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.”


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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  • Sandra Bettis

    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

    “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 funding mechanism and is not collectively bargained. Does the administration believe in collective bargaining?

    I think if the administration was serious they would use the state employees health plan as the model for “single payer.” It’s a known design with real numbers to look at. Too soon for reality?

    • Walter Carpenter

      “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

        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

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

      • John McClaughry

        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

          “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

          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

        “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 will pay most of the costs. Business and corporations will pay far less or get a pass.

        If someone has no health insurance anything else is better. I get that.

        The state(and former administrations) won’t even extend health insurance to correctional officers. They hire 98% of correctional officers as temps with no benefits whatsoever. Some are temps for YEARS. NO BENEFITS! NOTHING!

        So, I don’t trust people who claim they want everyone to have health care while year after year,they REFUSE TO EXTEND IT TO THEIR OWN EMPLOYEES!!

    • Moshe Braner

      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

      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 Commerce?)

  • Sandra Bettis

    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

      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 own costs more effectively in their own more favorable populations…. FROM THE MANY-ONE is a novel phrase I read somewhere….. was a good idea at one time…maybe once again??

  • Sandra Bettis

    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

      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

        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

          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

    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

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

      • keith stern

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

    • Walter Carpenter

      “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

    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

      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

        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 of the highest taxed states in the country with deep debt and a high percentage of people living at or below the poverty level. Indisputable facts and liberal control.

    • Walter Carpenter

      “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

        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

    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

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

  • Craig Powers

    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 pay for universal health care for all residents.

  • rosemarie jackowski

    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… one more attack of the ‘paper churners’… one more system to ‘reward’ political cronies.

    • Sandra Bettis

      Rosemarie – you said it perfectly.

    • Kristin Sohlstrom

      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

        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

          Thank you, Rosemarie – you explained it perfectly.

  • Walter Judge

    “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

      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

        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

          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

            @ 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

            “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

          “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

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

      • Walter Judge

        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

          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

          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

            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 homework realized this and offered an amendment to the health care bill HB 107 that would have fixed that which Act 48 allowed and would have allowed physicians in a private market to set their own rates and provide them to private paying patients at those rates. Our liberal legislature destroyed her attempt to put some freedom and sanity into the health care law and soundly defeated her amendment.

            So what does this mean for a patient facing a medical problem requiring a procedure provided by a Vermont healthcare professional? If the procedure is considered not covered, can a patient with his own money go forward with the physician to do the uncovered procedure and pay for it himself? I know that might sound like a silly question to ask in a free land, but this is Vermont, land of lets do it first, let’s make it outrageous, let’s make it unconstitutional (we have our people in the right places) and let’s do it even if we have no idea how we are going to fund whatever we do.

            I had a conversation with my House of Representative member, Larry Townsend, about the defeated Browning amendment to H. 107, health insurance, Medicaid and VHBE. I suggested to him that the amendment would have prevented what some us fear, and more should fear, and that an unelected board could end the private practice of medicine. With H48 being able to control what a physician charges for his procedures it could well mean that the private practice of medicine was a thing of the past. When I asked Mr. Townsend if that was so he responded, “In my opinion that is EXACTLY what is happening and I feel helpless to stop it!” Private physicians might not be willing to do the procedure at the price allowed and thus such procedures will become unavailable. And what happens if it is determined to be an unapproved procedure (no reimbursement), cosmetic or not, it seems that a Vermonter could not get the treatment even if he is going to entirely pay for it.

            As I age, I am developing a very insecure feeling about my ability to stay in Vermont, stay healthy and stay alive because of what is happening under the gold dome in Montpelier. What are they not telling us? The option offered by the legislature for a lethal dose of medicine may be the only option that a person with a terminal diagnosis may be entitled to under the law. That is coming. A non-terminal person might also be denied the ability to get a particular treatment if it is not approved by the board even if they are willing to pay 100% of it with their own money. That is coming. I even wonder if they will allow us to leave the state borders to get the care. When will the barbed wire fences be put up to keep us in where they can take care of us?

