Brock releases market based health care framework as counter to Shumlin’s single-payer proposal

Senator Randy Brock. VTD/Josh Larkin

Senator Randy Brock. VTD/Josh Larkin

Republican gubernatorial candidate Randy Brock released his vision on Friday for a “patient-centered” health care system that he said is fundamentally different from the single-payer proposal by the Shumlin administration.

The first line of the six-page document, however, could be a line from Gov. Peter Shumlin’s health care reform initiative. Brock wrote:  “As Governor, one of my highest priorities will be to ensure that every Vermonter – 100% – has access to quality health care at an affordable cost.”

From there, Brock describes two paths through the forest of health care choices that are fundamentally different: Shumlin’s, he wrote, leads to a government-run system with the specter of higher taxes and rationing; the other, his approach, takes the state toward a system, similar to the one we have now, in which “the power of individual consumers and the free market can drive the transformational change needed, just as they have done in every other aspect of the American economy.”

Brock says his reforms would keep health care costs under control through “prudent regulation, free choice and abundant competition.”

The state senator from Franklin County said his health care plan would place an emphasis on “patient-directed” care, a stronger safety net, competition and personal responsibility.

Brock consulted with health care, public policy and insurance experts on the plan, but no single health policy “czar” helped draft the document. He drew inspiration for the plan from policy initiatives in the states of Maine, Idaho and Indiana.

The proposal contains concrete qualitative proposals, from allowing Vermonters to buy insurance from licensed insurers throughout New England, to introducing patient smart cards and allowing health plan discounts for healthy lifestyles.

Much of the white paper, however, is dedicated to a direct attack on Shumlin’s single-payer initiative.

Brock says the governor’s reforms “will lead to rationing through global budgets, will drive up the cost of medical care, discourage physicians and dentists from moving to Vermont, make it difficult for businesses to add jobs and put critical health care decisions in the hands of five unaccountable government appointees (the Green Mountain Care Board).”

On the other hand, medical tourism could become an industry in Vermont, he said, for cosmetic surgery and orthopedics specifically, if revenue caps were lifted from providers under Shumlin’s plan. VPIRG sniped at that idea in a statement: “This is hardly the kind of health care reform that most Vermonters have in mind…They are not likely to be satisfied by having Vermont become the destination du jour for tummy tucks, facelifts and breast implants.”

Brock’s health care agenda receiving a mixed reception from experts and political activists.

Critics said Brock’s proposal contained little detail, wasn’t realistic politically, and would likely undo the progress the state has made toward affordable health care.

Alex MacLean, Shumlin’s campaign manager, said Brock wanted to return to a pre-1991 “broken system,” in which “the elderly, the sick, and those Vermonters with pre-existing conditions were often denied coverage.”

MacLean argued that Vermonters could see their health care costs rise dramatically, by up to 300 percent, if Brock’s recommendations for modifying Vermont’s community ratings were carried through.

Brock defended his vision by first attacking Shumlin’s alternative as “schlerotic,” but he said he believed that reinsurance pools funded by taxes on health insurance could increase affordability, and that a competitive and free health care market would bring down costs.

Brock called such concerns about the lack of detail in the plan as an “utterly disingenuous” critique from those in the single payer camp. Under the governor’s plan, he said, “you don’t know what’s going to be covered, who’s going to be covered, where you’re going to get it from: you know absolutely nothing.”

“My plan is more detailed than the single payer plan, and they spent a year and a half, $100 million and 100 people on theirs,” insisted Brock.

Donna Sutton Fay, policy director for the Vermont Campaign for Health Care Security Education Fund, said that bringing more health insurance firms into the state to increase competition hadn’t worked in the past.

Fay felt that Brock’s criticisms of Shumlin’s plan, sprinkled throughout his proposal, were not particularly informed. These include the claim that under Shumlin’s proposal, quality of care would worsen.

It would also be “a huge reverse of course” politically, said Fay. “I just don’t think the Legislature is going to undo all the work it’s done in terms of moving to single payer. I don’t see that as a reality as all.”

Brock said the changes he suggests would be incremental and could be politically cumbersome.

Prominent conservative John McClaughry, vice president of the Ethan Allen Institute think tank, rattled off some sentiments he agreed with while skimming through Brock’s proposal.

“Consumer choice, a crucial ingredient in any such plan … personal responsibility, absolutely … Robust choice, yes …” murmured McClaughry. He prefaced his remarks by saying that health care is a huge topic, where “a six-page paper isn’t going to do justice to the complications.”

In a phone interview, Brock emphasized that his plan was a broad framework. He lacked the needed funding, he said, of up to $300,000, to produce a detailed policy proposal.


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Comments

  1. walter carpenter :

    “Shumlin’s, he wrote, leads to a government-run system with the specter of higher taxes and rationing.”

    Rationing? How can we ration more efficiently than we already do now? And government-run means that it is run by us. Why do we want it run by the insurance cartels?

    “reinsurance pools funded by taxes on health insurance could increase affordability, and that a competitive and free health care market would bring down costs.”

    Competition has never reduced costs before. Why will it work now? It also has the added benefit of excluding people who need care. I suppose that under this scheme insurance companies will all be sweet and nice and will never deny a claim, refuse a procedure or test as “medically unnecessary,” or make premiums prohibitive for those of certain age groups or who have had medical histories.

    “He drew inspiration for the plan from policy initiatives in the states of Maine, Idaho, and Indiana.”

    Yes, the plans there have worked so well in raising costs for the most vulnerable and reducing access to care.

  2. Here’s an exercise: go to your nearest favorite internet search engine and search on the following: “us insurance companies exempt from antitrust laws”.

    Then ask yourself just what competition is Mr. Brock talking about?

  3. ruth sproull :

    Market-driven health care is just a rallying cry employed by demagogues with a specific ideology about how EVERYTHING should work economically. It doesn’t work with health care because health is too unpredictable and things like drive, initiative, creativity and personal responsibility often have little effect on one’s ability to keep healthy. Often it’s just the crap shoot of genetics, environment and yes some personal choices but the mix just boils down to whether or not you’re lucky.
    Therefore, this is an area where the “rugged individualism” model employed by the right is completely out of step with the reality of life. We are all in this together and as such should all share in the costs…equally. Besides, it is just common sense to realize that when you take profit out of any economic equation, it is less expensive!

  4. Kelly Cummings :

    It is telling that Randy Brock seems adamant about protecting the insurance company’s profits. This is kind of like trickle down economics….it didn’t work then and it won’t work now. Let’s face it, if it did….there would be more jobs than people and everybody would be healthy! There would be no preventable deaths, no medical debt, no bankruptcy. Right….

    “This is hardly the kind of health care reform that most Vermonters have in mind…They are not likely to be satisfied by having Vermont become the destination du jour for tummy tucks, facelifts and breast implants.”

    Really Randy? You belittle yourself with this comment.

    Move on already!

    We won’t go back.

    • Kelly Cummings :

      VPIRG sniped at that idea in a statement: “This is hardly the kind of health care reform that most Vermonters have in mind…They are not likely to be satisfied by having Vermont become the destination du jour for tummy tucks, facelifts and breast implants.”

      It was kindly brought to my attention that I had mis-read the above and that it was not Randy Brock who made this statement. So my apologies to you Mr. Brock.

      Instead, if I now have it correct, you said:

      “On the other hand, medical tourism could become an industry in Vermont, he said, for cosmetic surgery and orthopedics specifically, if revenue caps were lifted from providers under Shumlin’s plan.”

