Shumlin administration gears up for the nitty-gritty of single payer

Peter Shumlin signed the historic health care reform act on the Statehouse steps on Thursday. VTD/Taylor Dobbs.

Peter Shumlin signed the historic health care reform act on the Statehouse steps in May 2011. Photo by Taylor Dobbs/VTDigger

Gov. Peter Shumlin put Vermont on a path to creating the nation’s first single payer health care system when he signed Act 48 in 2011. But since then, his administration has made little progress up that mountain, drawing questions and accusations from the far political left and right about the governor’s sincerity.

Now, Shumlin and his team are beginning to shift gears, planning the implementation of a publicly funded, universal health care system. In the past two months, the administration has moved two of its policy heavyweights to the fifth floor Office of Health Care Reform — right around the corner from where the governor sits.

Michael Costa, former policy director at the Tax Department, took the elevator up to his new office at the beginning of June. He is charged with figuring out how to finance a single payer system with tax dollars.

David Reynolds, a co-architect of the Affordable Care Act and a former health policy adviser to Sen. Bernie Sanders, joined the team in July. He is tasked with bringing the moving parts of a single payer system together.

Costa and Reynolds join Robin Lunge, director of Health Care Reform, who helped craft the single payer legislation and has overseen the administration’s health care policy initiatives since July 2011.

“This shows that we’re serious,” said Secretary of Administration Jeb Spaulding. “But that’s not why we’re doing this. We’re doing this because we are serious.”

Shumlin doesn’t flinch when questioned about the proposal’s vulnerable points, like shifting more than a billion dollars in health insurance dollars to the tax sector.

“I am bound and determined to pass the first sensible single payer health care system in the country, and that’s going to be the most ambitious policy lift in Vermont history,” Shumlin said on Monday. “So, obviously, we’re going to gear up our staff and engage Vermonters from all walks of life.”

VTHealthConnect

For the past two years, Shumlin’s top health care team has been focused on creating and implementing a new web-based insurance market for more than 100,000 Vermonters. The exchange, called Vermont Health Connect, is slated to open Oct. 1. Then, on Jan. 1, 2014, Vermonters buying health insurance individually or through businesses with 50 or fewer employees will be legally required to purchase plans on this market.

The exchange is not the single payer system the administration has in mind. It is a market that is being created in accordance with the Affordable Care Act, aka Obamacare. To deviate from these federal regulations and implement a single payer health care system, Vermont will need a federal waiver from the secretary of Health and Human Services. But, under federal law, states are not eligible for the waiver until 2017.

This past legislative session, the administration was supposed to submit to the Legislature a financing plan for funding a universal health care system with public dollars. The plan was called for in Act 48, which became statute.

The financing plan, however, did not arrive on legislators’ desks. The administration said it would be premature to propose specific taxes and that the Legislature should focus on passing necessary laws for the imminent insurance exchange.

What did come was a road map of sorts for drawing up a financing plan. It was created by the University of Massachusetts, which estimated the state would need to raise roughly $1.6 billion in public dollars to finance a single payer system.

Robin Lunge

Robin Lunge, director of health care reform for the Shumlin administration. VTD File Photo/Alan Panebaker

Some critics of the study say that it’s an underestimate of the overall cost to the public. But Costa says this study is crucial for developing a single-payer financing plan.

“I am developing a specific financing plan for Green Mountain Care, and we will have that to the Legislature in January 2015,” he said. “When I read Act 48 and the UMass report, I basically see who is covered, what is covered and how much this costs. For the next 18 months, my role is to take the ‘how much’ and design several different ways that you could pay for it and look at what are the impacts on employers, individuals and Vermont’s economy.”

Green Mountain Care

Green Mountain Care is the name of the publicly financed plan that is proposed in Act 48. To get there, Lunge says the administration must cooperate with federal law.

“Our first step in moving towards Green Mountain Care and payment and delivery system reform was to start with the Affordable Care Act, and so a significant portion of our time and efforts and focus has had to be on the Affordable Care Act,” she said. “As we get closer to that being live and up and running, our focus is shifting to the bigger picture, long-term goals.”

Act 48 is explicit: Green Mountain Care would provide “affordable, high-quality, publicly financed health care coverage for all Vermont residents.”

Specifically, Lunge said, “It would provide coverage for doctor’s visits, hospital stays, preventative care, prescription drugs, all of the services that will be covered through all of the plans in Vermont Health Connect.” She added that Green Mountain Care would use a sliding scale for deductibles and co-pays based on residents’ incomes.

Shumlin says he is adamant that Green Mountain Care is applied universally — that includes teachers and state workers.

“Everybody in,” he said. “This is what we envision: No more health care premiums; public financing instead. Contracting out to one of our insurers to adjudicate the claims. We don’t want to be an insurance company. This means having a health care system where the health care follows the individual as a result of their residency in the state of Vermont, not where they work.”

One of the largest pieces to this puzzle is the business community. In 2011, Harvard economist William Hsiao recommended an 11 percent employer tax to fund a single payer system. The proposal was extremely unpopular among many of the state’s largest employers.

Professor William Hsiao, who proposed a design for Vermont’s proposed single payer health care system, spoke about the links between access to health care and economic vitality at a presentation last week at the Marlboro College Graduate School in Brattleboro. Randolph T. Holhut/The Commons

Professor William Hsiao. Photo by Randolph T. Holhut/The Commons

“Businesses are one of the many sectors that have so much to win if we get this right and so much to lose if we don’t,” Shumlin said. “One of the biggest challenges for businesses large and small is the unsustainable rise in costs of health care, which gobbles up our dollars faster than we can make them.”

Shumlin’s Business Council

In April, the governor organized a group of 20 business leaders from across the state to meet with him in off-the-record sessions about financing options for a single payer system.

The council’s representatives span the gamut of Vermont’s businesses, from IBM executive Janette Bombardier to Onion River Sports owner Andrew Brewer to Ken Perine, CEO of the National Bank of Middlebury.

David Coates is chair of the council. He heads the Vermont Long Term Disaster Recovery Group and is a former partner of KPMG LLP, the auditing firm.

“It seems to me that business is extremely important for health care, and, as you know, businesses provide a lot of it,” Coates said. “At the end of the day, if this is going to have a very negative impact on businesses, then it will have a very negative impact on jobs and the economy.”

Governor Shumlin and David Coates, head of the Vermont Long Term Disaster Recovery Group. VTD Photo/Taylor Dobbs

Gov. Peter Shumlin and David Coates, head of the Vermont Long Term Disaster Recovery Group, in August 2012. Photo by Taylor Dobbs/VTDigger

The group has met twice thus far and Coates says the members are waiting for the financing plan from Costa. He says his team won’t be devising financing mechanisms, but, rather, will react to the administration’s proposals.

“The hurdle in my opinion will be what is the cost and how will it impact these businesses’ bottom lines,” he said. “If those things come in in a positive way, then I don’t think there will be a hurdle whatsoever.”

But while thousands of Vermonters are keeping a close eye on the administration’s financing plan, one key official says he is focusing on how to make the rest of the system work.

David Reynolds

When David Reynolds founded Vermont’s first network of Federally Qualified Health Centers in 1976, he says insurance wasn’t the chief issue.