            Such decisions will be made for you and your loved ones, whether conservative Republicans or liberal Democrats. There may be some who know the direction all of this is going but I doubt if it is more than a small percentage of the population. We all need to ask some hard questions and get some real answers.

          • Bob Orleck

            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 to my and your health. Finally your objection about my statement that a lethal dose of medicine being the only option for a person with a terminal diagnosis, you only need to review letters sent to such patients in Oregon that did in fact deny coverage for their treatment but as an alternative offered them physician assisted suicide. No, not fear mongering, but good healthy realization that Vermont’s train is off the track and all of us are going to be injured in the wreck to come.

          • David Bell

            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

        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

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

        • John Greenberg

          What happens now?

          • keith stern

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

          • Sandra Bettis


          • keith stern

            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

            You got that right Keith.

          • Sandra Bettis

            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

            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

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

          • keith stern

            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 of money for the court and the office. What do you think was done to the incompetent that screwed up? Nothing at all because that is how the government works.

          • Sandra Bettis

            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

            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

            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

            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

            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

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

          • John Greenberg

            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

    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 business interests, scaring off the establishment of new commerce, especially large industry, and barely maintaining
    the existance of those smaller businesses already located
    here. High taxes, the never-ending growth of the regulatory establishment and the ever-expanding interference with the
    daily lives of residents precludes the atraction of new enterprises in the state. Now the threat of an increasingly unaffordable health care system provides a further deterrent
    to inustrial expansion resulting in the decrease in employment opportunities and the aggressive exit of young people.

    The introduction and possible implementation of a single-payer health care system may be the straw that breaks the camel’s back and pernmanently destroys the hopes that any of us once held that Vermont could be an attractive place in which one could afford to work and live without the kind of repercussions which inevitably lead to disaster when the government interferes with almost every aspect of our daily lives. Although about thirty years late, 1984 is finally reaching fruition in Vermont. Good luck.

    He’ll certainly deny it, but Shumlin, in his self-centered plan to build his own empire, inside or beyond Vermont’s borders, will have been the proximate cause for the ultimate complete fiscal collapse of the state economy and he’ll have all kinds of excuses for proclaiming, “It’s not my fault!”

    • Bob Orleck

      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 should be asking some hard questions instead of allowing this to move through the process as if it were some magical ride in Disneyland that they were on. If this keeps going this way when they get through the ride, the park will be closed!

      • Ross Laffan

        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

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

          • Sandra Bettis

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

          • Walter Carpenter

            “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

            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

            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 needed to pay up front for care. This includes maternity care and childbirth for one of my children while being uninsured. These scare tactics don’t work in the prism of reality. Sorry, folks. Nice try parroting the SEIU-funded VT Leads nonsense but it’s not true in VT.

    • Moshe Braner

      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

        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

        Thanks Moshe. Well put.

      • Craig Powers


        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

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

  • Robert Smith

    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.


    • Moshe Braner

      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 systems) and see.

  • 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 for the self insured including state employees, this would not affect coverages.
    As far as ERISA is concerned, those such as IBM can be taxed for Vermont’s single payer. It’s up to them whether or not they want to have their employees participate. IBM has facilities in many countries world wide, all of whom have various forms of universal health care.

    • Kristin Sohlstrom

      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

        “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

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

  • Kristin Sohlstrom

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

    • Cheryl Pariseau

      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.

  • 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


      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 on who will be administering this? Why is there zero info in general. Why, why, why…The State does not even know if the Exchange will be up and running by 10/1/13 and they will have spent $467 million dollars on it? That should really help to answer your questions on why some are prejudging.

      No one is arguing with you that outcomes are better and that costs are less in other places, but those places are other COUNTRIES…not small states that are lacking in population, industries, jobs and administrative infrastructure.