      Not much different really….but thought it important to take responsibility for my mistake.

  5. Dan McCauliffe :

    Vermont’s current single payer plan of developing a government administered single payer system that utilizes global budgets to ratchet down health care costs, is very similar to Canada’s single payer health care system. Gubernatorial candidate Randy Brock’s health reform plan develops a universal access system that is much more similar to Switzerland’s mixed payer health care system. Switzerland’s health care system is considered to be one of the best in the world while Canada’s system is not highly rated. In a 2010 Commonwealth Fund study Canada ranked dead last in terms of timeliness of access to care and quality of health care compared to six other nations. The 2010 edition of the Euro-Canada Health Consumer Index 2010, found that, despite the fourth highest per-capita spending, Canadian single payer health care system ranks 25th compared with 33 European countries, all of which are mixed payer systems of public and private funding. There is growing pressure in Canada to move away from its single payer system towards a mixed payer system where private health insurance will play a larger role and help the country remedy its health care long waiting times. So why has Governor Shumlin set Vermont on a path of developing a system like Canada’s when there are better systems to emulate?
    It is interesting to note that in the past Switzerland considered moving towards a single health insurer plan but decided against doing this. According to Pascal Couchepin, former President of Switzerland, “We rejected it because we think if you have a single payer, which is also the only [party] who makes contracts with … all the providers, it will be dangerous, because there is too much power in the hands of the [single] health insurance system. We think that if there is competition between the health insurance companies, there will be a certain control among themselves; they will denounce the excesses of the others, … and also they will try to provide better services, and so you can compare.” Mr. Couchepin also draws attention to the fact that if health care costs increase, there is a more rapid response in the Swiss system to raise the necessary funds, compared to the health care systems that primarily rely on raising taxes to cover the costs, such as the system in France (which is also how health care funding is covered in Canada). He states, “And if the [health care] costs increase [in Switzerland], you increase the premiums. In countries [such] as France, where the financing of the system is through the public taxes, you have political decisions to take, and you wait from time to time, and so they have great deficits. In Switzerland, the system not only [has] no deficit, they have even reserves”. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/couchepin.html
    His comment about politicians being reluctant to raise taxes to cover escalating costs is so true. This is a major issue in the single payer health care systems of Canada and Taiwan. In Taiwan “The government is not taking in enough money to cover the services it provides, so it is borrowing money from banks. The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians and they are afraid to raise premiums because of voters. http://en.wikipedia.org/wiki/Healthcare_in_Taiwan
    Funding of the Canadian health care system is also increasingly strained. http://dailycaller.com/2012/07/24/report-canadian-health-care-spending-unsustainable/

    Vermont should more carefully scrutinize Shumlin’s single payer plan for health care in Vermont. From what I have learned by reading about other health care systems in the world, I feel that the single payer plan is terribly misguided. If we weigh all the pluses and minuses of the single payer system and Brock’s proposed universal mixed payer system, it should become clearer which is better suited for us to reach our goal of achieving timely access to affordable and high quality health care for every Vermonter.

    • Craig Powers :

      Well researched and well written, Dan! We can create the necessary reforms if all points of view are considered. The British, Taiwanese and Canadian systems are going broke, so clearly those systems will not survive much longer than our current US model. To keep ignoring that simple fact will only further drive costs upward and dumb-down quality.

      The argument that the outcomes are better and that everyone is covered might hold a little water right now, but that argument will not hold true for long because the single payer system is as economically unsustainable as the present system.

    • Dan McCauliffe :

      Michael,
      Why has Shumlin and the Vermont legislature chosen a Canadian type system over the Swiss type system, when the Swiss type mixed payer system is superior to the Canadian single payer system? Shumlin and many single payer advocates have not realized that the vast majority of European countries do not have the Canadian type single payer systems. Many European countries have mixed payer systems, and the better systems usually follow the Bismarck model, like the Swiss system. Randy Brock is proposing a mixed payer system that offers universal access to health care for all Vermonters. A mixed payer system is far more likely to achieve our goal of universal and timely access to high quality affordable health care. Canada is realizing its failure as a single payer system, and there have been discussions of making it more of a mixed payer system. In fact a recent poll found that the majority of Canadians favor a mixed payer system, allowing private health insurance to play a greater role in its health care system. Yet Vermont continues to march down the road of the flawed Canadian type single payer system.

      As to your comment that Brock’s plan is not yet detailed enough, I reply, How detailed was Shumlin’s plan in 2010 when his campaign pushed for a single payer health care plan? As said in this VT Digger piece: “In a phone interview, Brock emphasized that his plan was a broad framework. He lacked the needed funding, he said, of up to $300,000, to produce a detailed policy proposal.”

      • walter carpenter :

        For one, who says that Vermont is copying the Canadian system? Perhaps we may incorporate some facets of it, but maybe not all of the canadian system, the key word being system here versus the confusing hash we have. For the record, Canadians have private insurance too. And it is in your eyes that the Canadians system is failing. It is undergoing changes, like all health care systems do, but it is not failing. The conservative Harper administration is trying to put more of it out to privitization, as a Montreal family told me. They are running into much resistance. The Canadians I talk to about their health care, and I meet many Canadians, like it and cannot understand why it is that we have not adopted something like theirs.

        Michael has already accurately described the swiss system so there is no need to add much to what he said, except that it is highly regulated by the government. They used to treat health care like we do — huge costs that left millions uninsured — but got sick of that and designed a system that covered everyone at less costs with better results. The key here, is that it is regulated by the government, something the right wing here abhors.

        Senator Brock’s plan, even judging from this broad framework, would do more to torpedo health reform than to help it. As Ross said below, quoting Marvin Malek, the state of texas has the largest number of uninsured with the largest insurers. Insurers make money not by paying claims, but by selling policies to people who will not cost them money.

        • Karen McCauliffe :

          Walter, You question “who says that Vermont is copying the Canadian system?”

          Answer: William Hsaio, the professor who developed Vermont’s single payer plan said that Vermont’s system would resemble the Canadian single payer system. He also helped devise the Taiwan single payer system, modeled after the Canadian system. The Taiwan system is having significant problems, including financial difficulties, overworked and demoralized health care workers, and a shortage of doctors.

          Walter once again you leave the same misleading comment that I previously corrected you on, in another post: Here is my previous response to your comment that “Canadians have private insurance too”.
          In Canada, private insurance is allowed to cover medications and services, such as dental care, that are not covered under the national health care system. However, private insurance is not allowed to cover services in Canada that are covered under the national health care
          system. Read about this unfortunate 36 year old woman who had to break the law to seek private care to diagnose her cancer to avoid the long 9 month wait time for colonoscopy.
          http://blogs.vancouversun.com/2012/08/01/will-canadas-health-care-system-evolve-into-european-parallel-private-model-charter-of-rights-case-will-decide-it/

          “Day said, noting a poll of doctors found one-quarter had patients who died while waiting for care. He was also referring to a landmark 2005 Quebec case (Chaoulli) in which the Supreme Court of Canada stated: “The evidence shows that delays in the public health care system are widespread and patients die as a result of waiting lists for public health care.”

          Canadians are suing the Canadian government for the right to purchase health care services outside of the national health care system. Will Vermont’s Canadian style single payer system take away our freedom to purchase health care outside of the single payer system, as was done in Canada? Will we lose this freedom of choice like Canadians have,
          and who are now subjected to long waiting times to receive health care services? Why not develop a mixed payer system, as proposed by Randy Brock, to avoid this potential problem that continues to get worse in Canada?