“Coverage alone does not equate to access,” Reynolds said. “Before I started Northern Counties, people in the Northeast Kingdom had health insurance, but they didn’t have a place to use it.”

Reynolds says a single payer system is about much more than financing, and it’s his task to make the system mesh. On the state government side of things, he is charged with greasing the wheels of state bureaucracies so that they work together.

“You need to have the workforce; you need to have integrated systems; you need to have more integration of mental and physical health; and those are the things I’m working on,” he said.

Reynolds left Northern Counties Health Care Inc. in 2007 to become U.S. Sen. Bernie Sanders’ senior policy adviser for health. When he said goodbye to Northern Counties, the network included six federally qualified health centers, two dental clinics and a home health and hospice division.

Working with Sanders, he pushed for progressive policies in Washington.

“David was the lead negotiator, researcher, and drafter of legislation to advance the senator’s priorities in health care,” Sanders’ spokesman Jeff Frank said. “He was involved in the drafting of the first national single payer bill introduced in the United States Senate.”

Reynolds says that one of his token achievements in Washington was helping to negotiate the creation of the 2017 waiver in the Affordable Care Act — the very waiver that would allow Vermont to deviate from the law to set up a single payer system.

“When the president gave up on not proposing single payer or a public option, that (waiver) was a compromise to get the votes of the more liberal members,” he said. “I call the Affordable Care Act the ‘private health insurance preservation act.’”

In 2011, he returned to Vermont to work on implementing Act 48.

“Having come from the dysfunctionality of Congress, working for Bernie Sanders, this is just remarkable to see,” he said. “People are really dedicated to this task.”

Andrew Stein

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164 Comments on "Shumlin administration gears up for the nitty-gritty of single payer"

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Sandra Bettis
3 years 29 days ago

Single payer is financed by income taxes – the only fair way to do it – there are no insurance cos involved, no premiums, no deductibles, no copays and it has nothing to do with your employer. What they are proposing does not sound like single payer to me.

Dave Bellini
3 years 29 days ago
“Shumlin says he is adamant that Green Mountain Care is applied universally — that includes teachers and state workers.” NO THANKS – State employees have a better model that costs less and provides more. We had ZERO percent premium increases last year, how much are catamount etc. going up?? And if facts matters: it will not be “everybody in.” Large private self insured plans will not be included. They are known as ERISA plans and not subject to state law. As a state employee I do not want to join a plan that is yet to be defined, has no… Read more »
Walter Carpenter
3 years 29 days ago

“State employees have a better model that costs less and provides more.”

Dave, how so? Isn’t the plan for state employees administered by Cigna? Does it have deductibles and all those other trappings of private health insurance. For me, single-payer cannot come fast enough.

Pam Ladds
3 years 29 days ago

Agreed! However, the Single Payer model as described is not the Universal Health Care many of us would like (UK and other countries) which are financed totally by taxes. I hear a lot of confusion when Single Payer is mentioned. 2 systems, both hopefully better than the mess we have currently.

Sandra Bettis
3 years 29 days ago

And Cigna is going away – BCBS will be controlling the field from now on – that is not single payer.

John McClaughry
3 years 29 days ago

Andrew’s good article says that Robin Lunge says that GMC “would use a sliding scale for deductibles and co-pays based on residents’ incomes” – that would be what Walter calls “the trappings of private health insurance”.
When the tax dollars run out, which they will since demand for servicves is infinite, provider reimbursements will be cut, expensive care will be rationed, investment in facilities will be cancelled, and patient co-pays and deductibles will increase to discourage utilization. Welcome to single payer, Walter.

Jason Farrell
3 years 29 days ago

“When the tax dollars run out, which they will since demand for servicves [sic] is infinite, provider reimbursements will be cut, expensive care will be rationed, investment in facilities will be cancelled, and patient co-pays and deductibles will increase to discourage utilization. Welcome to single payer, Walter.”

As income for premiums continue to run out, which has happened as health care premium increases have outpaced income increases, provider reimbursements have been cut, expensive care is denied by insurance companies, investment in facilities has been cancelled, and patient co-pays and deductibles have increased to discourage utilization. Welcome to the status quo, John.

Kristin Sohlstrom
3 years 29 days ago

It’s staggering that a man who developed the current physician payment system (Dr. William Hsaio) under Pres. George HW Bush is turned to as an answer to the “problem” of high costs of health care.

It’s also staggering that his work is still being referred to when there is a 15% error margin in his data making it junk. Even Anya Wallack knew enough to distance herself from that.

Dave Bellini
3 years 29 days ago
“how so?” Walt: The state employee plan was rejected by the GMCB. The state employees plan is better because it actually exists, costs are known and rate increases are a matter of record. Reality vs. a concept. Also, we are self-insured. All Cigna does is process paperwork. HUGE difference. The state employees plan is negotiated with employees. A new single payer means all would be at the mercy of politicians and budget writers. EVERYTHING the politicians touch “costs more than anticipated.” If a new plan would be better, I would jump on the band wagon. I’m concerned average working Vermonters… Read more »
Moshe Braner
3 years 29 days ago

Collective bargaining has nothing to do with it, since health care will be divorced from employment. And that is how it should be.

Marjorie Power
3 years 24 days ago
ERISA is not an impediment to the inclusion of all Vermonters in Green Mountain Care. The state has the legal right to provide health care for its residents and to raise taxes to pay for their care. The only reason that an exemption for IBM or other employers would be considered is purely political–that IBM or one of the other 900 pound gorillas makes threats. (It amazes me that IBM would go around saying that they won’t deal with single payer. They operate in single payer countries all over the world. Are they really flacking for the US Chamber of… Read more »
Sandra Bettis
3 years 29 days ago

Single payer means everybody in – otherwise, it is not single payer. Do you want to pay ins premiums and taxes too? The taxes would be much cheaper – there would be no copays and no deductions and you would not lose your ins when you left your job. PS – Catamunt is thru Blue Cross Blue Shield, not the state. (Unlike VHAP which was a great program and run by the state.)

Robert Hooper
3 years 29 days ago
Universal coverage means everyone is IN…. Single payer means administration for all those who are IN happens with one payer which would not be driven by the profit margin of the corporations like BCBS, CIGNA or MVP,etc. UNIVERSAL COVERAGE is one of the keys to keeping costs lower for everyone. Weeding OUT selected employers from the mix automatically fouls up the pool of members that would mitigate cost spikes that happen when adverse populations are represented in greater numbers than present in the population. IBM and other employers want to stay out because they know they can successfully manipulate their… Read more »
Sandra Bettis
3 years 29 days ago

Also, Catamount and VHAP are both going away. Being forced to buy ins from an ins co is not single payer or anything like it and should not be called single payer. The reason that single payer saves money is because there are no admin ocsts – no billing – you get a card and you are good to go – you will never see a bill – wouldn’t that be wonderful? One less thing to worry about – no wonder the Europeans live longer than we do!

Bob Orleck
3 years 29 days ago

Sandra, I bet you believe in the Tooth Fairy, Santa Claus and the Easter Bunny as well. I imagine Unicorn exist in your world as well.

Ross Laffan
3 years 29 days ago

Actually, believing in Santa Claus is the same as believing the free market will fix the problem. It hasn’t and it never will.