      Go march on Washington and convince the FEDS to do this. VT cannot do this alone…although you seem to think the bureaucrats can snap their fingers and transfer $5 billion in three years.

      We are still waiting for those answers.


      • Walter Carpenter

        “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

          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 he can get from it and then he will blame others for its failure.

          The reason Vermont is going it alone is because it is wrong headed. My daughter taught me a lesson about restaurants once. Look to see if there are a lot of cars around and are busy and if that is so the food will probably be good and if not the food probably is not so good. I have found that to be a good test and applies here as well. The reason Vermont has no others joining them around the table is because what they are trying to feed us is bad food.

          • John Greenberg

            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

            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

            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

            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

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

          • keith stern

            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

            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.”

            Indeed, the reality seems to be that more Americans seek helthcare in Canada than the reverse. According to one source (, “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 Online and the Wall Street Journal among others.

            On the other hand, the New York Times reports: “A report prepared for Ontario’s Health Minister indicated that from August 1992 to February 1993, 60,000 medical claims had been made on behalf of patients who held American drivers’ licenses.” Twenty years later, it seems unlikely that the number would have shrunk. The article also quotes a doctor saying: “”It’s not an epidemic in any one person’s practice,” said Keith MacLeod, an obstetrician in Windsor, Ontario, across from Detroit, “but I would estimate that from 12 to 20 of my patients at any one time are ineligible Americans. And I’m just one of 520 doctors in Windsor, 23,000 in Ontario.””

          • keith stern

            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

            “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

            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 people. Act 39 (physician assisted suicide) was an exercise in legislative malpractice and needs a special session to fix it. What outrageous mischief will our Governor be advocating next? Maybe wind turbines on every ridge line of Vermont? Won’t that be lovely and when Vermont goes into complete darkness with the shutting down of Yankee and the Governor realizes there are not enough tree lines in all of New England to power little Vermont, then what next? Just had a thought? Instead of physicians prescribing a lethal dose of medication for our dying citizens (mostly elderly and others not worthy of continued life), we can offer them the option of going up to top of one of the wind turbines and jumping off.

        • Craig Powers


          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

      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

        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

        “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 me off first. And then I faced bankruptcy. We need single-payer.

        • keith stern

          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 $5000/ year the individual was responsible for. Insurance companies would provide very low cost coverage for those individuals. The government would not incur any expense until the level was reached.
          How often would the government incur expenses compared to the current and proposed systems?

          • John Greenberg

            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

            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

        “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

          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

            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.).

            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).

            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 > 25 and 30 and BMI 20 and BMI <25). Similarly, consuming one to two drinks of alcohol per day appears to actually be beneficial to longevity.

    • Sandra Bettis

      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

    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 notice that vermin are abandoning the ship, it’s likely that the vessel is about to sink, so when Anya Rader leaves the chair of the Green Mountain Care Board, as she plans to do near the end of this year, it may well be that she has seen the handwriting on the wall and doesn’t want to go down with the proposal of which, at the behest of her boss, she has been one of the principal architects as it is swallowed up in the inescapable sink-hole to which it is destined.
    Being opened-minded or not has nothing to do with it. If the plane is falling out of the sky, there is very little doubt that it’s going to crash, wouldn’t you agree?

  • Dave Williams

    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 at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them. There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure. What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic. The nonpartisan Congressional Budget Office has indicated that the IPAB, in its current form, won’t save a single dime before 2021. As everyone in Washington knows, but less frequently admits, CBO projections of any kind—past five years or so—are really just speculation. I believe the IPAB will never control costs based on the long record of previous attempts in many of the states, including my own state of Vermont.”

    So Howard Dean believes more bureaucratic control of our health care system will not control costs but will ration care. So are we on the right path or are we trading one set of problems (too many uninsured and under insured) for another (loss of doctor and patient control, and rationing)?

  • Kenneth Atwood

    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???????

