The health care reform record is one of failure

by Rob Roper

In his weekly press conference, Governor Peter Shumlin spoke bluntly about the record of health care reform in America, including our own recent attempt at controlling costs and extending coverage, Catamount Health.

“The failure of Catamount is no more significant than the failure of every single reform effort of every single health care reform plan that’s been passed by every single state legislature and any federal plan in the country which is that no-one has figured out how to contain costs,” said Shumlin. “Is it a failure? Well, sure. It’s a failure at containing costs. It’s a promise that can’t be kept unless taxpayers find endless money that we’re not going to find [to prop up the system].”

His analysis of the record is accurate. Dirigo Health in Maine was a failure. Massachusetts’ recent reform efforts are not delivering promised savings. TennCare, perhaps the closest thing to a single payer system any state has tried, was an explosive failure.

It’s more that a bit disconcerting that our Governor thinks somehow, this time, the results are going to be different.

TennCare was launched in 1994 with the objective of containing a Medicaid budget that was clearly unsustainable. The caveat, which will sound familiar to Vermonters contemplating single payer, was that TennCare had to be “revenue neutral.” The promise, also eerily familiar, was to reduce health care costs by creating efficiencies and using the savings to provide coverage to people who were otherwise uninsured.

To make a long story short, the program quickly spun out of control. Eligibility levels were increased, coverage was cut. Nevertheless, the total annual budget for TennCare increased from $2.64 billion in 1994 to more than $8.5 billion in 2005. A 2003 report declared the system unsustainable. Nearly two hundred thousand beneficiaries of TennCare were purged from the rolls to save the state from bankruptcy. So much for a government attempt at revenue neutral cost containment.

Governor Shumlin asserts that the problem with Catamount Heath was that its goal was expanded coverage, not contain costs. This is not exactly true. The 2006 law that brought Catamount into being reads, “Legislative intent: that all Vermonters receive affordable and appropriate health care at the appropriate time and that health care costs be contained over time (emphasis added).

Equally misleading is Shumlin’s implication that Ethan Allen Health (the new name for Vermont’s single payer scheme) is all about cost containment. Indeed, it will expanding coverage to the 7 to 8% of Vermonters who currently don’t have it is a big part of the mission, particularly for its supporters.

Governor Shumlin is right that the current situation is unsustainable. But the answer “we must do something” cannot mean “we must do anything.” Government has demonstrated time and time again (every time, as illustrated by Governor Shumlin himself) that what it does can make things dramatically worse.

As the Hippocratic Oath states, above all else, do no harm.