Robert Hooper
3 years 29 days ago

actually a FREE market might, but in this economy where everything is too big to fail and antitrust regulations are GONE…. well, it is almost impossible for an individual or small company to compete and impact the marketplace. Insurance companies are no different than BEST BUY or LOWES… your local hardware store isnt going to be able to fight…

Jim Barrett
3 years 29 days ago

As long as the tens of millions keep rolling in from the feds (our tax MONEY) Shumlin will be able to force all of us to do as he wishes no matter what the costs. This huge socialist takeover by government is just what this closet socialist will get no matter what the opinions of the slaves may be.

Pam Ladds
3 years 29 days ago

Socialist?? Unfortunately not even close! If he was we wouldn’t be having this discussion, we have universal health care by now.

keith stern
3 years 29 days ago

Not hardly. They still have no clue how to finance it.

Walter Carpenter
3 years 28 days ago

“This huge socialist takeover by government is just what this closet socialist will get no matter what the opinions of the slaves may be.”

I suppose that no one is a slave to the capitalist system of health care which we have now. Some are lucky enough to have it; others are not. When the insurers raise their premiums or change plans, well it is your tough luck. So what. As for socialist takeover, ask our senior citizens if they feel like slaves on Medicare and want to go back to private health insurance.

keith stern
3 years 29 days ago

Look at Detroit’s example of liberalism destroying a city. California has such huge economic advantages over most states and it has a high percentage of people living at or below the poverty level.
Vermont has the oldest population per capita and it will continue to get worse as taxes increase and good paying jobs decrease. I know I won’t stay here after I retire and watch my retirement money get eaten by high taxes even though I had always planned to live my entire life here.
Good job liberals in destroying a once very good state.

keith stern
3 years 29 days ago

California is billions in debt. Get it right. Vermont will get along without me? That isn’t the point. People shouldn’t be forced to leave because of taxes.
Detroit has been run by liberals for decades. It shows.

keith stern
3 years 27 days ago
You stated that California has a surplus. How is my statement irrelevant to the “facts” you stated? No one has been forced to leave because of taxes? How about businesses? Or don’t they count? How about people on fixed incomes who can’t pay their property tax and are forced to sell? You cite Mississippi but ignore Texas and Florida. Very convenient. I don’t know the problem faced by Mississippi economically and I assume you don’t either. We have all heard the financial problems of Detroit and that has had Democrat control for at least a half century. California is one… Read more »
Walter Carpenter
3 years 26 days ago

“Look at Detroit’s example of liberalism destroying a city .”

I am curious how detroit was destroyed by solely by liberals when it was that bastion of conservatism — the auto industry. When the auto industry went down, Detroit did too. It was a combination of things which destroyed Detroit, among them that the once-mighty automobile industry caved in. I am sure you will blame this fall on the unions, but that is hardly the reason that Detroit went under.

keith stern
3 years 26 days ago

Sorry but the auto industry didn’t go down. It is alive and well with Subaru, Toyota, VW, etc. in non-union jobs.

keith stern
3 years 29 days ago

Also, in Vermont are government pensions fully funded or are they kicking the responsibility down the road as most state and municipal governments as well as the federal government is doing? Definitely a recipe for disaster.

Phyllis North
3 years 29 days ago

Will retired state workers and teachers be forced into this too? What if they have moved to another state like Florida?

Craig Powers
3 years 29 days ago
We all cannot wait to see the details of the financing plan. I predict a financing scheme very similar to the current VT property tax program. High taxes for a few and income sensitivity for a huge chunk of the VT population (hey…the property tax funding scheme created a HUGE voting block for the Democrats/Progressives..WHY NOT DO IT AGAIN TO REALLY SOLIDIFY THE VOTING BASE!) I can guarantee that if the taxes needed are higher than the premiums currently being paid, this will not work. VT does not have a large enough population of “rich/wealthy” people to even begin to… Read more »
Sandra Bettis
3 years 29 days ago

The taxes will be cheaper than the premiums if we get true single payer – no admin costs which run about 1/2 of your health care costs.

Craig Powers
3 years 29 days ago

Sandra:

Please provide valid proof of your statement with actual figures to back up your claim. Where can I see that info?

Thanks

Dan Carver
3 years 29 days ago

Admin costs have been documented to be around 4% of the total health care costs. This has been a constant % for years. (I’ve never heard anyone–not even politicians quote 50%–unitl today…)

John Greenberg
3 years 28 days ago

“There are very substantial administrative costs in the U.S. healthcare system, making up, by one estimate, nearly one-third of all spending (Woolhandler et al., 2003).” James G. Kahn, “Excess Billing and Insurance-Related Administrative Costs,” http://www.ncbi.nlm.nih.gov/books/NBK53942/

” An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, nearly double the administrative overhead in Canada, on a percentage basis.[95]” http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Administrative_costs

The study mentioned is http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Administrative_costs

Bob Orleck
3 years 28 days ago

Give me a break. If you going to give us facts don’t use Wikipedia. Use real sources not those that have no assurance of accuracy.

John Greenberg
3 years 27 days ago

My bad. I copied the Wikipedia link twice. The source forthe Wikipedia entry is http://www.pnhp.org/publications/nejmadmin.pdf, which is an article in the New England Journal of Medicine. The other source is the National Center for Biotechnology Information. Real enough?

keith stern
3 years 27 days ago

Cost could be contained by a privately run single payer system. No increase in government and no more unfunded pension obligations. Simple, inexpensive, and cost effective.
But no good for people addicted to bigger government.

sandra betttis
3 years 27 days ago

Privately run?? As by an ins co that only cares about their bottom line?? That would not be single payer.

keith stern
3 years 27 days ago

No not an insurance company. By a company hired to do billing and collecting. Not a government agency.

Sandra Bettis
3 years 27 days ago

And, since that would be a ‘for profit’ co (as all cos are, whether they admit it or not, except the govt which you seem to hate but provides our schools and roads etc w/o making a profit – maybe you’d like to privatize those too?), how would that be different from an ins co?

keith stern
3 years 26 days ago

Companies have to excel to succeed or be forced out of business by competition so mediocrity is discouraged. With government mediocrity is the norm because there is no competition and usually outstanding work is not rewarded.
That is so obvious in public education where subpar teachers get the same pay as outstanding ones.
That is also the problem with union jobs.
You can disagree if you want but the truth is obvious.

Bob Orleck
3 years 27 days ago

John: Maybe you should have stuck with double-wikepedia quotes instead. Tell us about your other citation and what it said about the situation in 1999, xome 15 years ago. 1999!

Walter Carpenter
3 years 26 days ago

“Cost could be contained by a privately run single payer system.”

How so? How would a privately run single-payer system reduce costs more than a public system? Would not there be similar layers of bureaucracy, if not more in private, as they need to protect the profits of the CEO’s.

keith stern
3 years 26 days ago

The government could set aside a sum of money that the company that wins the bid invests to fund their expenses.

John Greenberg
3 years 26 days ago

If you don’t like my figures, provide you own. Feel free to prove them wrong, if you can.