        • walter carpenter :

          “He also helped devise the Taiwan single payer system, modeled after the Canadian system.”

          Karen: This is completely incorrect. While Dr.Hsiao does admire the british/canadian systems, he did not incorporate them into his designing of taiwan’s system. He used elements of them, but he did not model taiwan’s system after either of them. Instead, he used what was already in place in Taiwan and worked from there. Taiwan is a public-private type system. Its problems stem from a reluctance of the politics to increase the low rate of spending on health care that they enjoy for fear of igniting a revolution:)

          “William Hsaio, the professor who developed Vermont’s single payer plan said that Vermont’s system would resemble the Canadian single payer system.”

          Again, this is incorrect, though I presently lack the time to go digging back through Hsiao’s presentations to provide the example. As stipulated by S.88, Dr. Hsiao designed three health care systems for Vermont: a single-payer model, based more or less on the british/canadian models, a public option, and a public-private option based on the german, swiss, and taiwanese models. Hsiao favored the public-private option for Vermont. This is not the Canadian system.

          “Walter once again you leave the same misleading comment that I previously corrected you on, in another post.”

          I apologize. I did not see that other post you mentioned. What you said is true. I am not sure if I denied it or just left it off as canadians do have private insurance in that previous post, which I do not remember, but what you said is true. It has been verified to me by many Canadians I have met who tell me about their system. Still, Canadians do have private insurance. That is a fact. One Canadian, though, from Montreal, and a journalist, did tell me that his company provided private insurance.

          “Read about this unfortunate 36 year old woman who had to break the law to seek private care to diagnose her cancer to avoid the long 9 month wait time for colonoscopy.”

          For one, the Vancouver Sun is a paper with markedly conservative leanings. So,naturally, they are going to highlight this. I have seen this story before. Compare it, however, to the millions of Americans who cannot get colonoscopies because they lack the access to care, and how many that die because of it.

          “Will Vermont’s Canadian style single payer system take away our freedom to purchase health care outside of the single payer system, as was done in Canada?

          We should not have to purchase health care outside of the single payer system (key word being system) because all that we need should be included within it. Yet, all single-payer systems of whatever the type, do allow purchasing of private health insurances for, as you said, the stuff not covered by the public plan. But if they allowed purchasing of health insurance for the same stuff as the public you would eventually have a two-tiered system, where the poorest and neediest are dumped into the public, making it cost more, with fewer in it, while the more well-off go private system that would take away the resources from the public.

          That is not the purpose of single-payer where health care is a public good. Randy Brock’s health plan is (from reading this article) not a public-private health plan. It is a private health plan with the same disasters for so many that have dogged us all along — higher costs, especially for those who are most vulnerable, less access, and rich profits for the insurance industries, earned by denying care.

        • Patricia Crocker :

          Walter, you say, “Compare it, however, to the millions of Americans who cannot get colonoscopies because they lack the access to care, and how many that die because of it.”

          Please cite your reference to this number. Hospitals are obligated to provide services to anyone who walks throught the door. If someone cannot pay for a colonoscopy, they can still get it. I have not read any study that talks about widespread deaths, as you state, from cancer because people cannot pay for a colonoscopy. I have, however, read something about people dying because they avoided getting colonoscapies because of the unpleasant nature of them. There is, however, ample studies documenting the wait times and consequences in Canada http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658115/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830632/

        • walter carpenter :

          “Hospitals are obligated to provide services to anyone who walks throught the door. If someone cannot pay for a colonoscopy, they can still get it.”

          Patricia. Are you sure about that? I know, for example, that hospitals are required by law to stabilize and tend anyone who walks through the door, but not to cure them. I did not know that you could walk in and still get a colonoscopy if they cannot pay for it. And if a colonoscopy, who is it that pays for it if they cannot? Us. Have you tried being uninsured and trying to get a colonoscopy? I have had to face this, though not for a colonoscopy.

          Here is a CNN money piece about the number of uninsured Americans:
          http://money.cnn.com/2011/09/13/news/economy/census_bureau_health_insurance/index.htm

          Here is a piece I stumbled across, a blog for people without insurance and with symptoms of colon cancer. It is sad.

          http://www.coloncancerresource.com/colon-cancersymptoms-and-no-insurance.html

          Here is a list of what colon cancer screenings cost here. This is old info, circa 2008. It has probably doubled by now.

          http://coloncancer.about.com/od/screening/a/Uninsured.htm

          The number of Americans who die each year for lack of health care. This one also tells of public hospitals closing.

          http://theimmoralminority.blogspot.com/2012/08/study-finds-that-up-to-45000-americans.html

          The number of uninsured Americans is about 50 million. Of these 45,000 perish annually. I would wager a twelve-pack that many of these unnecessary deaths were from colon cancer that was not caught or treated.

    • Paula Schramm :

      Dan McCauliffe states:
      “Randy Brock’s health reform plan develops a universal access system that is much more similar to Switzerland’s mixed payer health care system”.

      He has not paid attention to his research at all. There is NO basic similarity ,that I can tell through this article, with what Randy Brock is proposing , and the Swiss system, as others have pointed out in these comments. His plan is based on the plans of Maine, Iowa and Indiana, which as far as I know do not mandate that everyone buys health care insurance as the Swiss system does, and do not make all insurers provide the same basic health care coverage without making a profit on it. Gosh, this Swiss system sounds a bit, um, kinda ” socialist”!

      Bottom line : you can talk about the Swiss system, or any other system in other countries all you want, but that really has nothing to do with what Randy Brock is proposing, which is a variation on totally for-profit systems being tried in these other states, none of whom are making the basic commitment that all other industrialized countries have made : to provide affordable health care to everyone. Period.
      Vermont is working on a system that is based on this commitment. Brock is simply offering to “ensure” it and I don’t trust what that’s supposed to mean one little bit.

      • Dan McCauliffe :

        Paula,
        You say, “His plan is based on the plans of Maine, Iowa and Indiana, which as far as I know do not mandate that everyone buys health care insurance as the Swiss system does”
        Starting in 2014 everyone will have to purchase health insurance, under the ACA (ObamaCare) law. It is a given that Brock’s plan will have to be in compliance with the federal law. There is also a federal mandate for a basic level of health care coverage, that again, Brock’s plan will have to be in compliance with.

        If Romney gets elected and the ACA law is changed, or overturned, it will be a whole different ball game. Under this scenario, the federal subsidies that Vermont hopes to capture through the ACA health care exchange may disappear, and this will make it more difficult to raise sufficient funds to finance the single payer health care system.

        • David Bell :

          Dan,

          Brock’s plan is nothing, and I must stress again, nothing remotely similar to the Swiss system. In order for Brock’s plan to resemble the Swiss system, it must actually incorporate most of the significant elements of the Swiss system. Elements like mandates, subsidies and regulations; none of which are present in Brock’s plan.

          The insurance mandates under federal law are a separate issue.
          Just by being in a country that has incorporated an element of the Swiss system (mandates) does not, in any way, mean Brock’s plan resembles the Swiss system.

          It’s not a difficult distinction.

