By Robert Maynard and Agnes Clift
The advocates of imposing a single payer health care system on Vermont are continuing what is being billed as a “listening” tour. According to Agnes Clift, and other in attendance, it was more of an exercise in building support for the the single payer system that the advocates have already decided on. Last December I reported on an event held in South Burlington that was part of the original listening tour. On Wednesday May 2nd at Burlington City Hall’s Contois Auditorium another such event was held from 6:00 – 8:00 pm.
The event started out with the Secretary of the Agency of Human Services Douglas Racine introducing the Green Mountain Care board. He then turned the microphone over to the Shumlin Administration’s Director of Heal care Reform Robin Lunger, who ran the event. Lunge wasted no time in informing the assembled crowd that health care reform was an opportunity to enact a single payer health care system. That, she informed the crowd, was the path that Act 48 was pointing toward. What she did not mention was that the state of Vermont has tried at least twice before to use health care reform as an “opportunity” to enact a single payer system: (Taken from the brochure put together by the “Vermont Healthcare Freedom Coalition.”)
When Gov. Dean’s dream of a government run system collapsed in the 1994 legislature, he got it to create the Vermont Health Assistance Plan (VHAP). This enrolled thousands of people in expanded Medicaid – but the government couldn’t adequately pay the providers who served Medicaid patients. Their losses were shifted to private insurance payers – making private insurance that much more expensive.
In 2006, after Gov. Douglas’ veto of a bill to impose universal taxes for universal coverage,the government acted to expand coverage for 12,000 of the uninsured through “Catamount Health”. Gov. Shumlin now wants to scrap Catamount Health because it pays providers more than Medicaid (but still below costs), and the Medicaid budget is in crisis.
Before that our health insurance market was already ruined by an attempt at “reform” that involved yet more government intervention onto the health care market: “In 1991-92 the legislature enforced “community rating” (no adjustment of premiums for age or condition) and “guaranteed issue” (you can wait until you get sick to buy insurance). These “reforms” saved Blue Cross from insolvency by driving all other competitors out of the state, but it wrecked Vermont’s insurance market.”
So, seemingly oblivious to the wreckage caused by past attempts at health care reform that involved even more government intervention into private health related decisions, these “listening” tours are promoting health care reform as yet another “opportunity” to try and impose a single payer system on Vermonters. The idea is to de-link health care coverage from employment. Such a de-linking is a lynch pin of most free market approaches to health care reform and it does not require a government controlled single payer system to accomplish this.
She then went on to show how the cost of health care has gotten out of control without mentioning that part of the reason for this is government intervention in the health care market. No option to undo the mess government has made of this market through previous efforts at “reform” was offered. The only option was to tinker with the details of the already decided rush to a government directed and controlled single payer system.
The group then broke into smaller groups for two exercises. Exercise one was titled “Hopes and Fears.” Prior to the exercise the crowd was provided with three definitions of the term “medical necessity.” They were also given a list of the different types of care that will be provided under Act 48 to review. In this exercise members of each group were asked to “consider the health we all seek during our lifetimes and provide feedback on your and your community’s health care needs.” They were to then choose a facilitator and each of them was too discuss their hopes and fears for a universal health care system. The following suggested questions were given:
a. What health services do you feel are essential to yourself and your community?
b. What health services do you think are less important?
c. What services are easy to access in your community?
d. What services are difficult to access in your community?
Each person was given two index cards. They were asked to write their hopes for “our new universal health care system” on the first card their fears on the second card.
The second exercise was titled “Preferences & Priority Setting”. In this round they were to tell which health care services were most important to them and their community. They were given a list of essential services that federal law mandates be covered under Green Mountain Care. For this exercise they are the universal payer of health care services in Vermont and that they have $1000 to spend. The $1000 represents current health care spending. (The actual amount is about $5.5 billion per year, but the number 1000 was used for the purpose of this exercise.) Of the $1000 they have to spend, $900 has already been spent on essential services. The idea of the exercise is to figure out how best to spend the other $100. They were offered the choices of adding services, cutting out of pocket expenses, or a combination of both. In addition, the option of raising additional funds to cover additional services, or shift out of pocket expenses, was offered. The following methods were suggested as ways to raise additional finds, or save more money:
1. Charge a “premium” (defined monthly amount)
2. Increase cost-sharing (out of pocket expenses when you use services)
3. Raise taxes If you know which one, list here___________________________
4. Cut or limit another health service. Which service?
5. Cut another public service and move the money to health care. Which service?
6. Create additional savings. How?
7. Create a supplemental insurance market where people could purchase coverage for additional services at an additional cost. Which services would you move to a supplemental market (you cannot move essential services)?
These very tightly controlled sessions do not allow for much of an open discussions of the real pitfalls of a government directed single payer system, or of genuine free market alternatives. In a previous piece I noted that:
There is an inherent problem in an approach that sells the notion to the public that health care is a human right that must be guaranteed by government, while at the same time tries to control costs by having a distant bureaucracy put arbitrary caps on medical spending that have no relation to demands. When people get the idea that medical care is free, that greatly increases the demand and thus the costs. The effect being created by the supporters of government controlled health care is to drive up demand and then issue restrictions on how much can be spent by medical professionals and on what. The end result inevitably is the rationing of care and the lowering of its quality. Furthermore, the global budgeting approach has not been able to keep costs down over the long run after the demand has been artificially driven up.
As a Cato Institute report notes, this dynamic is playing out in government controlled health care systems around the world.