Bob Orleck
3 years 25 days ago

1999 John.

Dan Carver
3 years 29 days ago
I agree. 70% of Vermont home owners receive income sensitivity relief for their property taxes. Therefore, 70% can not afford the homes they “own”. As health care is reportedly $5 billion per year versus the $ 1 billion spent on primary education, I will guess the percentage of Vermonters recieving tax relief for health insurance will be closer to 85%. Unfortunately, we have forgotten what the Greeks learned 2,500 years ago. The “rich” is a finite number and when their funds dry up, or they leave, etc. they system collapses. For those who rail against the insurance companies, did you… Read more »
Kristin Sohlstrom
3 years 29 days ago

Touche, Craig Powers. I can’t think of any Vermonter who wants their property taxes to be higher regardless of party and political affiliation. Robin Lunge is being a copycat ‘cuz she can’t come up with anything else.

rosemarie jackowski
3 years 29 days ago
It is still looking like bait-and-switch to me. Single Payer eliminates all insurance companies. Vermont has been going in the opposite direction. You can’t get out of a hole by digging deeper. All insurance companies should be banned from the State. As long as they are here wielding their power we are doomed. One of the hallmarks of a good Single Payer Plan is simplicity. All medically necessary care is paid for. Period. Simple. That includes dental, vision, and long term care. If Shumlin sets up boards, commissions, study groups we know that it is just one more delay tactic…… Read more »
Sandra Bettis
3 years 29 days ago

Rosemarie – you said it perfectly.

Kristin Sohlstrom
3 years 29 days ago

You do realize, I hope, that the notion of “All insurance companies should be banned from the State.” and “We don’t want to be an insurance company” can’t actually happen as long as the end result is everyone is insured, don’t you?
Please tell me you are smart enough to figure that out.

rosemarie jackowski
3 years 28 days ago

We need universal access to health care, not insurance companies… especially not Wall Street insurance companies. If it is administered correctly, Single Payer eliminates insurance companies. Kristin…you get that, don’t you? Insurance companies are part of the problem. They have blocked Single Payer.

Sandra Bettis
3 years 28 days ago

Thank you, Rosemarie – you explained it perfectly.

Walter Judge
3 years 29 days ago

“One of the hallmarks of a good Single Payer Plan is simplicity. All medically necessary care is paid for.”

Yeah, so who decides what is “medically necessary” for YOU to get, with MY tax dollars?

Peter Liston
3 years 29 days ago

Well right the insurance company decides … that is if you’re fortunate enough to be fully insured.

And they don’t care as much about you as they do their bottom line.

We can’t do much worse than that.

Kristin Sohlstrom
3 years 29 days ago

Right now, if you disagree with an insurance company’s decision to determine medical necessity you can appeal that decision or ignore it and pay cash if you have cash. Will that protection still exist?

Peter Liston
3 years 29 days ago

The appeals processes of insurance companies are a joke. But yes, in single payer systems there are appeals processes and we have the opportunity to design an effective one.

Also, the system would be ultimately governed democratically, so the people who run the healthcare system are accountable to the PEOPLE, via the ballot box.

Right now, the system is governed by the insurance companies and their motive is profit. (even our ‘not for profit’ insurance companies pay their executives tens of millions of dollars.)

keith stern
3 years 29 days ago

@ Peter You think a repeal system for any government program is better? Go talk to veterans who have to hire lawyers to get the benefits that were promised them. Getting on disability is an extremely drawn out process for many.
At least with private insurance there is a repeal process that is available through the government. That will basically go away.

Walter Carpenter
3 years 28 days ago

“Right now, the system is governed by the insurance companies and their motive is profit.”

I agree, Peter. The entire system or, rather, dysfunction, is governed by this motive: profit. This is why we have tens of thousands of Americans dying annually for lack of access to health care.

Walter Carpenter
3 years 28 days ago

“Right now, if you disagree with an insurance company’s decision to determine medical necessity you can appeal that decision or ignore it and pay cash if you have cash.”

Have you ever tried to appeal an insurance company’s decision through the “appeals” process? I have. It is not much fun, and requires you to be as obdurate as they are — medically necessary or claims. In general, you pretty much have to take them to court.

rosemarie jackowski
3 years 29 days ago

You and your doctor decide – not some nameless, faceless ‘paper churner’ sitting in a cubicle hundreds of miles away.

Walter Judge
3 years 29 days ago

Suppose “you and your doctor” decide that cosmetic surgery is necessary to make you feel better about yourself? At least under the private insurance system, I am not required to pay for that. But under a single payer system, the public might be forced to pay for all kinds of things that a person “and their doctor” decide is medically necessary for that person: gender reassignment surgery, aromatherapy, expensive experimental cancer treatments that haven’t been proven to work, trips to Mexico to be treated by witch doctors, etc.

Peter Liston
3 years 29 days ago

Or what if my doctor says that I should get a new Mercedes-Benz every week? Or a castle on the moon?

There are all kinds of silly ‘what if’ games that we can play.

rosemarie jackowski
3 years 29 days ago

Walter…there is a difference between ‘cosmetic’ and ‘reconstructive’ surgery. Surgery to repair a birth defect or accident injury should be covered.

The standard is MEDICALLY NECESSARY. If it is ‘cosmetic’ it does not meet the required standard.

Bob Orleck
3 years 29 days ago
Lot of opinions here not backed up with facts, but what we need is to look at some hard truth. Act 48 (Green Mountain Care Law) passed in 2011 and signed by Governor Shumlin in part gives the Green Mountain Care Board the job of setting rates charged by healthcare providers and under the law they maintain perpetual jurisdiction of such matters. Not only does this involve payments to be made that are covered by the government but also involves charges by healthcare providers to people paying out of their own pocket. Representative Browning (Democrat from Arlington), having done her… Read more »
Bob Orleck
3 years 28 days ago
Michael: Your reply reminds me of someone objecting to having been called “old and ugly” by saying “I am not old”. So while you think what is being done is constitutional you recognize Vermont is doing it first and its outrageous. And my friend, there are many unconstitutional actions by government that either have not yet been ruled so or have been allowed by activist wrong minded judges who like you and me are not perfect and make mistakes. On the health issue you need to address what I said on Act 48 which you ignored which is a threat… Read more »
David Bell
3 years 28 days ago

Correction, I was responding to your response to Michael.

Should read Michael never said what Vermont is doing is outrageous.

Wow, that was a Rick Perry level oops on my part.

Jim Christiansen
3 years 29 days ago

I’m not convinced that a nameless, faceless ‘paper churner’ sitting in a cubicle in Montpelier is a better solution, especially when I have no alternative under penalty of law.

keith stern
3 years 29 days ago

There has to be enough money to cover the medical bills. What happens as the money runs out?

John Greenberg
3 years 28 days ago

What happens now?

keith stern
3 years 27 days ago

The insurance companies have the money, that is regulated. That is not the case with a government.

Sandra Bettis
3 years 27 days ago

What???

keith stern
3 years 26 days ago

Insurance companies are required to have a certain amount of money available. Governments don’t. US government $16 trillion in debt, over $100 trillion in unfunded liabilities, see Detroit. Government can pretty much operate unregulated but insurance companies are heavily regulated.

Bob Orleck
3 years 25 days ago

You got that right Keith.

Sandra Bettis
3 years 25 days ago

I guess these ‘regulations’ don’t cover ceo’s making millions. I’d like to see a govt employee get a bonus like that.

keith stern
3 years 25 days ago

The salary and bonuses are based on a company’s performance. Why would a CEO work to build a very profitable company if there is no financial incentive to do it? He/she would be better off running a nonprofit that pays its CEO a huge salary.

