential problems might be foolhardy.
The architects of single payer are willing to drop the bureaucratic equivalent of a hell-fire missile into our health care delivery and insurance systems without any regard to the damage it could cause, thus generating understandably high levels of apprehension about the future of our personal health care and our state’s economy.
Dr. Robert Emmons is a clinical associate professor of psychiatry at the University of Vermont, and also maintains a private practice in psychiatry in Burlington. He is deeply concerned about many aspects of GMC, including the attempt to completely eliminate private practice. He recently co-authored a bill with Representative Cynthia Browning (D-Bennington) that was designed to protect the rights of doctors and patients to directly contract for medical services outside of Green Mountain Care. The bill read, in part: “Every Vermont resident should have the ability to enter into voluntary financial arrangements with the health care professionals of his or her choice. In addition, every Vermont health care professional should have the ability to establish his or her practice where and when he or she chooses.” Incredibly, H.311 was defeated by a vote of 44-94, basically along party lines. Only two Democrats voted for this common sense measure.
In comments following the vote, Rep. Browning expressed her dismay about how far the House Health Committee is willing to go to reduce costs by reducing compensation to physicians. She also noted their interest in protecting the regulatory power of the GMC Board at the expense of the rights of private citizens.
“I presented the amendment as a way to ensure that Vermonters would be able to have choice of a variety of doctors as we go forward with health care and health insurance reform, including those who might choose to operate as independent private practice physicians. This ongoing choice was ensured by prohibiting the GMC Board from setting the rates for provider services that were not part of their re-imbursement system. So if a Vermonter chose to contract to see a doctor and pay for that service themselves , or bill their insurance company themselves, they could do so. The concern is that the GMC
Board currently has the power to regulate all physician rates. They could set rates for treatment or services that are below a level at which an independent practice is financially sustainable. If this were done, such doctors would retire, leave the state, or otherwise alter their operations, and Vermonters would no longer have that option for care.”
Dr. Emmons emphasized that H.311 puts the focus on the patients right to contract privately with a physician, clarifying and protecting their rights. It also would allow doctors to set their own rates, so that practicing medicine in Vermont remains economically feasible. Without those built-in guarantees, doctors will be forced to accept the fees are set by the GMC Board, or retire or move out of state. “Over half of the doctors in Vermont are over 55. All they have to do is wait it out, stay quiet and then retire,” he said. That could, and probably will, result in a critical shortage of doctors who would be willing to practice under the directives of the GMC Board and their reimbursement policies.
“Apart from maybe North Korea, no nation goes this far in prohibiting private practice,” said Emmons. “Even Britain, Cuba and Canada have private practices. They’re creating a little Banana Republic.” Emmons noted that Vermont has a history of pushing laws that are unconstitutional, as many aspects of GMC under it’s current framework surely are, resulting in expensive litigation at taxpayer expense.
Emmons is troubled by the fact that proponents of single payer will not address concerns that don’t fit their template, and further that the new system will be entirely overseen by the Green Mountain Care Board, a group of unelected political appointees. “They haven’t done their due diligence,” Emmons asserts. “They have a proactive responsibility to research and understand what they are causing. Single payer proponents should build in statutory protections today (such as H.311) so we don’t have bad outcomes. But supporters of single payer don’t engage concerns, they just dismiss them. If you had a doctor who wouldn’t listen, how would you feel about that? I hope you would fire them, part ways.”
Vermont’s single payer champions consistently cite Canada and Britain as models for a perfect single payer system, but a bit of “due diligence” and a quick Google search would quickly disabuse them of the notion that those countries are health care utopias. Both are currently struggling to find ways to make deeps cuts to their health care funding – because they can’t afford it. Margaret Thatcher was right, and they have finally run out of other people’s money. Britain has actually encouraged a return to private practice in recent years, so it is fortunate that they still have a workable private medical system in place. Vermont legislators are proposing to remove that safety net, so when the unrealizable system that GMC proponents plan to force on the state collapses, Vermonters won’t even have that to fall back on.
Further, as a state of well under 700,000 citizens, Vermont doesn’t have a lot of “other people’s money”, i.e., taxpayer money, to work with.