Dr. Allan Ramsay. VTD/Josh Larkin
Thirty-five years ago Allan Ramsay graduated from medical school at Emory University and moved to a small town in Southern Colorado.
He was planning to go into the specialized field of oncology during med school, but he became a general practitioner instead because he wanted to build relationships with patients.
“I thought, if I’m going to be a real doctor, I better do it now,” Ramsay says. “A real doctor to me was a family doctor.”
Ramsay started Valley Wide Health Services, a rural, clinic health care system in southern Colorado. After five years, he moved back to the East, and embarked on what would become a career as a prominent physician in Vermont. After 30 years of holding various posts at Fletcher Allen Health Care and the University of Vermont College of Medicine, Ramsay resigned to take on a new role on the Green Mountain Care Board, which will play a major role in reforming the health care system in Vermont.
Ramsay, 64, gave up a successful career in medicine to take the position. He will not be able to work for a large hospital like Fletcher Allen because of conflict of interest issues, but will likely teach at the college of medicine as a professor emeritus.
Ramsay created the Palliative Care Service at Fletcher Allen Health Care in 2005 and the Rural Palliative Care Network to provide expertise to rural hospitals in Vermont and New York. He recently received the Distinguished Service Award from the Vermont Medical Society—the organization’s highest honor. He was, and is, passionate about his work.
One of Ramsay’s main goals is to ensure good palliative care for Vermonters. Palliative care, often confused with hospice, is a medical specialty that reduces or eliminates suffering — no matter what stage of treatment. Hospice is a version of palliative care that is specifically for people at the very end of life who would no longer going to benefit from curative or life-prolonging treatment.
Ramsay tells a story about a colleague and mentor in the palliative care field who helped convince him to get involved in the reform effort. Dr. Diane Meier, a pioneer in the palliative care field, had told him: “Allan, when it comes to reforming the health care system, you will be at the table, or you will be on the menu.”
Ramsay wants to be at the table.
The way Ramsay sees it, he has two constituencies. First and foremost, he has a responsibility to the people of Vermont: that means providing universal access, more primary care and good palliative care. He also has a responsibility to the medical community, to ensure high quality not only in the care the doctors provide but also in their practice life.
Part of this means giving doctors a voice in malpractice reform. Harvard University Economics Professor William Hsiao, who issued a report on health care reform to the Legislature, recommended that the state move toward a no-fault system that limits or eliminates medical malpractice litigation by ensuring compensation for those who are injured. For example, in New Zealand, a government-funded system compensates people with personal injuries, including those caused by medical malpractice, regardless of who is at fault.
Tort reform did not make it into Act 48, the health care reform bill. However, Ramsay says his colleagues will still expect to have a say in the issue.
Ramsay’s goal is pretty straightforward — he wants to focus on high quality care for all Vermonters. But reaching that goal is not so simple since the state has previously embarked on reform efforts like the Blueprint for Health and Catamount Health. According to recent U.S. Census statistics, Vermont already covers more of its residents than most states in the country.
“The problem in Vermont is that there isn’t any low-hanging fruit because we moved forward with reform faster than anyone else,” Ramsay says.
Ramsay is no stranger to making tough decisions, and he is not afraid to have conversations with patients that a lot of physicians might be afraid to have.
Dr. Tom Peterson, chair of the University of Vermont Department of Family Medicine, said Ramsay’s widespread respect in the medical community will go a long way in his new position.
“You need someone who has a really good understanding of how the system works,” Peterson said.
He said Dr. Ramsay has a track record for making difficult decisions, particularly in his work in palliative care, which is his passion.
“You see a lot of things [in palliative care],” Peterson said. “You see a lot of illness; a lot of health; and you see the way things you value over time changes.”
Treating patients with chronic illnesses; making sure they understand all their options; and trying to make care as good as possible for patients rather than focusing simply on fighting a disease is a tough thing for physicians to do, Peterson said.
Like Ramsay, Dr. Peterson said he understands the angst among physicians and Vermonters who do not know what reform means for them, but “the alternative is worse.”
For now, Ramsay said he is settling in and getting used to the learning curve in his new position on the Green Mountain Care Board.
“I’m just reassuring everyone they have a voice,” he said.
As a prominent physician working on health care reform issues, Ramsay says he might be a “lightning rod” for frustrations with the process or change that people do not like.
“I just have to remember,” Ramsay says. “It’s not about me. It’s about what we have to do.”
Permalink |
“I’m just reassuring everyone they have a voice,” he said.
How can he say that everyone will have a voice when they already have their agenda…pass single payer (by default) at all costs…This is about politics, not healthcare. If they are so proud of this whole process, then how come their report is not due out until AFTER the elections? And how come there is no back-up plan? I’m one of those people and healthcare providers that plan on leaving Vermont if this socialized healthcare scheme goes through! I’m all about improving healthcare…but other solutions that were ignored…TORT Reform….Letting people know costs…use of health Savings Accounts…competition with healthcare Insurance Companies across state lines offering individualized plans…disconnecting coverage from employment…setting up high risk pools… I believe, could be enacted quickly and would not only increase coverage but would also decrease costs. The only areas of medicine that have gotten cheaper and have improved (Eye Laser Surgery and Cosmetic Surgery)did so because of patient control..not control by Beaurocratic Czars, as in the green Mountain Care Board!