Sandra Bettis
3 years 25 days ago

Ok, so huge salaries and huge bonuses – and this is better than govt processing how?

keith stern
3 years 24 days ago
Accountability and results. I have an employee who has child support withheld from his pay weekly by my wife and sent to the state. Two years in a row they have sent him a letter telling him he has underpaid and that he owes more money. My wife has given him a printout of what was paid in which matches what he owed but that was not good enough for the office. Two years in a row he has had to take them to court and have a judge rule against the office. Incompetence, harassing a citizen, and a waste… Read more »
Sandra Bettis
3 years 24 days ago

Please see Fred Woogmaster’s comment. He hit the nail on the head. This is the way health care should be – no hassles, no stress to make the situation even worse.

Bob Orleck
3 years 25 days ago

Sandra, you really do have blinders on. Their paycheck might not show large bonus money but are you naive enough to believe that the liberal democrats who run this country don’t get something ($) (payback) in exchange for billions they give, grant, contract, waste to their cronies for “supposed” necessary projects. Solindra comes to mind. What we are talking about here makes CEO bonus money look like “chump change.”

Sandra Bettis
3 years 24 days ago

Well, I can tell you that contracts at the state level are not awarded that way. On the other hand, I didn’t think we were talking about contracting this out – that is always a more expensive alternative than having the work done by a state employee.

keith stern
3 years 24 days ago

Bob you mean to imply that the deal with Solyndra wasn’t legit? Next you’ll say that the government giving millions to Hillary’s PR firm in exchange for forgiving her campaign debt wasn’t above board.

Bob Orleck
3 years 24 days ago

Keith: Please forgive me. How could I be so insensitive. For the sake of those who cannot understand “tongue in cheek”, what does it take for these people to see truth. I am amazed at the stupidity of smart people if you know what I mean.

Peter Liston
3 years 26 days ago

What happens now is the CEO gets an $8 million dollar bonus and rides into the sunset.

John Greenberg
3 years 26 days ago

Right, IF the patient has insurance, IF the insurance company doesn’t find a reason not to pay, IF the patient’s limits (abolished by Obamacare)are not exceeded ….

Ralph Colin
3 years 29 days ago
Dollars to donuts the plug will be pulled on the plan. It’s only a matter of time. Chances are Shumlin will jerk it out when he realizes that he can’t squeeze any more political capital out of it. From the beginning it’s been a political ploy. There is absolutely no way that it can be financed without probably doubling (or more) the already intolerable tax burden for individuals and small businesses in Vermont. Because of the progressive (small P) nature of the General Assembly leadership and now the Administration as well, the state government has discouraged the the advancement of… Read more »
Bob Orleck
3 years 29 days ago
There is no doubt in the minds of clear thinking Vermonters that this cannot work and I believe you have hit it on the head when you indicate that he will milk it for all its worth politically before he lets it go, of course using the blame game to make sure the smell of it all does not stick to him. I know that there are many well-meaning folks who think this is going to work but it is nothing but pie in the sky and they along with those of us who know that will be hurt. They… Read more »
Ross Laffan
3 years 29 days ago

You should change your statement to read “there is no doubt in the minds of Vermonters who are already insured that this will not work”. People who are uninsured or are under-insured have been left out in the cold most likely have no doubt their lives will improve, unless they’ve been bought by the years of nay-saying by people like you and FOX news. How about we try this for a while and if it doesn’t work we’ll try something else, okay?

Walter Judge
3 years 28 days ago

Name one personin VT, under our current private system, who was denied needed treatment because he or she couldn’t pay.

Sandra Bettis
3 years 28 days ago

OMG – that happens all the time! Even with insurance!

Walter Carpenter
3 years 28 days ago

“Name one personin VT, under our current private system, who was denied needed treatment because he or she couldn’t pay.”

As Sandra said “that happens all the time.” I can also tell you what it is like to fight denied claims from private insurance.

Ross Laffan
3 years 28 days ago

Right, in the emergency room. It’s been a long time since I met someone, even an anti, that thinks that’s a good idea.

Kristin Sohlstrom
3 years 28 days ago
It doesn’t happen all the time that people are denied care over payment in an emergency room. I believe (although someone please check me on this) it’s illegal to do so. Must be those of you who say this haven’t actually been? During registration you are asked if you have insurance, if you do you give the info. If you don’t, they make a note of it and they send you either to a triage nurse or to an urgent care situation. Never once in all my years of receiving care via an ER, doctor’s office, hospital, etc have I… Read more »
Moshe Braner
3 years 29 days ago

Here we see the usual tactic of decrying the increase in taxes while not mentioning the elimination of premiums. It’s not a matter of raising more money, it’s raising the same total money in other ways. Of course the burden will shift somewhat between people. The poor will pay less and the rich will pay more. Some of us think that is fair. Some of us don’t. That’s politics.

Kristin Sohlstrom
3 years 28 days ago

You do realize that “rich” is a relative term which will have to start applying to those of us who don’t think we are rich because those who actually are wealthy will leave.

John Greenberg
3 years 28 days ago

Thanks Moshe. Well put.

Craig Powers
3 years 28 days ago

Moshe:

Bottom line is there still are not enough “rich” people in VT to pay for all the poor people and their long list of “human rights”. That is a Progressive fantasy. Believe what you want but understand this is a reality in a competitive world.

Sandra Bettis
3 years 28 days ago

Then how do other countries do it?? I think you are underestimating how much untapped tax money there is.

Robert Smith
3 years 29 days ago

As a family of four with a small home and no mortgage, I’m looking forward to being permanently unemployed under a single payer system combined with the current social safety net.

Since we’re Social Security eligible in 25 tears, we’ll earn 10K under the table and the rest of you taxpaying fools can support us in modest comfort for the next 45 years.

After all, I know you won’t judge my family’s lifestyle choices.

Thanks!

Moshe Braner
3 years 29 days ago
Snide comments aside, actually removing the link between health coverage and employment means that people are free to follow their dreams, start up new trial business ventures, get more education, etc., without worrying about health coverage. This is not just a huge boost of personal freedom (and health and peace of mind), it is also a boost for the economy. The current system only benefits certain employers, as a method of keeping their workers in wage slavery. Just watch how people live and work in any other industrialized country (Canada, Britain, France, Germany, Japan, etc. – they ALL have single-payer… Read more »
3 years 29 days ago
Although Medicare is referred to as a “single payer” by many, it does have a very small deductible, a small premium for Part B and does involve insurance companies for the supplemental coverage(medigap). That being said,it is still the closest thing we have to universal/single payer for the general public, only with an age qualification. I would bet that no Medicare recipient would trade their coverage for a private individual policy,including those of the future Vermont Health Connect. So lets not jump to conclusions until we see the actual product. Also if BCBS only handles the paperwork as CIGNA does… Read more »
Kristin Sohlstrom
3 years 29 days ago

There are plenty of people who refuse Medicare, pay the penalty for doing so and use private health insurance instead. Another thing folks do is they supplement their Medicare with private insurance so that they have broader coverage because Medicare denies more than private insurance does. Talk to any biller in a doctor’s office or hospital and they will tell you Medicare is the worst to deal with because they can’t get reimbursed.

John Greenberg
3 years 27 days ago

“There are plenty of people who refuse Medicare, pay the penalty for doing so and use private health insurance instead.”