  • 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

    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

    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.

    • keith stern

      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

      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.”

      The US is lacking on tort reform (something that William Hsiao recommended for Vermont to do to lower health care costs, but this was written off by the Shumlin administration). Defensive medicine significantly increases health care costs.

      • keith stern

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

      • keith stern

        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

          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

            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


      • John Greenberg

        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, but doesn’t provide a link.

        The Gallup survey appears to have been commissioned by Jackson Healthcare, which describes itself as “provid(ing) healthcare facilities with physicians, nurses and allied health professionals to ensure the delivery of timely, high-quality patient care.”

        According to Jackson (not Gallup), “Between December 2009 and January 2010, Gallup conducted telephone interviews with 462 randomly selected practicing physicians from across the U.S.,” and found that “physicians attribute 26 percent of overall healthcare costs to the practice of defensive medicine.”

        I wonder what the findings would have been if Gallup had asked the same question of attorneys who represent patients in medical malpractices suits.

        It would also have been interesting to see estimates by those same physicians of the actual amount of “overall healthcare costs” in the US and how well that estimate jibes with the real figure. My guess – and it’s only that – is that most physicians haven’t got a clue as to the correct figure, yet putting a percentage figure on the proportion of costs appears to presuppose such knowledge.

        Let’s do some back of the envelope reasoning to see if the figure the docs came up with makes any sense.

        Administrative costs account for somewhere between 1/5 and 1/3 of all costs in the US healthcare system, and these costs are not related to tort issues (in any way that I can see). Buildings account for another significant percentage or healthcare spending. Unless one supposes that whole complexes of hospitals, medical offices, etc. would not need to be built were it not for malpractice issues, then these costs too must be taken out of the equation. It’s conceivable, but unlikely, that that a significant percentage of expensive equipment like scanners, etc. would go un-built if tort were no longer an issue, so again, most (if not all) of these costs would need to be taken out of the calculation. (Let me put that sentence backwards just to be clear: MOST scanners and other expensive equipment are needed for procedures and tests which make up good medical practice, not “defensive medicine.”)

        I’m just doing this off the top of my head, but all that must mean that at least 50% (probably significantly more) of all medical costs are completely unrelated to malpractice. If that’s so, then the number the docs are coming up with suggests that at least half of all tests and procedures are unnecessary (25% of the whole = 50% of 50%).

        In sum, I can’t prove that these Gallup numbers are wrong, though I strongly suspect that they’re WAY higher than the actual cost.

      • Curtis Sinclair

        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 for Public Citizen’s Congress Watch division and the author of a recent study. “Trying to stop people from being compensated for catastrophic injuries is not the answer. We should instead concentrate on making hospitals safer and disciplining doctors who repeatedly commit malpractice.”

        High insurance costs may be driving some doctors out of practice, but that is due to the insurance companies gouging doctors. A study by Dartmouth College researchers suggested that huge jury awards and financial settlements for injured patients have not caused the explosive increase in doctors’ insurance premiums. The researchers said a more likely explanation for the escalation is that malpractice insurance companies have raised doctors’ premiums to compensate for falling investment returns.

        A study published in the journal Health Affairs calculated the cost of malpractice litigation and defensive medicine combined at only 2.4% of total healthcare spending.

        • keith stern

          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, if the business/professional loses the finding would be entered into a database that anyone could access to use to evaluate whether to do business with it/him/her. That in itself would weed out the chaff.

          • Curtis Sinclair

            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 every year.”

            Many other people don’t die from medical mistakes, but need even more costly follow-up care. Medical incompetence is driving up health care costs.

            Having a panel of professionals from the profession being sued deciding on malpractice would be like putting a fox in charge of a henhouse. Everyone who has been a victim of malpractice will tell you how hard it is to get a doctor to admit a colleague made a serious error. Doctors stick together and protect each other in medical malpractice cases. Dr. Joseph Abate who pleaded guilty to performing unnecessary vaginal exams on women had plenty of doctors testify on his behalf at his first trial. I know that was a criminal trial, but the same thing happens in malpractice cases. And look at how many years Dr. David Chase got away with performing unnecessary eye surgery.