Permalink |
Ms. Crocker
Please provide evidence that tort reform saves money for patients as opposed to doctors and insurance companies.
As for health savings accounts, they are of no use to families without sufficient income to save. HSAs are of most use to healthy people and to wealthy people as tax shelters.
Permalink |
“As for health savings accounts, they are of no use to families without sufficient income to save. HSAs are of most use to healthy people and to wealthy people as tax shelters.’
That is why they call it a savings account. You have to start saving…get it? Instead of the Playstation and the trip to Disney and the $9 pack of cigarettes, try savings your money. Novel concept. Mr. Hoffer clearly likes class warfare rhetoric…blame the wealthy.
As I have said before, the Progressives are just as bad when it comes to creating division on this issue.
Permalink |
Doug,
Tort reform does not just lower the medical liability costs of physicians and insurers. When physicians order tests defensively to protect themselves from a possible malpractice claim, health care dollars are spent. Protection from such claims would lower the number of these tests that would save the payers (Medicare/Medicaid/taxpayers/patients/employers) money. “Medical-liability reforms such as capping noneconomic damages and tightening the statute of limitation for filing a suit would trim $54 billion from the federal deficit over 10 years, largely by curbing defensive medicine, according to a report released Friday by the Congressional Budget Office (CBO).”
See: http://www.medscape.com/viewarticle/710364
Unfortunately, the minimal amount of tort reform in the PPACA law will likely be sidelined. See: http://www.politico.com/news/stories/1111/67780.html
Permalink |
But Mr. Powers, don’t you understand? Doug and Bernie think it’s unfair that Person A should have to spare himself the Playstation and cigaretts in order to pay for something when Person B doesn’t have to do that. Don’t you get it? It’s not fair to Person A that he can’t buy a Playstation and cigs AND have healthcare! It’s downright un-American!
Permalink |
“You have to start saving…get it?”
We get it alright. We know how much of a scam these health savings accounts are. Except in rare circumstances among the 1%, precious few among the 99% will be able to save enough to cover even a minor medical expense, never mind a major one. And once that savings is gone, then you’re stuck with the rest of the bill yourself. Good luck with that one.
Permalink |
Mr. Carpenter..
HSA’s work and they work well. They may not work for every single person in the USA, but that does not mean we should abolish the entire system for some Progressive dream of another free government entitlement program. Expand your horizons beyond 294 N Winooski Avenue and try to understand overspending by governments and less than 50% taxation of the population. It does not work…it will never work. Also try to understand that the very same politicians you adore were the ones that bailed out the 1% and continue to do so.
Try to think through this statement…”I dislike business and making money…but I want jobs” Can’t have one without the other.
Permalink |
Mr. Powers
Your assertion that less than 50% of the population pays taxes absolutely is untrue.
– Everyone who works pays payroll taxes: 6.75% right off the top for Social Security & Medicare. Note that someone who earns $300,000 from wages pays only 2.5% because they only pay on the first $110,000.
– Everyone that owns a home pays municipal & statewide education property taxes (and renters pay indirectly since landlords cover their taxes through rents.
– Everyone who buys goods at the store pays sales taxes.
– Seventy six percent (76%) of Vermonters who filed income taxes in 2009 paid taxes. Note that 298 filers with income over $100,000 paid NO income taxes, including 42 with income over $300,000.
Permalink |
Mr. Hoffer:
I was speaking about tax evasion in Greece on a much more macro level. Should have clarified better.
Look at your long list of taxes people pay in VT. Now the Progressives want to add another payroll tax to fund a government healthcare system? What’s next…free TV’s, free cable, free housing…etc funded by another tax? Sooner or later you will run out of folks to tax because there will only be people living in VT who suck off the system instead of paying in. The flight of people moving to FL from VT, to escape the tax insanity, is real. Everytime you go after them, they leave. Unintended consequence that the Progressives never think of…
Permalink
Mr. Powers
You said, “Now the Progressives want to add another payroll tax to fund a government healthcare system.”
Actually, a majority of legislators supported the effort to move toward single payer health care, not just Progressives. Moreover, while any tax to fund it would technically be new, it would simply replace what we currently pay for health insurance premiums so it’s not new expenditures.
You also said, “The flight of people moving to FL from VT, to escape the tax insanity, is real.”
According to the Census Bureau, the rate of out migration from Vermont is nearly identical to the rate in New Hampshire, which has comparatively low taxes.
Much of what you’ve been told about these issues is false.
Finally, to compare health care to cable TV is to trivialize an issue of great importance.
Permalink |
“competition with healthcare Insurance Companies across state lines offering individualized plans.”
I have had experience with insurance companies across state lines and can tell you what it is like. While it sounds great in theory, just like the theory of competition in general regarding health care, this is no panancea to substitute for the whole sale health reform that we need. Insurance companies across state lines are as bad, and probably much worse, than the ones here.
Craig:
Thanks for your post. I am sure that HSA’s (Health Savings Accounts) do some good for a few people. For most people, however, including me, they would do aboslutely no good at all since they could not possibly cover the amount of what a medical expense would cost, especially a major one, no matter how long you have saved. And since most major illnesses require more than one trip to the hospital or whatever, an HSA would be wiped out long before it could do much good. To paraphrase Doug H. from one of his posts above, about all that they are good for is a tax write-off for the wealthy.
Permalink |
I think Walt has hit it exactly right.