Could you provide some evidence and/or documentation for that claim please? I find plenty of links to articles about practitioners refusing to accept Medicare patients, but none about patients eligible for Medicare refusing to accept coverage.

Sandra Bettis
3 years 29 days ago

Jerry – I would say that the VA has a closer union with single payer than Medicare does.

Kristin Sohlstrom
3 years 29 days ago

Time to boycott these businesses playing this dangerous game with our health

Cheryl Pariseau
3 years 29 days ago

What business are you boycotting? The State?? BCBS and MVP are simply jumping on the government money wagon just like anyone and everyone else. What needs to happen is these elected officials who are passing this garbage on to us “common folks” need to go.

Bob Orleck
3 years 29 days ago

Yes!

Sandra Bettis
3 years 29 days ago

BCBS was chosen as the ‘single payer’ back when the gov started talking about ‘single payer’. In this case, it is a misnomer.

Kristin Sohlstrom
3 years 28 days ago
3 years 29 days ago

Nothing like pre-judgeing and/or speculating on a system that hasn’t even hit the drawing board yet! So much for being open minded.
The present system has failed millions(U.S.), cost double in percentage of GDP of other countries, and has poorer results.

Craig Powers
3 years 29 days ago
Jerry: We are prejudging this because the details are SO completely lacking from the VT leadership on how a tiny state like VT can even remotely pull this off. From where we sit it appears that VT has put itself up on a pedestal and declared that it knows how to make this happen simply because we are Vermonters! If they know how to make it happen, then why is there ZERO info on the financing piece after three years? Why is there ZERO info on how VT residents will be treated across state lines? Why is there ZERO info… Read more »
Walter Carpenter
3 years 28 days ago

“Why is there ZERO info on how VT residents will be treated across state lines? Why is there ZERO info on who will be administering this? Why is there zero info in general.”

Probably because the Shumlin Administration is setting this up. What makes you think that these questions and more will not be answered? Vermont can do it alone. It will lead the way and then it will no longer be alone.

Bob Orleck
3 years 28 days ago
Walter, when three years have gone by and there is no plan revealed how to pay for it, how can you just trust that they are working on it? Why can’t we see what their best thinking is on that? Show us something! Could it be that even the Governor has no idea but is stuck on the same lie that others are stuck on and can’t get away from and that is that government can do it and can do it better than private industry. He will back away from this after he has drained all the political advantage… Read more »
John Greenberg
3 years 28 days ago

Then try looking around the world, where the vast majority of of developed nations have universal healthcare and better outcomes than the US. To use your analogy, if you’re driving a Chevette and every car in the parking lot is a Rolls, you might be at the wrong restaurant. Of course, if you ARE driving a Rolls, everything is just hunky-dory, but you’d kind of expect that now wouldn’t you.

Bob Orleck
3 years 28 days ago

Could that be why so many Canadians drive their Chevette to the US for health care that they have waited for and waited for and waited for but never got in Canada?

Sandra Bettis
3 years 28 days ago

What about the Canadian family that won’t come to the US as they are afraid something will happen while they are here and they won’t have health care?

Bob Orleck
3 years 28 days ago

You are just shooting from the hip. The Canadians who come here have to pay for their health care with cash because they had to if they wanted to get it at all. They were forced to do so because of the failure of the system there to be able to supply appropriate medical procedures in sufficient time to save the patients health or life.

Sandra Bettis
3 years 28 days ago

You are incorrect – ask a Canadian sometime if they’d prefer our system.

keith stern
3 years 27 days ago

They probably wouldn’t until they faced an extreme emergency and couldn’t get the treatment promptly and thoroughly. Their system is very good for broken bones, sprains, and the like but not for life saving procedures.
One guy had a brain tumor that he couldn’t get treatment for because he was told there was no treatment. He came to the US and received treatment and is healthy 10 years later.

John Greenberg
3 years 27 days ago
The claim that massive numbers of Canadians cross the border for healthcare in the US has been investigated and debunked: “Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.” http://content.healthaffairs.org/content/21/3/19.long Indeed, the reality seems to be that more Americans seek helthcare in Canada than the reverse. According to one source (http://www.medicaltourismmag.com/article/canadians-seeking-healthcare-abroad-why-and-how-many-.html), “In total, in 2011, an estimated 46,159 Canadians sought medical care in another country.” That’s ANY other country, not just the US. The number is not documented in the article; the author writes for National Review… Read more »
keith stern
3 years 27 days ago

They are ineligible patients? What does that mean then? They have no insurance in either country so they go to the closest practice maybe? Cherry picking anecdotal evidence does absolutely no good without the complete facts.

Walter Carpenter
3 years 26 days ago

“Could it be that even the Governor has no idea but is stuck on the same lie that others are stuck on and can’t get away from and that is that government can do it and can do it better than private industry.”

Could it also be that the Governor and his administration were stuck on the mammoth project of Obamacare, now mandated by Fed law, which refused to allow single-payer until 2017? Could it be that this got in the way first?

Bo Orleck
3 years 25 days ago
And could it be Walter that the Governor is just buying time in hope he can solidify his hold on power before he reveals that none of this is going to work, blame others for the failure then go about doing some other kind of mischief. What mischief you ask? Any Governor who would sign the likes of Act 39 into law (and with a smile as the photo shows), shows me that he is either not analyzing and has no idea what he is doing or is just up to doing mischief and harm to a certain group of… Read more »
Craig Powers
3 years 28 days ago

Walter:

I am confused by your answer “Probably because the Shumlin Administration is setting it up”…Did you not vote for Gov Shumlin? Are you saying that they are doing a poor job and that someone else could be doing better? In past posts you have been very positive regarding the current administration and their quest for single payer. Are you as disillusioned as some of us are with the lack of details?

keith stern
3 years 29 days ago

The system hasn’t failed, it’s the havoc we wreak on our bodies. Fast food, pre-made food, stuff loaded with sodium and fat, abusing alcohol, smoking, drinks loaded with sugar, and lack of exercise.
Single payer isn’t going to fix these factors.

Peter Liston
3 years 29 days ago

It’s an excellent point, Keith. More has to be done to improve public health. First we should stop subsidizing the production of junk food at the federal level.

Walter Carpenter
3 years 28 days ago
“The system hasn’t failed, it’s the havoc we wreak on our bodies.” Keith, I agree with you to a point. You’re right about the havoc, but cancer and heart attacks also strikes vegans and marathon athletes. I speak from experience. Although by no means a marathon athlete who does not smoke and all the rest of it, I am an athlete — telemark skiing, cycling (mtn. and road), kayaking, etc — and got nailed by a serious illness. When I got sick, the system failed; it was an open question whether the illness or the health insurance dysfunction would finish… Read more »
keith stern
3 years 27 days ago
The problem Walter is catastrophic coverage and the devastating costs from a major illness. I have proposed in the past and still try and push for catastrophic coverage by the government based on one’s income level. If the government guaranteed covering medical expenses beyond a certain point based on one’s income then insurance would be much lower for most Americans while the cost of health insurance the government paid out would be also much less because there would be no need to be paying out from 1st dollar costs. Example: Say the base insurance the government had was the first… Read more »
John Greenberg
3 years 27 days ago

I have had the kind of insurance policy you describe for decades now: a $5,000 deductible and 20% co-pay for the next $5,000. The cost has climbed slowly and is now a bit over $325 per month.