          • keith stern

            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 obvious situation?

          • Curtis Sinclair

            “..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 can read stories like that on ratemd. I urge everyone who has gotten inadequate medical care to give that medical professional a bad review on sites like ratemd, because medical boards are not doing a good job. There are actually doctors that make prospective patients sign “gag contracts” before they are accepted as patients to stop that from happening.

        • keith stern

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

          • John Greenberg


            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 would you want them to go after the smaller target, especially since, as Curtis Sinclair correctly spells out above, some (perhaps most) of the 2.4% represents real harm done to patients that “reforming” tort law would paper over?

            As to your suggested reform, I’m not knowledgeable in the field, but your suggestion appears to imply that the biggest expense is for the lawyers and that taking them out of the equation would save most of the money.

            For that to be true, lawyers must be charging disproportionately high fees for services which could be provided at substantially less cost or could be left un-provided. That could be true, but it’s a proposition which cries out for some kind of factual basis. Can you provide any?

          • keith stern

            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


            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 and what these other folks charge. And if, after all that, lawyers are actually more efficient than these other folks at what they specifically do, then what you save in dollars per hour you may lose in excess hours.

            I’m not making any assertions. I’m merely trying to point out that your proposal may or may not make sense, but to the extent it does, the potential savings is quite limited. And to make the proposal even plausible requires far more evidence than you’ve provided here.

            Sure, I agree: save money wherever you can. But, unlike you, I don’t blame those attempting to reform the system for looking first and foremost at the areas where the greatest savings are possible. And it’s clear that’s NOT tort reform.

          • keith stern

            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 are called as a witness. Do you feel you would have enough information after hearing from lawyers on both sides, paid experts testifying for both sides, and technical information that you have no idea what it means without taking medical classes first?
            With my plan the patient or his/survivors tells the jury what the reason for suing, the cardiologist provides his/her evidence including all documentation, and the jury looks at it and can make a 100% informed decision.
            My system isn’t perfect because, after all, humans are involved but it is much simpler and the decisions would be informed ones.
            As for your last statement, look for savings anywhere possible. It doesn’t have to be a single idea approach.

  • John Greenberg

    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 medical claims had been made on behalf of patients who held American drivers’ licenses.” That’s not an anecdote.

    As to cherry picking, if I’ve done that, then surely you’ll provide the more convincing sources to show how the studies I chose misconstrue the facts. Until you do, however, I’ll stand by the sources I’ve cited.

    3) “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?” First, I didn’t miss the point about maximum exposure; you never made it. Second, the whole point of catastrophic insurance is to provide coverage for precisely the kind of exposure which you’re now trying to eliminate: namely, medical catastrophes.

    If you’re now suggesting that it would cost less to cover only those expenses between, say $5,000 and $50,000 (or $100,000), that’s no doubt true. But then who covers the expenses after that, and at what cost?

    4) “All this posturing by Shumlin and Co. but still no talk of containing costs through tort reform.” The highest estimate I’ve seen for tort costs is in the 3% range. Even if tort reform eliminated all of it – which would allow incompetent health professionals free rein to continue wreaking havoc – that would make a very small difference in overall medical costs.

    • keith stern

      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 liability coverage. The insurance company will pay out if necessary but if it doesn’t then it costs them nothing. Very simple idea that people don’t quite understand.
      4. If you take simply the cost of malpractice insurance you are probably right on the number. Include tests and procedures done to cover themselves, the cost built into equipment and instruments, and the extremely high cost of insurance for pharmaceuticals and the percentage is much greater.
      Prescription drugs are much cheaper in many other countries and I believe insurance has a great deal to do with that.
      Good discussion.