          • Dan McCauliffe :

            David,
            The point I have been trying to make is that the best health care systems in the world that offer universal coverage are mixed payer systems, not single payer systems like Canada. I mention the Swiss system, as an example of one of these highly rated systems. My original post said that Shumlin’s single payer plan was more like the Canadian system and Brock’s plan was more like the Swiss system. I did not say Brock’s plan would be identical too, or very similar to the Swiss system. His emphasis on consumer driven plans to constrain health care costs, use of mixed payers, and coverage of 100% of Vermont citizens, are features shared with the Swiss system, and other mixed payer systems.

            I think all of us posting responses on this topic want universal and timely access to high quality and affordable health care. Where we differ is which type system we think is best suited for us to achieve these goals. There are not enough details for me to cast final judgment on the Brock proposal, but I remain optimistic that the conversation that it has already started will help us build a better health care system in Vermont to achieve or mutual goals.

          • David Bell :

            Dan,

            You have falsely claimed that Brock’s plan is like the Swiss system. I have pointed out it is not.

            Furthermore, Brock’s emphasis of “market based solutions” could, charitably, bear a great deal of resemblance to the Texas healthcare reforms that have left more people without affordable insurance.

            While I believe many of us do want “universal and timely access to high quality and affordable health care”, your obfuscations and inability to acknowledge that the Swiss system is based on subsidies, mandates and regulations demonstrates you are not one of this group.

            You simply seem to want less government involvement in healthcare. If this means fewer people with access to healthcare and longer wait times for many, you seem fine with this; just as log as the government is less involved.

            This saddens me, but you could at least do us all the favor of admitting this, instead of posting another op-ed in which you make the false comparison between Brock’s plan and Swiss healthcare.

        • Paula Schramm :

          Dan McCauliffe – David Bell & Deb Richter have made many points in answer to your repeated attempts to find similarities between Brock’s plan and the Swiss health care system, so I will let my statement stand that there ARE no basic similarities. I would just like to clarify something else. In your reply to me you mention the ACA, or Obamacare, as a mandate to buy health insurance with which Brock’s plan would have to comply. That of course is not the same as in the Swiss system. Their mandate works so that everyone does end up with health care. Under the ACA there will still not be universal health care because those who refuse to purchase coverage face a fine, but are still not covered by insurance. The ACA will reduce the number of uninsured, but there will, unfortunately, still be estimated millions who are not insured. Therefore I remain completely skeptical as to how Brock’s plan will “ensure”, as he promises, universal affordable health care, unless, as others have pointed out, his plan provides subsidies to those who can’t afford the premiums.

    • David Bell :

      Karen,

      I find it ironic that you provide a number of misleading statements after calling Walter’s comment misleading.

      Hsaio states that Vermont’s system would resemble Canada’s, resembling a system and copying it are two very different things.

      Furthermore, despite your repetition of the tired canard that Canadians are ulcerating to eliminate their healthcare system and replace it with private insurance, actual evidence shows that Canadian approval of their healthcare system is significantly higher than approval by US citizens for our healthcare system (http://www.webmd.com/healthy-aging/news/20041029/us-health-care-satisfaction-trails-others, http://scienceblogs.com/denialism/2009/05/22/are-patients-in-universal-heal/).

      No system is perfect, which is why it is very simple to point to an example or two and attempt to generalize it as proof that Canadians are envious of the US system; when the evidence is overwhelmingly to the contrary.

      Finally, Brock’s plan is not a mixed payer system that provides government healthcare (ie a public option) combined with private insurance. His plan is a series of tax cuts and eliminated regulations; resembling the Texas plan which promised “market based” reform to lower healthcare costs and boost affordability, when in reality this plan has given Texas the largest number of uninsured people in the nation, and the second largest number of children without health insurance.

      You ask why not adopt Brock’s plan; perhaps because it is based on a set of ideals which have, for decades, failed to provide the result they have promised.

      Canada, for all its flaws, provides a system that gives its citizens longer life expectancies, cheaper healthcare as well as actually being popular with the people it is expected to serve.

      When Brock, or any other Republican, actually offers a mixed plan based on methods that have actually been demonstrated to work, you will have a point worth making.

      • Karen McCauliffe :

        David,

        I am not arguing for the status quo. I am arguing that we should look at other systems than the single payer systems due to the problems with the single payer systems. I have never said the Canadians are envious of the US system. Read the link I posted above…Depending on the outcome of the Canadian Supreme Court, Canadians may end up with a mixed payer system like most of Europe. That is what I am advocating for, a system like the Swiss system that is not as problem prone as the single payer systems.

        We can quibble about the semantic differences between “copy” and “resemble”. The fact remains that the man who laid the foundation for Vermont’s single payer plan stated that the Vermont single payer system resembles Canada’s. People who have been following Vermont’s health care reform closely are aware of the similarities between the Canadian and Vermont single payer systems. It has been mentioned in the newspapers, like these:
        Analysis — A Canadian-style single-payer health system in Vermont? http://www.publicintegrity.org/2011/03/01/2102/analysis-canadian-style-single-payer-health-system-vermont
        “Vermont is now the first state in the Union to model its healthcare system after Canada’s single-payer system.”
        http://www.darkdaily.com/vermont-enacts-nations-first-single-payer-healthcare-system-amid-controversy-062711#ixzz260hi3hih

        Before going forward with the single payer system, we should look more at the better European mixed-payer systems that offer universal access at lower cost, but without the long wait times that Canadians experience. As I stated in the previous post, Canadians are discussing the need to reform their single payer health care system to be more flexible like the higher rated mixed-payer European systems due to the problems with the Canadian system. Randy Brock’s plan calls for universal access for all Vermonters to health care, via a mixed payer system, like the highly rated Swiss system. His plan deserves more discussion.

        • David Bell :

          Karen,

          Again, you are making false assertions regarding Brock’s plan.

          Randy Brock’s plan does not, as you claim “call for universal access for all Vermonters to health care, via a mixed payer system, like the highly rated Swiss system”. Randy Brock’s plan calls for nothing more or less than the magic market solution that has been used in Texas for the past decade.

          This system has utterly failed to provide universal healthcare, make healthcare more affordable or do anything that bears even the faintest, most remote resemblance to Swiss healthcare.

          Swiss healthcare is a combination of healthcare mandates, subsides based on income level and myriad government regulations to keep private insurance companies honest.

          Brock’s plan is to eliminate regulations, pander to business interests at the expense of consumers and avoid the type of government interventions that have given the Swiss their impressive healthcare system.

          His plan deserves the derision that it is receiving, an actual plan that could conceivably implement a Swiss style healthcare system in Vermont would deserve more discussion.

      • walter carpenter :

        David:

        Thanks so much for your post. I had not seen it when I replied to Karen’s criticisms of my earlier post. You covered much and I would have quoted from it, but did not see it until after I had posted my reply to Karen. Thanks again. You are right about the Canadian system in that they are not about to adopt what we have. In fact, the Canadians I meet (and I meet a lot of them) have told me that they are amazed that we tolerate what goes on down here. They are stunned. While their system is not perfect and is evolving there is a reason why Tommy Douglas, who founded their health care system, is the most revered Canadian leader.

        • David Bell :

          Walter,

          Good to hear from you as well.

          I imagine Douglas had to put up with the same naysayers in his day; can’t let it get you down.

    • Mr McCauliffe- I think most of us would be happy enough if we had a system similar to any other system in the industrialized world…including the Swiss system. I rather doubt that Senator Brock is endorsing a Swiss system where they enforce heavy regulation of their private insurance companies, have uniform benefits, uniform reimbursement and their tertiary care is for the most part publicly financed. Is that your interpretation of what Senator Brock is advocating?