Presumably, most of that premium pays for coverage actually used by me or others, so the answer to your question is that the cost to the government at the level you chose would actually be quite substantial.

keith stern
3 years 27 days ago
You completely missed the point. What is the maximum exposure by the insurance company for your policy? It could be $500K, maybe a million? What if it were $50K or $100K? Can you see how the policy could be much less because the insurance company has far less exposure? As for the government being responsible for first dollar coverage versus only catastrophic coverage the savings would be huge. What do you think the costs of catastrophic is as a percentage of the entire cost of health care to the government? My guess is in the 15-25% range.
John Greenberg
3 years 28 days ago

“The system hasn’t failed, it’s the havoc we wreak on our bodies.”

One does not preclude the other.

Healthcare outcomes are worse in the US than in other countries, whose inhabitants often wreak precisely the same damage on their bodies as we do, and yet US costs are significantly higher.

keith stern
3 years 27 days ago

Second highest rate of obesity in the world which can lead to heart disease, diabetes, etc. We have a higher problem of alcoholism than many countries.
Gotta look at the factors.

John Greenberg
3 years 24 days ago
Please provide a source for your statistics. According to the WHO, the US is not even close to be second in “overweight and obesity (BMI > 25), though admittedly most of the countries with higher levels are pretty small (Nauru, Cook Islands, Tonga, etc.). http://apps.who.int/gho/data/node.main.A897 When it comes to alcohol consumption, the US is behind quite a number of other nations, including big ones with better health statistics than ours (E.g. UK). http://apps.who.int/gho/data/node.main.A1032?lang=en It’s also worth noting that while grade 2 obesity (BMI > 35) IS associated with poorer health results, there are now studies indicating the overweight people BMI… Read more »
Sandra Bettis
3 years 29 days ago

Jerry – I would be very happy with the new system IF it was single payer. It is not. As long as you are still involving the ins cos, nothing will change.

Ralph Colin
3 years 29 days ago
Jerry, Modern medicine has made it possible for doctors to early predict that a pre-born baby may be in serious physical or mental danger. Post-partem, even a lay person is frequently able to observe a terribly damaged infant. It’s not all that difficult for anyone with a modicum of common sense and the ability to comprehend a financial spread sheet to predict that certain pie-in-the-sky fantasy schemes are doomed to failure long before full-term gestation. But if that’s too problematic for some, one can learn from observing more down-to-earth and basic manifestations. For instance, as we all know, if we… Read more »
Dave Williams
3 years 29 days ago
After reading Howard Dean’s article in yesterday’s Wall Street Journal, I thought it would be interesting to have him weigh in on Vermont’s single payer plan and the powers of the Green Mountain Care Board. This is what former Governor Dean had to say about Obamacare’s Independent Payment Advisory Board, the unelected board that has similar powers of Vermont’s Governor appointed Green Mountain Care Board. “One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and… Read more »
Kenneth Atwood
3 years 29 days ago

I am on Social Security Disability and my son lives with me. I get $1066.00 per month and am supposed to pay rent, utilities and other bills on that amount plus food which we get a small sum of $16.00 per month. I have Green Mountain Health Care and it went up from $15.00 to $49.00 in January. My question is WHY did it go up so much and it is hurting low income people like me who do not have enough to buy food for the month!!!! Why don’t you increase the amount of the EBT Card???????

3 years 28 days ago

Kristin “there are plenty of people that refuse Medicare.” According to the Kaiser Group, the are over 49 million participating in Medicare, of which of which 40 million are seniors. The rest get Medicare for disabilities,or live out of the country etc. There may be some, like Mitt Romney who are self insured and refuse Medicare or have pensions that include health care, but the vast majority of us, Medicare is a life saver.
Concerning Medicare billing, check Time Magazine’s issue called “Bitter Pill.” You should find it educational.

keith stern
3 years 27 days ago

All this posturing by Shumlin and Co. but still no talk of containing costs through tort reform. That kind of talk could lead to a reduction in campaign contributions after all.

Curtis Sinclair
3 years 26 days ago

Tom Baker’s The Medical Malpractice Myth shows that hysteria about medical malpractice suits is “urban legend mixed with the occasional true story, supported by selective references to academic studies.” Including legal fees, insurance costs, and payouts, the cost of the suits comes to less than one-half of 1 percent of health-care spending. The best way to cut the number of medical malpractice cases is by reducing medical errors. This was explained in an article in the New England Journal of Medicine. http://www.nejm.org/doi/full/10.1056/NEJMp068100

keith stern
3 years 25 days ago

Talk to a medical professional. My doctor told me that the biggest cost because of the tort system is running tests and doing treatment that they know are unwarranted just to cover themselves. That wasn’t covered in that study I’m sure. Also it probably fails to include the cost of insurance tacked on to every piece of medical equipment and drug.

Dan McCauliffe
3 years 25 days ago
Curtis, You conveniently leave out the cost of defensive medicine – a much larger problem for high health care costs in the US than the cost of malpractice suits. “Eighty-two percent of physicians order more tests and procedures than are medically necessary—and almost on a daily basis—in fear of potential lawsuits. According to a 2010 poll conducted by the Gallup organization, about $1 in every $4 spent in healthcare can be attributed to tests and procedures that are clinically unnecessary.” http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-now/how-defensive-medicine-has-caused-healthca The US is lacking on tort reform (something that William Hsiao recommended for Vermont to do to lower health… Read more »
keith stern
3 years 25 days ago

The trial lawyers own the Democrats because they contribute to their campaigns close to 100%. Liberals conveniently ignore that.

keith stern
3 years 25 days ago

As of a few years ago there was no OB-GYN in the northeast kingdom of NH because there wouldn’t be enough patients to pay the cost of malpractice insurance.

John Greenberg
3 years 25 days ago

There probably aren’t a lot of OB-GYNs in Antarctica either. Is that because of tort issues?

Here’s another explanation: doctors go where the patients are and tend to avoid (trying to set up a practice) where there aren’t any. Nah. Too simple. Must be tort law because the lawyers support Democrats.

keith stern
3 years 24 days ago

I’m sorry to burst your bubble but it was a story done by NPR several years ago pointing out the very real problem and how the doctor with the practice had to leave because of the financial situation.
If you want to get absurd about it don’t waste my time.