      • John Greenberg

        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 is not significant to EITHER medical system. Given that tens of millions of people use the system on either side of the border, the numbers of incidences of border crossing (mid tens of thousands) is simply statistical noise.

        In other words, the number of people crossing the borders for healthcare IS, as you suggest, insignificant, but paradoxically, the fact that only insignificant numbers do so is actually quite meaningful.

        In particular, it means that Canadians are NOT flocking to the US healthcare system in statistically significant numbers which puts to rest the theory that their discontent with the inadequacies of the Canadian health system is leading massive numbers of Canadians to seek the superiority of American healthcare. This is especially significant when you consider that an estimated 75% of Canadians live within 100 miles of the US border. It’s also completely consonant with surveys of satisfaction with the healthcare system, which show that Canadians are far more content with their system than we are with ours.

        If your point now is that the number of Americans crossing the other way is essentially meaningless and impossible to interpret: I agree, and for the same reason: the number is WAY too small to matter, but according to the sources I cited, it happens to be quite similar (making it far smaller in relative terms, of course, since there are far more Americans than Canadians).

        3) I think your point really is this. Insurance functions on probability. First dollar coverage is always the most expensive, because it is far more likely to happen. The higher the deductible, the lower the probability that within a given period of time (usually a year) the insurance company (or, if the government becomes the insurer, the government) will have to pay anything.

        But healthcare is not quite as simple as that principle implies. In a system which, for WHATEVER reason, people feel that there’s a disincentive to approach the system, the human tendency is often to wait for problems to become more serious before approaching the system. If patients pay the first dollar of their care, how many will forego regular consultations? For patients who might have heart disease, for example, a $50-150 office visit and a $75-150 blood test (very roundly) may detect high cholesterol or high blood pressure both of which are quite treatable at quite low cost (including, if the treatment is diet and exercise, NO cost). Patients receiving medications or other therapeutic interventions are far less likely to need angiography (ca $10,000+), stents (ca $30,000) or bypass surgery (ca $75,000). That’s not the case with other forms of insurance: if my homeowner’s policy doesn’t cover repairs of, say, $250, they’re not likely to turn into repairs costing tens of thousands of dollars.

        There’s also the problem of guaranteed access. As noted above, while our system does ration care in a variety of ways, it does NOT ration the most expensive kinds: anyone arriving at a hospital having a heart attack is going to get treated regardless of whether or not they can pay for it. Contractors who know in advance that you can’t or won’t pay them are NOT going to fix your house.

        The real question is whether the insurance model has any applicability to something as basic as healthcare.

        4) Re tort reform, you suggest:
        a) “Include tests and procedures done to cover themselves, the cost built into equipment and instruments, and the extremely high cost of insurance for pharmaceuticals and the percentage is much greater.” I’m not sure what either of your second and third phrases mean, so I’ll let you explain them. The first two – unnecessary tests and procedures is what is generally considered under the rubric “defensive medicine.”

        A 2010 study in Health Affairs (abstract only available free online) concludes: “Overall annual medical liability system costs, INCLUDING DEFENSIVE MEDICINE, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.” (emphasis added)

        b) You also state: “Prescription drugs are much cheaper in many other countries and I believe insurance has a great deal to do with that.” It’s certainly true that drugs are far cheaper elsewhere than in the US, but I have no idea how you reach the conclusion that insurance has anything to do with it. Other governments negotiate prices with the drug companies, just as the VA does here. But in the US, such negotiations are explicitly disallowed outside of the VA, which means that drug companies can negotiate with entities which they can afford to play hardball: patients, small groups, and even insurers. The US also protects drug patents against generic competition for longer than many other countries.

  • Fred Woogmaster

    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

      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

        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

    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 be addressed openly and clearly early on because it will be the government in charge of rationing, not the haphazard rationing of today’s ‘system.’ The GMCB should not have unaccountable control over rationing.

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