Editor’s note: This oped is by Matt Dunne, a Google executive, former state senator and Democratic candidate for governor.
A year ago we had great hopes for serious health care reform on the national level. However it’s becoming more and more clear, especially after the recent election in Massachusetts, that we cannot count on Washington to do the job we need to do ourselves here in Vermont – transform our health care system.
Let’s face it. Health care costs are driving most of the financial problems in our state.
Bankruptcies? Health care. School budget increases? Health care. Teacher pension fund? Health care. Small business costs? Health care. Most of the state budget deficit? Health care.
We can cut back on reimbursement to providers from state programs; we can slash low-income children off the rolls; we can lay off teachers; we can raise taxes; we can force everyone to have high deductibles. All will be short-lived fixes unless we fundamentally change the system.
Over the last two decades, Vermont has tried a variety of small changes here and there to solve the looming health care crisis. It is now clear that they have failed, and in some cases have made things worse, as we have subsidized more people’s care without effectively addressing the core cost drivers.
The Vermont Legislature is now facing a horrible decision: Will we stop serving our citizens or will we cause even more cost shifting for hospitals by cutting reimbursements below what it costs to do a procedure?
If we raise taxes today to cover the deficit caused by health care costs and do nothing to change our system, we will find ourselves in exactly the same situation next year.
Instead, we can do what large businesses do and self-insure Vermonters under one system to increase our buying power, reduce administrative costs, and guarantee that everyone pays and everyone is covered. The fact is that some large companies employ and cover nearly as many people as we have living in Vermont.
When I was the head of AmeriCorps*VISTA, I self-insured all 6,000 people working for me, not because it was the right thing to do, but because it saved money. We then used those resources to achieve our core mission.
With one large pool, the state will then have the buying power to change the way we reimburse for medical care – rewarding doctors, hospitals, and citizens for prioritizing health care activities that lead to health outcomes, rather than paying per procedure. Hospitals like the Cleveland Clinic and the Mayo Clinic have demonstrated that better care can come at dramatically lower cost. We can bring these demonstration projects to scale.
When I was in the Senate, I proposed adopting an electronic health care record system similar to what VA hospitals have been using for years. We successfully created VITL organization, but unfortunately, four years later and despite financial support from Sen. Leahy, the administration has not finished the job. This system would allow hospitals to share information with each other. This will allow us to measure the effectiveness of our health care providers, reduce medical errors, and help prevent expensive and unnecessary mistakes.
If mechanisms are not found to cut the ever-spiraling costs of medical procedures, prescriptions drugs, and hospital visits, our towns will continue to run deficits to devastating effect. Vermonters will continue to go bankrupt. Our business growth will be stifled, prolonging the recession. Taxpayers will be saddled with huge tax increases. Our hospitals and doctors will be focused on uncertain revenues and paperwork, not making people well. And our ailing friends, neighbors and relatives will continue to suffer because they cannot afford, nor will they seek out, even the most basic of health care.
Now is the time for Vermont to use its scale, sense of community and our in-state expertise to lead the nation in health care reform. As urgent as it is, such a change will not happen overnight. The Legislature must take steps now, like initiating a statewide hospital budget, so we can start to achieve real cost-containment in the near future. Vermonters must let our elected officials know that change must start this year and demand real leadership on this issue for the future. We cannot wait any longer.
I tried posting on Friday, but didn’t ID myself enough! So here I am back again. (This is a great site, by the way.) I wanted to weigh in on something I’d read about the UK system — because frankly, I worry that the health care reform plans coming out of Washington will some day get us there. I worry about could happen as/if we head down the path toward government-run health care. Look no further than England. I have a friend from there (has lived in states for probably 25 years now) and she just keeps saying we have no idea how good we have it. Her father has waited years for a procedure. Years.
On top of her personal stories, there’s David Sharman’s personal story about his hip replacement surgery, “Hip Replacement in Kettering General Hospital.” He had all kinds of difficulties, including MRSA and much post-op problems, including his dislocations. He doesn’t think he would have survived his hospital ordeal if not for his wife, who has an African herbal background.
He intends the book for readers interested in the state of modern medical care, because they might find useful information that could prevent mistakes. Just what you want with your surgery — mistakes! Because of all the drugs he was given, he lost his memory for a year after the surgery. Thankfully, he’s recovered it now. Do we want this here?
I’m not saying it WILL happen here, I’m just saying I sure don’t want it to. And I also freely acknowledge I don’t have the answers. I just fear some of the answers I’m reading about, that’s all.
Emmendation – porsch – Drs don’t drive porches. Just us rednecks.
Sounds very nice, but it isn’t a plan. It has no substance. How do we get there?
I think if we we were starting from scratch we would have a single-payer system. We are starting with a mess. Promoting a plan that changes every aspect of health care, from billing, to administration, to reimbursement is irresponsible.
We need a governor with pragmatic plans not one with pie in the sky dreams.
Matt:
Nice editorial here. At least you get it. We need a single-payer system in Vermont — everyone pays, everyone in. That is the only way that you will keep cities and towns from going bankrupt, and also ascertain that people do not go bankrupt because of medical illness, a phenomenon that is completely unknown in the rest of the democratic world, but which is common here in Vermont and in America, with our enlightened and stupid belief in the free market.
None of the fixes being talked about even begin to address half of what is wrong with the medical system. The sick here are, essentially, treated as medical losses, and dealt with accordingly. When you are sick, you have to fight for everything here — fight the insurance companies, fight the bill collectors, even fight hospitals and doctors. I know. I had to fight. I had to wait. I not only had to fight the disease, but also fight the system at the same time. It is a miracle, or a curse, depending on who is viewing it, that I survived.
Our medical system is a failure. We have to realize that and legislate accordingly. We cannot count on Washington. The big companies run Washington; the reps we elect are their paid employees, and Washington is so corrupt now that it is essentially only out to enrich itself. we have to do it alone. We have to do it soon.
You only grazed on the subject; what about the cost? If you brought your car to a mechanic and they ruined it you would ask for your money back. But physicians can misdiagnose, misprescribe, etc. for decades even (as in my case) and still bill and drive porches. Pharmaceutical companies perfected marketing and, as dozens of studies show; sway prescribers to take leave of their common sense and medical training. The profits of the drugmakers outpaced the oil companies two years ago. We need to demand drug companies stop marketing and lobbying. We then demand fair prices from health-care providers who look at the bottom line before the patient. And last, any politician should voluntarily give up their shares in these organizations while in office.