Bob Orleck
3 years 24 days ago

“Like”

John Greenberg
3 years 24 days ago
Dan McCauliffe: The first link you provide goes to an article by Jeffrey Segal who is described at the end of the article as “a neurosurgeon; founder and chief executive officer of Medical Justice, an insurance company that has the goal of providing physicians with legal resources to fight frivolous lawsuits and bring complaints before bar associations, state licensing boards, and professional medical societies; and a board member of Patients for Fair Compensation, a nonprofit organization seeking to revamp the medical tort system in states throughout the country,” NOT to the Gallup study. Segal’s article refers to the Gallup study,… Read more »
Curtis Sinclair
3 years 23 days ago
Tort reform will only deprive medical malpractice victims of their right to recourse. I know a nurse who works in a major trauma hospital in the northeast and she tells me that there is a surgeon who works there who should not be allowed to practice. But other doctors cover for him and refuse to blow the whistle so he keeps on practicing and harming patients. If doctors would do a better job of policing themselves there would be fewer medical errors and fewer lawsuits. “There is a crisis in medical malpractice, not lawsuits,” according to Taylor Lincoln, research director… Read more »
keith stern
3 years 23 days ago
You assume that tort reform means eliminating lawsuits but there is a much better way to proceed. I have proposed taking lawyers out of lawsuits for malpractice and business negligence and instead have both parties describe their cases to a panel of professionals from the profession being sued. A paralegal will help both sides prepare their cases and a judge or at least a legal professional will attend the hearing to rule on issues of law. No precedent is set, the case can be prepared and adjudicated swiftly, and the cost factor for both parties would be greatly reduced. Also,… Read more »
Curtis Sinclair
3 years 22 days ago
The New England Journal of Medicine reports that there are 1,500 cases a year of foreign objects that are left in a person’s body during surgery. In July 2004, HealthGrades released a study, based on Medicare data from all fifty states, estimating that an average of 195,000 people a year died from preventable medical errors in U.S. hospitals in 2000, 2001, and 2002. According to this recent NY Times article “Today, exact figures are hard to come by because states don’t abide by the same reporting guidelines, but a reasonable estimate is that medical mistakes now kill around 200,000 Americans… Read more »
keith stern
3 years 22 days ago
With the current system they are far more likely to stick together testifying for colleagues. That is one of the failures of the present system. My plan doesn’t use doctors testifying for others, colleagues with no ties to the defendant will decide and I have to believe they would take their responsibility seriously. Also by weeding out the incompetents insurance would be reduced so it is in their best interests to be honest. As for leaving instruments in a patient, does that patient really need to wait many months and forfeit one third of their award/ settlement in such an… Read more »
Curtis Sinclair
3 years 22 days ago
“..colleagues with no ties to the defendant will decide and I have to believe they would take their responsibility seriously.” You may believe that, but I don’t. A panel of doctors is going to side with the doctor. Doctors sided with their fellow doctor in the Abate case and it caused the state to spend money on a retrial. I also know of a VT dentist who should not have been allowed to practice for years. Most complaints the the board of dental examiners were simply dismissed and that allowed the dentist to do more damage to more patients. You… Read more »
keith stern
3 years 23 days ago

What’s 2.4% of a trillion dollars? Hardly worth bothering with wouldn’t you say?

John Greenberg
3 years 23 days ago
Keith: This part of the discussion began because of a comment you made about VERMONT health care expenses: ‘All this posturing by Shumlin and Co. but still no talk of containing costs through tort reform.” Vermont does not spend a trillion dollars on healthcare. Moreover, the Shumlin administration HAS focused — well or badly — on administrative costs which account for a MUCH higher percentage of the costs in both VT and in the US. 31-33% (see John Greenberg July 31, 2013 at 10:33 am above) is a good deal larger, at least where I learned arithmetic, than 2.4%. Why… Read more »
keith stern
3 years 23 days ago

First, lawyers receive 1/3 of settlement plus expenses for the plaintiffs and charge defendants by the hour, win or lose. That is why so many cases are settled out of court to avoid the enormous expense of litigation.
Also, medical malpractice is a national problem, not a state issue.
Third, why not address all issues of healthcare expense? Any dollar saved is a necessity.
Finally, I addressed a plan to greatly reduce the cost of healthcare by going to a private billing/collecting company.

John Greenberg
3 years 22 days ago
Keith: When you say “… so many cases are settled out of court to avoid the enormous expense of litigation,” you appear to be saying that eliminating lawyers would eliminate “the enormous expense.” But above I suggested that that’s not necessarily the case. In the model you propose, the paralegals, the panels of professionals, the judges, and so forth aren’t going to work for nothing. The expenses you referred to will still be there: time, documentation, (often expert witnesses), etc. all cost money. So taking the lawyers out of the equation takes out only the DIFFERENCE between what they charge… Read more »
keith stern
3 years 22 days ago
I guess I didn’t make myself clear enough. This system would still use a jury but the jury is made up of people from the professional/ business being sued. The jury would be from different areas and/or have no ties to the two parties. Expert witnesses would be unnecessary. Each side states his/her case, judge states any legal facts relevant and the jury deliberates. The cases could go to trial in weeks instead of taking sometimes years while the injured person runs out of money. A cardiologist is being sued because a patient dies and the family is upset. You… Read more »
John Greenberg
3 years 25 days ago
I will combine here responses to 4 of Keith Stern’s remarks. 1) “They are ineligible patients? What does that mean then?” The phrase you’re misquoting was not “ineligible patients,” but “ineligible Americans.” Given the context, I assume it means that they are ineligible for Ontario health coverage because they are Americans seeking health care in Canada. 2) “Cherry picking anecdotal evidence does absolutely no good without the complete facts.” I quoted more of this article than just an anecdote. The article also says that ““A report prepared for Ontario’s Health Minister indicated that from August 1992 to February 1993, 60,000… Read more »
keith stern
3 years 25 days ago
Response back to you: 1+2. Why are they seeking medical care in Canada without coverage? My best guess is they are there and happen to need care or live closer to Canadian healthcare providers than US healthcare providers. So that means little. Without more facts, the statistics mean nothing. 3. The point is the government could provide catastrophic coverage to eligible people so the cost to the taxpayer would be reduced by only having the money available rather than paying all medical bills including catastrophic coverage. The exact same thing with auto or home insurance where you have $1 M… Read more »
John Greenberg
3 years 25 days ago
Thanks for the replies, Keith, but they don’t get us very far. 1&2) I’ve cited evidence which shows that while some Canadians cross the border to use American doctors, the actual number doing so is minute, and is, in fact, similar to the number of Americans crossing the border to use Canadian docs. You’ve challenged the statistics as cherry-picked and/or ancedotal (see discussion above), but you haven’t supplied better estimates, so I’m going to assume the numbers I supplied are correct until you or someone else does so. What they show — quite clearly actually — is that border crossing… Read more »
Fred Woogmaster
3 years 24 days ago

My apologies; I have not thoroughly read all of the comments on this thread, however it is my belief that one of the greatest threats to the democratic process is the insistence on maintaining essential services within the “profit” sphere.

Medicare provides my coverage. While serving in the military I was covered by “universal care”.
For the good of society, universal care is the only ultimate solution – in my view.

Sandra Bettis
3 years 24 days ago

Exactly. I had a child when my husband was in the military – it cost us $1. That’s the way healt care should be.

Ann Meade
3 years 22 days ago

Why is it possible for the armed services to have such a system and the rest of the country can’t? It is true, as a former military spouse, I had an ID card with my spouse’s social and that was it. He wasn’t underpaid, we had a typical middle class income but never thought about health care costs. As a divorced spouse I am on my own but that is another story.

David Usher
3 years 24 days ago
While the debate rages above, we must face the simple reality that Vermont’s small size may be an insufficient base for a single payer system. Do single payer advocates assume/believe that all Medicare expenditures ($941 Million in 2009) will come under Vermont’s control as well as the VA system’s dollars ($105 Million in 2012)? Without those dollars, single payer is not viable, IMHO. When will the Medicare and VA population be told that this may be their future in Vermont? The may not like it at all. Rationing is inevitable in any system with fixed budgets and that fact should… Read more »
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