      • Dan McCauliffe :

        Dr. Richter you deserve much credit for pushing Vermont forward toward the development of a single payer health care system. You and other single payer activists lobbied Montpelier and encouraged Peter Shumlin to hire single payer advocate Dr. William Hsiao to make a proposal. Dr. Hsaio offered three options (2 single payer options, and a public option). He endorsed one of the single payer plans that became the foundation of Act 48, our single payer health care law. However, Dr. Hsaio never offered us a Swiss style option. I wish he had.

        I was once a proponent of single payer health care systems and read single payer advocate Don McCanne’s daily comments on the Physicians for a National Health Care Program (PNHP) web site. I began to read about other countries health care systems and soon realized the problems with the single payer systems. I now feel the mixed payer systems, as in many European countries, offer more flexibility and are better suited to meet the needs of patients, without the degree of rationing and under funding that is found in the single payer systems. That is why I favor a Swiss style mixed payer system that offers universal access to health care. Senator Brock’s outline discusses the use of a mixed payer system that offers universal access to health care for all Vermonters. At this juncture I await more details, but am excited about the prospect of having a better alternative to the single payer health care system.

        • Dan McCauliffe :

          Michael,

          As I previously mentioned to Paula earlier, starting in 2014 everyone will have to purchase health insurance, under the ACA (ObamaCare) law. It is a given that Brock’s plan will have to be in compliance with the federal law.

          You do not need a public option to achieve universal coverage. The Swiss system has no public option.

          Brock’s plan is to cover 100% of Vermonters, and that means universal access. Read his plan at the link in this article above. “Brock emphasized that his plan was a broad framework. He lacked the needed funding, he said, of up to $300,000, to produce a detailed policy proposal.” I think the $300,000 was in reference to what Vermont paid William Hsaio to develop a more detailed plan for Vermont that laid the groundwork for the single payer plan.

  6. Ross Laffan :

    Marving Malek used cite the example of the state of Texas where they have large numbers of insurers but, also, the largest number of uninsured in the country. Is that still the case? According to the Washington Post 26 percent of Texans are uninsured.

    In the end, what we have now is unacceptable. What would happen if the United States adopted a single payer style health care system? For decades, we have operated with a system that allows for tens of millions of uninsured. Would single payer be worse than that? Why isn’t it possible for this country to figure how to solve this problem? There is no other reason except greed.

  7. Allison Costa :

    One group understands individuality and the health of competition.

    Another group wants to hand something over and consolidate, but at what price?

    “government-run means that it is run by us” – you mean, like the ex-public, now government schools?

    I think individuality matters in education and in health care.

    I keep seeing the “individualist” camp hunkering down and being willing to work toward their goals. I keep seeing the “one world/we are all in this together/let’s share the misery and the joy/socialist” camp believing in, what? So far all I can see are hand-outs.

    If you haven’t, please read your history, and think about what you want. Do you like the country you are living in? Which precepts do you think it was founded on?

    Why are you willing to kill the individual in order to amass a large group of basically dead (powerless) people?

    That is what I don’t understand.

    • I guess if you don’t participate in the running of your local public schools then governance is indeed a distant thing – on the other hand if you avail yourself of the many opportunities open to Vermonters and local school districts then governance is at the kitchen table each and every day.

      Your choice.

    • David Bell :

      Allison,

      We have a system of healthcare designed by the “individualist” camp; and it shows a belief in profits to the rich put ahead of healthcare for the poor, medical bankruptcies and constant misery shared by the poor in order to line the pockets of the rich.

      The “socialists” in Vermont do not want “handouts”, they want a system of healthcare that is affordable for all, that protects societies most vulnerable and is run by the people and for the people.

      You suggest we “read history”, perhaps you should try looking at the effectiveness of healthcare systems by country. The “socialists” have us beat by most significant metrics; in the US we spend more for worse results.

      • Patricia Crocker :

        Jeffrey Wennberg and Bob Gaydos did an unscientific study of “medical bankruptcies” in Vermont by surveying law practices who deal in bankruptcy law. They found no evidence of “medical bankruptcies” by anecdotal reports from these law practices. What they did find was that people were bankrupt because they lacked disability insurance and their disability prevented them from earning a wage to pay bills, including mortgages. Bob Gaydos whose company deals with medical insurance, tells people (to the detriment of his own income) that if they cannot afford both, they should purchase disability insurance, NOT medical insurance, because they can still get medical care through free clinics or hosptials who have to provide services to anyone who walks through the door, and the disability insurance would continue to provide a steady (albeit,% of) income.

      • Patricia Crocker :

        you also state, “he “socialists” have us beat by most significant metrics; in the US we spend more for worse results.” What is your source for this statement? First of all, the US spends more money because we can. Many people pay more for private rooms in the hospital, and they also pay for elective procedures such as cosmetic surgery. Did you know that if you take into account accidents and homicide, that the US actually has the highest life expectancy? Did you know that the infant mortality rate is higher in the US because we bring more high risk pregnancies to term through technology and other procedures than any other country? Many of these children may die shortly after birth because of the high risk nature of their gestation. Plus, in other countries like Germany and Sweden, they don’t count children born under 500 grams as a live birth. if those children die, they don’t count them as an infant death. This skews the infant mortality rates. How about the fact that 18 of the last 25 winners of the Nobel Peace Prize in medicine have come from US doctors? How about the fact that 80% of all medical innovations have come from the US? Or how about the fact that the US has the highest survivability rate of any country in almost all conditions including cancers and heart disease? I wouldn’t consider the US as having a broken system like the current politicians want people to believe.

      • Allison Costa :

        I am thinking the answer is a balance of the two: individual choice and competition to keep costs down, and a social contract to aid those who ask for it.

        • Paula Schramm :

          Allison Costa – What you are describing here:

          “I am thinking the answer is a balance of the two: individual choice and competition to keep costs down, and a social contract to aid those who ask for it ”

          sounds to me a lot like our complex collection of (non-)systems that the U.S. now has , and which has become so expensive, while not giving everyone access to adequate health care.
          As long as there is the profit motive driving insurance companies, they will continue to make money by denying care….there has got to be another way !

    • Paula Schramm :

      “One group understands individuality and the health of competition.”

      They don’t seem to understand that “health of competition” has brought us an extremely flawed , inequitable health care situation where insurance premiums skyrocket at much greater than the rate of inflation, half the individual bankruptcies are due to health care bills and 81 million Americans are under- or uninsured. And we spend nearly twice as much as all other industrialized countries, and with worse over-all outcomes.

      The individuals getting killed are literally the 40,000 people who die every year in our country from lack of access to health care. When will the group that Allison Costa speaks of ever admit the facts and an accurate assessment of our plight, and compare what we do with all the other countries whose more successful systems ALL have elements of the “dreaded” socialism.

      • Patricia Crocker :

        Please provide references to your statistics.

        • Paula Schramm :

          Patricia Crocker – you wrote at the start of your earlier very glowing description of the strengths of health care in the U.S. , asking someone else in reference to their post :

          ” the “socialists” have us beat by most significant metrics; in the US we spend more for worse results.” What is your source for this statement?”

          I would like to recommend reading T.R. Reid’s book “The Healing of America- a global quest for better,cheaper, and fairer health care.”
          It is full of facts, figures & comparative studies, with plenty of footnotes. It is also much more than individual pithy factoids…it provides an overview and historical context for how the health care systems of the other industrialized countries developed, and why they out-perform the U.S. in over-all results and affordability.

