A recent article by VTDigger (“Antitrust oversight of OneCare will be up to state regulators”) reminded me of the old warning about letting a fox guard a henhouse. OneCare is Vermont’s “only remaining health care reform company,” and it was decided that any antitrust overview will not be needed “now that lawmakers have approved a rule regulating such companies.”

It appears that some citizen “advocate” was not aware that foxes are supposed to guard henhouses. “Top officials at the Green Mountain Care Board, which had been writing a rule for months to regulate accountable care organizations, pushed back against an advocate’s request to have federal antitrust review be part of that rule,” the article reads.

Ah, the Green Mountain Care Board, that omnipotent group that was to be set up to have “stewardship” over health care decisions because “no one was in charge” of making such decisions. The result is that we now have a single remaining health care reform company. In short, we are moving from single-payer to single-provider. Gee, who would have seen that coming?

Oh, that is right, I predicted this would happen back in 2013:

I have long argued that the logic of the “health care is a human right” argument leads not only to single payer, but to single provider as well. Single payer really is only a stepping stone in the eyes of those who believe that government should control not only the paying for services, but the providing of services as well. Back in May of 2011, TNR ran a story about a health care reform forum held by Burlington Democrats, in which both Mark Larson and Anya Rader Wallack argued that the problem with the current health care system is that “no one is in charge.” Anya lauded the push for health care reform because it would create “stewardship” over our health care system. Mark Larson complained that the current system is too fragmented and spoke about how centralizing authority in the Green Mountain Care Board will fix this problem. We should keep this in mind when considering the creation of “OneCare Vermont,” which is described as follows: “Fletcher Allen and Dartmouth-Hitchcock have created OneCare Vermont – an accountable care organization (ACO) that will work with a network of providers to coordinate the health care of approximately 42,000 of Vermont’s 118,000 Medicare beneficiaries.

How can the Green Mountain Care Board argue that they are in the right position to oversee antitrust, monopolistic trends in our health care system when it was them that envisioned taking “stewardship” over that system because “no one was in charge”? Well, someone is in charge now, and that centralized authority is raising antitrust concerns. No worry — we are assured that the outfit that was set up to have control over our health care system will protect us from antitrust issues.

This would be funny if it wasn’t so serious. Let’s look back at the argument from the people who designed this system.

Here is a clip of TNR’s coverage of that forum:

Starting at the 1:36 mark and lasting to the 2:00 mark, Ms. Wallack argues that the idea was to create a system that had “stewardship” with everyone in it. The objective of setting up the Green Mountain Care Board with such stewardship was because the system at that time had “no one in charge.” At the 4:47 mark up to the 5:00 mark, then state Rep. Mark Larsen of Burlington complains that our system is so fragmented and complex that “no one is in charge.” He sees an opportunity for the Green Mountain Care Board to take charge by providing “strategic leadership.”

So which is it? Do we have an antitrust issue, or a case of effective “stewardship” and “strategic leadership”? Is the top down, monopolistic nature of our health care system a feature or a bug? It would appear that the system was designed for centralized decision making.

Robert Maynard writes a column for True North Reports. He lives in Williston, Vermont.