New board set to lead ground-breaking health care reform

Allan Ramsay will serve as one of two physicians on the Green Mountain Care Board. VTD/Josh Larkin

Vermont took an important step Tuesday in the long and difficult climb toward a radical overhaul of its health care system.

Gov. Peter Shumlin unveiled his appointments in Montpelier to the five-member Green Mountain Care Board, which will lead the state to a first-in-the-nation “single-payer” health care system.

He said the panel has a difficult task but he’s convinced they will be able to accomplish that goal by 2014.

“We realize the enormity of the challenge,” he said, but the governor insisted the state can’t continue with a health care system that doesn’t serve the needs of Vermonters, is inefficient, and so costly it threatens the long-term economic security of the state.

“We have a tough job to do, and I picked five folks who are most qualified to do it,” he said.

Heading the panel is Anya Rader Wallack of Calais, who spearheaded the effort in the administration to pass Act 48 in the past session of the Legislature, setting the path toward a single-payer plan. Shumlin made a single-payer system a keystone of his campaign for governor in 2010 and signed his signature accomplishment into law in May.

Best known of the four other committee members is Con Hogan of Plainfield, a longtime advocate of health reform and highly regarded veteran state official. Joining him are Dr. Allan Ramsay, of Essex Junction, businessman Al Gobeille of Shelburne, and doctor Karen Hein, of Jacksonville in southern Vermont. (See panel bios in related story).

Shumlin said 107 Vermonters applied to be on the panel, and 22 were chosen by a nine-member nominating committee. The governor said he personally interviewed all 22 and chose members “who are fully committed to the goal of controlling health care costs, achieving universal coverage and who can work as a team.”

With the board’s appointment, the process of designing a new health care system is set to begin.

Under the law, the board has broad powers to change the way Vermont pays for health care and to try and control growth in health care costs. The creation of the board spurred some controversy in the past legislative session, with critics decrying its extensive power.

The panel also will have to develop a benefits package for the single-payer plan, and the administration will then have to figure out financing to provide universal coverage for all Vermonters. The Legislature will then weigh in with approval of the financing plan.

We’re not winning. We pay more than many other countries and we get less.”
- Al Gobielle

Shumlin laid out stark numbers that he said make it essential that Vermont take action. Vermonters paid $2.5 billion in health care costs a decade ago and are paying over $5 billion today, he said. Without taking action, the state will see overall costs rise another $1.7 billion in four years, which is “$2,500 out of the pockets of every single living Vermonter,” the governor said.

“We understand the enormity of the challenge when we look at what’s happening with health care spending in Vermont, he said.

While the job may be complex, the goal of Act 48 is simple, Shumlin said, “a health care system that makes sense for all our residents.”

Rader said the board begins work Oct. 1, and “we have a long list of things to tackle.”

First on the list is payment reform, she said. She promised that aspect would move at “lightning speed” and said conversations are already occurring with large providers on alternative models for payment. The so-called “fee-for-service” model that exists now won’t disappear, but she said when large providers adopt a new model, it will create momentum for change.

Joking that she would try to avoid being “wonky,” she said the key to reform is designing a system that pays to ensure good health of patients instead of a system that pays by volume of patients seen or for the number of medical procedures accomplished.

That theme resonated with both of the physicians on the panel.

Dr. Hein called soaring health costs “the biggest humanitarian and economic threats to our country” and said the current system is not working.

“I think this is an opportunity of a lifetime What we have already done by passing this bill is historic,” said Dr. Hein, who has been working at a small clinic in Jacksonville to help those injured by Tropical Storm Irene.

Dr. Allan Ramsay, a family physician who said “primary care flows in my veins,” said he felt the only way to control costs was to assure every Vermonter had a family physician and a “patient-centered medical home,” because that’s where good health and screening for diseases and avoiding hospitalization take place. “Primary care first and foremost. That is all that counts,” he said. “That has got to be our foundation.”

He said doctors have faced 10-15 frustrating years of increasing barriers to providing quality care and will welcome a change.

In response to a question about what success would look like, Rader said health care costs are rising at a 6-7 percent clip annually and “bending that curve” closer to the rate of growth in the economy was her goal.

She said it was well-documented that efficiencies can be found in the system. “I think we can do that fairly quickly,” she said.

According to Rader, the next major step after addressing health care costs is a July 2012 target for addressing hospital budgets.

The governor also said he believes the state can get a required federal waiver by 2014 when the state hopes to implement the new system.

The board will be working with a total of 10 staffers at the department of Banking, Insurance, Securities and Health Care Administration (BISHCA), Rader said, and will have 13 staffers in all as it wades into its task.

The lone businessman on the board, Gobeille, said he came to the panel with a perspective of owning a restaurant business with 230 employees, not as a single-payer advocate. But he said it was clear to him that the current system was not working, noting that the U.S. pays almost twice as much for health care as a developed country like Germany, but has health outcomes far worse.

“We’re not winning. We pay more than many other countries and we get less,” he said.

He had another reason for applying to the board, he said. The complexities of insurance — deductibles, copays and the like — are “gut-wrenching” for his employees, and he said “you feel like a jerk as a business owner” for inflicting it on your workers.

“It totally doesn’t make the common sense test,” he said.

Gobeille said Vermont’s small size and unique character and passage of Act 48 make the state ideal to lead the way to an improved and less costly system of health care.

“I think there’s a better way to do it, and it can’t be politicized,” he said.

Hogan, who was Human Services secretary for Vermont and has long championed health reform with advocate Dr. Deb Richter and a single-payer system, agreed wholeheartedly.

“We are uniquely positioned to do something positive here,” he said.