          You stated : ‘ First of all, the US spends more money because we can,” and go on to talk about how people pay for more expensive things like private hospital rooms and elective surgeries. But actually far more of the expense of our system is caused by the fact that so many Americans don’t get health care until they are very sick. This is the “broken” part of our health care…and it is the result of millions of our citizens being uninsured or underinsured.
          I totally agree with you about the skill of our doctors, our research, and our medical innovation. It’s not that we don’t have much that is excellent about our health care. But for those who can’t afford to get that excellent care, it doesn’t matter, does it ?
          What struck me about your spirited “defense” of our health care system is that you didn’t even mention the biggest difference between all these other countries’ systems and ours : that we have people ( tens of millions) who do not get health care.
          Even with the ACA, it is estimated that there will still be 23 million Americans without health insurance. That’s a big improvement over what we have now, but still an immorally high number. And there is no guarantee that people who have insurance plans will have adequate coverage… or be protected from bankruptcy any better. ( According to a 2005 joint study by Harvard Law School and Harvard medical School, around 700,000 people in the U.S. go bankrupt because of medical bills. How many people do you suppose go bankrupt because of medical bills in Britain, France, Japan, Germany, the Netherlands, Canada and Switzerland ? Zero. )

          I urge you to read T.R. Reid’s book so you can get the big picture.

          • Paula Schramm :

            That’s 700,000 people that go bankrupt because of medical bills EVERY YEAR.
            ( Since this figure is from a study done before the 2008 economic collapse, I would guess that the figure is much higher now .)

  8. Walter Carpenter :

    “Why are you willing to kill the individual in order to amass a large group of basically dead (powerless) people?”

    Alison, what makes you so sure that we will be dead and powerless under a single-payer type system versus being completely dead and powerless under the market-based system that we have now? Ever have to fight a denied claim against a private insurance company bureaucracy? And why is it killing individuality? What is individuality, anyway, without the group to support it?

    • Allison Costa :

      Individuality is not ever, ever defined by a group.

      • David Bell :

        Isn’t that the choice of the individuals?

        What gives you the right to speak for other people as to how they define individuality?

        • Patricia Crocker :

          Depends on what your definition of “is” is.

        • Allison Costa :

          Was not trying to speak for other people! Just giving my understanding on what appears to me as an absolute. :-)

  9. Mr. Brock’s plan of unrestricted proliferation of out of state insurance companies in spite of past predatory practices as a solution for health care reform is no reform at all and is why we have community rating. It would guarantee making a bad situation worse for the 190,000+ Vermonters that are now uninsured or underinsured. His mantra of “free market health insurance” advocacy makes him a more suitable candidate for president of AHIP (American Health Insurance Plans), the insurance trade association and lobby group than for state wide office. Maybe this position is required to secure financing from the insurance sector and their agents.

  10. Patricia Crocker :

    “contained little detail, wasn’t realistic politically, and would likely undo the progress the state has made toward affordable health care”

    Was there sufficient detail in the plan that our Legislature passed (Act 48) when they headed us in the direction of single payer? They gave no specifics about what was to be covered
    and how much it would cost. They essentially said, “let’s pass this bill so we can find out later what’s in it”. Seems to me I’ve heard that story before.

    • David Bell :

      I assume you mean the Republican party’s promise to tell us what their tax plan is after they get elected.

      If you are referring to the sad, pathetic, provable false statement that Nancy Pelosi and the Democrats passed the ACA without reading it, then it’s time to turn off the Fox News; not only was the ACA thoroughly debated before the vote, it was available online to anyone who bothered to read it.

      Which I am guessing did not include you.

      • Patricia Crocker :

        How can anyone read 2000 plus pages of a document filled with legal jargon? I’m guessing you read the whole thing David? It has been stated by a majority of our legislators that they could not read the document before the voted for it, simply because they would have had to be certified speed readers to fit it in between the time it was released and when it was voted on? To this day, we are now finding things in this bill, that no one knew anything about (even the people who wrote the bill)and the unintended consequences that were not considered.

        • Patricia Crocker :

          ACA summarized in one sentence, http://www.youtube.com/watch?v=DRGq5ZSJ3Ys

        • David Bell :

          I will turn your mantra around on you.

          Please cite source proving that the majority of legislators did not in fact read the bill before voting on it.

          Furthermore, please prove that “we” are still finding out what is in the ACA.

          And use actual evidence, rather than youtube videos.

  11. Karen McCauliffe :

    “Is Brock going to provide subsidies based on income levels to insure that everyone can afford healthcare? Will he pass laws requiring every citizen to purchase healthcare?” (Michael Stevens’ questions above)

    Here is from Randy Brock’s more depth analysis that I found at his website…
    “Ensure that the Health Insurance Exchange, established under the federal health care law, is easy to use, clear and has an abundance of choices.” So yes, Randy would have the insurance exchange go forward and as long as the federal subsidies keep coming into the state of VT.

    To address the question, “Will Randy Brock pass laws requiring each Vermont citizen to purchase health insurance”? Randy Brock does not have to pass a law mandating that each Vermonter purchase health care insurance as this is already the law of the land with the Affordable Care Act.

  12. Jason Farrell :

    Check out this bullet from Mr. Brock’s “Plan”

    “Gradually reduce and eventually eliminate the vicious cycle of the cost shift under which government programs (Medicaid, VHAP, Dr. Dinosaur, Catamount) systematically underpay providers, who in turn shift the uncompensated costs to private insurance customers. This shift makes private insurance less affordable, creating more uninsured people, and driving more people into underfunded government health care programs. Providers would need to agree to reduce the present cost shift to private insurance by the approximate amount of the increased state payments.”

    This gem is hidden under the heading “PROTECT PATIENTS WITH REASONABLE RULES” on page four of Brock’s five-and-a-quarter page “Health Care Plan”.

    Mr. Brock plans to decrease the burden he claims (without evidence) that Medicaid, VHAP, Dr. Dinosaur [SIC], Catamount place on the privately insured due to cost shifting, by increasing the payments these programs make to providers as long as they promise not to continue to shift their losses onto the privately insured. What the…? Who will pay for the increased funding for physicians for these programs? All of us, not just those who have private insurance. GENIUS!

    In addition, it doesn’t bode well for the candidate if Mr. Brock can’t even correctly identify and spell the name of the very successful healthcare program that currently provides necessary health care coverage for nearly 60,000 of our state’s children.

    The program is called Dr. DYNASAUR, but with this single bullet Mr. Brock has shown that it’s his thinking that’s the “Dinosaur” in the room.

  13. Dave Bellini :

    I hope whatever the future is, that it provides Vermonters who need medical care to receive it and without going broke. I’m less certain an all government system is the best solution at a state level. It could be a system that meets the needs of all Vermonters, but will it? What guarantee is there, that promises made today will be kept? What happens if Vermonters elects another conservative Governor? Do people really trust that a new health plan model would be left alone? I can tell you from 34 years experience in state government that state programs are political footballs. I don’t trust insurance companies. That doesn’t mean that I trust politicians to be the vanguard of fairness.

    A red flag for me was that the GMCB rejected the state employees plan to be used as a model. The state employees plan is self insured and has a long experience history to look at? It’s a very good plan. So why would the GMCB reject it? Are the benefit levels too good for all Vermonters? Is that the message GMCB? If the difference is only “1%” what’s the problem? It’s likely that the state doesn’t want a model that is collectivly bargained. The plan members have a direct say in what the benefit levels are. There’s a concept.

  14. Paula Schramm :

    “the power of individual consumers and the free market can drive the transformational change needed, just as they have done in every other aspect of the American economy.”

    This quotation from Randy Brock just stopped me in my tracks. The 2007 economic disaster, caused in considerable part by the Wall Street titans of our “free market” system, is still so heavy on my mind – because the middle class has as a result lost 40% of its net worth ! That just might not be the best model to “drive the transformational change needed” for universal health care, since it hasn’t been successful in 50 years of trying.

  15. This remark by Walter Carpenter caught my eye: “Taiwan is a public-private type system. Its problems stem from a reluctance of the politics [sic] to increase the low rate of spending on health care that they enjoy for fear of igniting a revolution:)”
    Yes! There is nowadays no practical limit on the amount and expense of health care that the public can consume. Under single payer (Green Mountain Care), the Vermont public will be given as much health care as the GMC Board can persuade the legislature to pay for with ever increasing taxes.
    In fact, the single payer advocates extol their plan because it assures “cost containment”: once all the tax dollars are spent, there won’t be any more costs incurred. Presto!

  16. I was struck by this line from Walter Carpenter: “Taiwan is a public-private type system. Its problems stem from a reluctance of the politics [sic] to increase the low rate of spending on health care that they enjoy for fear of igniting a revolution:)”
    Yes! Nowadays there is no practical limit on how much health care services a public wants. There is a very practical limit on how much legislatures will vote in increased taxes to support a single payer system. That’s why the UK, Taiwan and Quebec health systems are chronically “underfunded”, producing the usual results of demoralized providers, shabby facilities, technological retrogression, and government rationing of costly services while offering inexpensive services (with lengthy waiting) to hold public discontent in check.
    In fact, the single payer advocates extol the merits of single payer “cost containment”. There is only so much money; once the Green Mountain Care Board allocates and spends it….costs are contained! Presto!
    Single payer will offer primary care free at point of service, to keep discontent in check, but eventually (5 years?) that care will be largely given by non-MDs with less and less training and experience, the waiting times will lengthen, and people of even moderate means will start buying Medigap policies to cover care at boutique practices. This self-protection is what Canada outlawed, but the Chaoulli decision (2005) held that the government could not prohibit people from buying health care with their own funds when an inevitably “underfunded” government system becomes life threatening.
    Some other commentators seem to think the 2007 financial collapse typifies “the free market” at work. This is really ludicrous. The market crash was a combination of artificially cheap money from the Fed, plus government complicity with rent seeking private actors (Goldman Sachs comes to mind) to keep the profits, bonuses, and political money flowing. Curiously, the key political actors were almost all Democrats. Don’t take my word for it: read Reckless Endangerment, by NY Times reporter Gretchen Morgenson and Joshua Ratner (2011).

    • David Bell :

      Yes, the crash was all about dastardly regulators forcing the poor, innocent banksters to give loans to deadbeat minorities.

      The free market simply can do no wring.

      HA!

      Read the Big Short by Michael Lewis, it details the rather obvious fact that the crash was caused by the most criminally irresponsible private financial services sector since the 1920’s; you know the last big crash that occurred when a President declared “we need less government in business and more business in government” (Herbert Hover).

    • walter carpenter :

      “That’s why the UK, Taiwan and Quebec health systems are chronically “underfunded”, producing the usual results of demoralized providers, shabby facilities, technological retrogression, and government rationing of costly services while offering inexpensive services (with lengthy waiting) to hold public discontent in check.”

      John: I am glad that my comment struck you. But if you read between the lines of that remark, which came to mind after reading about the Taiwanese system (for the fifth time or so) it suggests that the people of those countries would in no way accept what we have had to deal with here — the unfettered free market raising premiums by 10, 20, 30% a year, or almost 50% as wellpoint did to its California customers a couple years ago. In other words, the people rule. Not the health insurance companies.

      You talk of demoralized providers. I met one today. In Vermont. A private practice. A specialist. His eyes were all but popping out at fury because of health insurance companies — not getting paid, only getting paid half the bill, having to constantly battle claim denials on behalf of patients, not getting reimbursed for months and months while dealing with the heavy load of paperwork just for one claim (cigna was the worst, he said) and all the rest of it. As Steve aptly pointed out “why should a profit motivated company be allowed to make life and death decisions?” In your beloved free market, this is what happens. It happened to me.

      You talk about shoddy services. Yet, the undeniable truth is that these countries do a much better job at actual health care than we do. We are ranked about 37th, I believe. This must mean that it is not all shoddy and that they really do a good job of caring for their citizens. And I doubt that the doctors and medical providers in these countries have to worry about getting paid like they do here. My doctor is, in fact, leaving private practice because he is sick of dealing with insurance companies. And, unlike here, no one is faced with losing health insurance and access to care.

      We also have the same shoddy services, though in our system, the shoddiness is relegated by income levels. Go into a big city emergency room sometime. I’ve been in clinics here where there is no room to sit and the people are standing anywhere there is a square inch to stand. I have also been a patient here, in Vermont, and been forgotten in waiting rooms and surgery prep rooms by the staff — just left there for hours — because someone screwed up. Was that not shoddy care?

      “Some other commentators seem to think the 2007 financial collapse typifies “the free market” at work. ”

      These commentators are right. The 2008 collapse was because of the free market, without anyone to watch it, at work. Curiously, you said why it crashed: “to keep the profits, bonuses, and political money flowing.” The key political actors were not democrats. While many democratic politicians were certainly complicit in the schemes, the key actors here with this crisis, just like in 1929, were republicans and republican administrations.

  17. Steve Merrill :

    Why should a profit motivated company be allowed to make life and death decisions? Why are people taking 5-15 “medications” daily? Ask your pharmacist what the “average” person takes for med’s, and from how many doctors? Insurance is a business and we once allowed human slaves to be sold in the “free market” barely 150 years ago, it was just a business. Pharma’s a business, hospitals, even non-profits, are businesses now when they used to be a communal responsibility and the revolving door at the FDA, along with the massive drug recalls, show the inherent problems with the “free” market. We discount data showing health problems from GMO foods, corn syrup vs. cane sugar, antibiotics and hormones in animal feed, pesticide over use, confined animal “farms”, incessant alcohol promotion and consumption, install soda machines in school and wonder why obesity rates skyrocket? Randy Brock seems like a nice guy but claims Vt. Yankee is “clean, safe, and reliable” too, maybe we should examine the system before we expand it’s present model of “health care” delivery. SM

  18. Christian Noll :

    My family physician recommended that I see a “Specialist.”

    So I did.

    It cost me a $50. copay and a half a day off work.

    My visit consisted of a twenty minute conversation which was awkward at best.

    The “Specialist’s” office charged my premium (most expensive/best) Cigna insurance $295. for the twenty minute visit.

    So that’s 50 + $295 = $345 x 3 = $1035 an hour.

    This doesn’t count my unpaid time off work and visit was in my mind totally useless other than understanding that the “Specialist” didn’t care if I were to die right there on her floor.

    PATHETIC and remorseful are words that come to mind.

    This is one of about FIFTY stories I’ve accumulated from my American Health Care Prividers since I’ve moved back to the US.

    • Karen McCauliffe :

      Christian, thanks for your comment. The $295 is only what your doctor’s office billed and is not what your “specialist” got paid for by your insurance company. Transparency is needed in the health industry.

      If your specialist was at a hospital then MVP will pay an additional “facility fee” for your office visit. Also the amount that MVP would reimburse is at a higher rate to an academic medical center.

      So irregardless if you are using a private practice office, a physician based in a hospital or a physician based in an academic medical center, what is charged and/or billed is not what they get reimbursed. (I would assume that it is the same with Federally Qualified Health Clinics if you were using your MVP, but I can not tell you that for a fact. I do know that FQHCs pay much higher reimbursement rates for both Medicare and Medicaid than if that patient was seen at the private practice office.)

      • Christian Noll :

        Thank you Karen and I suspected as much.

        FYI, I don’t have MVP (do they still exist?) I have Cigna and its the most expensive and highest quality option my part time employer offers.

        Also sorry for the early morning math ! I’ve asked vtdigger to either delete the post or correct my math but I’ll just go ahead and mention that;

        $50 + $295 = $345 and NOT $245! Sorry. So 3 x $345 for one hour = $1035 and as Karen makes mention, this is not a complete cost analysis.

        Maybe if I took better care of myself, I’d be a little more alert in the morning.

        • Cate Chant :

          Your earlier post has been corrected.

          • Christian Noll :

            Thank you Cate !

      • Paula Schramm :

        A similar, perhaps more trivial short story- no insurance provider involved, so I know exactly what my specialist was paid :
        In early 1980’s, I crushed my finger at work, and being self-employed and uninsured I went to the emergency room at my local VT hospital. They looked it over and bandaged it up ( $300 ….not a small sum in those days). But they weren’t sure about the ligaments in the finger and told me to go to a specialist the next day. It took half my work day to see him. When he came in to check me, he simply asked me to bend my finger in several ways, and announced that the ligaments were fine. The whole thing took 5 minutes. On my way out I was charged $100. I protested : this whole fiasco was costing me 2 weeks of wages, though I was certainly grateful to learn for myself how to tell if ligaments are OK. They relented, and lowered the charge to $50.
        Even $50 for 5min. works out to be a pretty good pay rate : $600/hr , 30 years ago !

  19. Christian Noll :

    Whats the record for the most posts to a vtdigger article?

    Seems like this might be it!

    It takes my computer for ever just to load the page!

    Not just posts, but a lot of good content and well thought out responses also!

    Way to go Nat !

    • Karen McCauliffe :

      Christian, We are out of space in our earlier discussion, so I will just post a comment to you here. (anyone new to the discussion, please see Christian’s post and my earlier post) Just to add for clarification as my main point was missed yesterday.

      What a doctor’s office, hospital, provider etc bills is not what they are reimbursed. So your specialist billed MVP $295, it does not mean that they will get paid that. You need to look at your MVP explanation when your bill is paid by MVP to see what has actually been paid.

      MVP may only decide to pay $150 (arbitrary figure as I explained in the earlier post if varies where you are received treatment etc)then MVP will factor in that you have paid a $50 co-pay so they subtract it out. MVP would mail the doctor’s office a check for $150 – $50 = $100.

      Also in your calculation, you assumed that this amount is pure profit for the doc’s office, hospital, or academic medical center, but quite the contrary as they have employees, taxes, utilities,equipment etc. Plus it is complicated in that you 20 minute visit was not even just limited to 20 minutes of the staff’s and doc’s time, your appointment had to be scheduled, often a nurse calls back with results, docs speak directly with patients with return calls if questions/complications, your doc dictates a letter back to the referring doc, etc

      BUT the main point to come away with is what is billed to your insurance company is not is what is paid back to your provider’s office.

      Hope my explanation makes sense as it was confusing yesterday.

      Christian, as you said this must be the record number of posts on Vt Digger. Thanks for the discussion!

  20. Paula Schramm :

    Patricia Crocker asked for sources for my statistics on number of preventable deaths/year in the U.S. caused by lack of access to health care. I gave the figure of 40,000. See below:

    Despite slight drop in uninsured, last year’s figure points to 48,000 preventable deaths: health expert
    Persistence of large numbers of uninsured and related deaths shows urgency of enacting an improved-Medicare-for-all system, physician says
    The Census Bureau’s official estimate that 48.6 million Americans lacked health insurance in 2011 means approximately 48,000 people died needlessly last year because they couldn’t get access to timely and appropriate care, a health policy expert said today.
    The estimated death toll is based on a peer-reviewed Harvard study published in the American Journal of Public Health in 2009, widely cited during the health reform debate, which found that for every 1 million persons who were uninsured there were about 1,000 related, preventable deaths.
    Dr. Steffie Woolhandler, professor of public health at the City University of New York and visiting professor of medicine at Harvard Medical School, is a co-author of the 2009 study. She said, “The Census Bureau’s latest figure, 48.6 million uninsured, conjures up a very grim picture: a preventable death every 11 minutes.”
    She said studies have shown that uninsured people with chronic illnesses like heart disease delay or forgo care, often leading to serious complications of their medical condition and, in many cases, premature death.
    Woolhandler continued: “As a physician, I simply cannot accept a situation where tens of thousands of people die every year because they lack insurance coverage. And lest anyone think this problem has been solved by the federal health law, the Congressional Budget Office estimates about 30 million people will still be uninsured in 2022. That figure translates into roughly 30,000 excess deaths annually – again, an intolerable picture.”
    The slight drop in this year’s total number of uninsured – to 48.6 million from a record 50 million last year – was largely attributable to an increase in government health insurance coverage, particularly persons covered by Medicaid and Medicare, the Census Bureau said.
    There was also a modest gain in coverage among people between the ages of 19 and 25 – 539,000 – approximately 40 percent of whom obtained coverage through their parent’s health plan as a result of the 2010 health law, the bureau reported.
    Woolhandler said that while the number of persons covered by private health insurance last year was statistically unchanged from 2010, the share of Americans with private coverage, 63.9 percent, shows a slight drop and continues a three-decade-long trend of diminishing coverage through private insurance.
    She also noted that while the national count of uninsured went down slightly, the number of uninsured climbed in 21 states, most significantly in California, where 197,000 additional people became uninsured since 2010. The Census Bureau reported that California’s uninsured numbered 7.4 million in 2011, or 19.7 percent of the population.
    “We should adopt a zero-tolerance policy toward lack of health coverage,” Woolhandler said. “Today’s Census Bureau report underscores the urgency of going beyond the federal health law and swiftly implementing a single-payer, improved-Medicare-for-all program.
    “Such a program would assure truly universal, comprehensive, high-quality coverage for everyone while simultaneously ridding us of the scourge of insurance-company-related waste, bureaucracy and profiteering. A single-payer system would save both lives and money.”
    Woolhandler is co-founder of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance. PNHP played no role in supporting her 2009 research study, which she co-authored with Dr. David Himmelstein, among others.
    Historical state-by-state data on the uninsured from 2011-2008, compiled by PNHP staff from the Census Bureau’s newly published data, can be found here.
    Physicians for a National Health Program (www.pnhp.org) is an organization of more than 18,000 doctors who advocate for single-payer national health insurance. To speak with a physician/spokesperson in your area, visit http://www.pnhp.org/stateactions or call (312) 782-6006.

  21. David Cadran :

    Want a good example of government run health care? The VA. A 100% government run healthcare institution.

    While the VA has had some problems in the past, it does provide great care a majority of the time to our nations veterans.

    All I can say is that the system we have now (which Brock proposes to expand) is clearly no working. It’s time to try a new direction.

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