This commentary is by Robert S. Emmons, M.D., a psychiatrist in private practice in Burlington, and the founder and staff psychiatrist for the Franciscan Free Psychiatric Clinic in Moretown.
[T]he repeated refusal of Vermont’s Democratic leadership to disclose the tax bill for a single-payer system makes it hard for me, as a taxpayer, to plan for my family’s financial future. To add injury to insult, Vermont Health Connect is a catastrophic failure, shut down until after Election Day. Health insurance premiums are rising, as in the recently announced 18 percent increase for state employees, and higher deductibles only add to the patient misery index. As a physician, though, I am even more concerned about the Green Mountain Care Board’s unlimited authority to regulate the practice of medicine in Vermont. Documents available online at the board’s website detail plans for a system that takes decision-making power out of the hands of patients and their doctors.
We can help our neighbors in need without taking away everyone’s rights. If there is the political will, the final authority to make clinical decisions can be restored to Vermont patients and doctors, with the following specific statutory fixes:
• Just in case Vermont Health Connect continues to malfunction, and just in case the exchange plans use managed care techniques that degrade quality of care, give Vermont citizens the legal right to make their own choices by purchasing health insurance insurance outside the exchange. As it stands now, Vermont citizens do not have that right.
• Just in case it turns out that that quality, cost and wait times get worse under Green Mountain Care, give Vermont citizens the legal right to spend their own money to get timely, excellent medical care from private physicians outside the system. Last year, nearly all House Democrats (with the exception of Cynthia Browning, who introduced the bill) voted “No” on H.331, a bill designed to give citizens the unrestricted right to make private financial contracts with doctors of their choice.
In the next stage of implementing Vermont’s single payer system, errors in judgment by state officials mean patient deaths, because medical financing decisions have real clinical consequences, especially when patients cannot realistically opt out of the system.
• Give Vermont citizens the unrestricted legal right to say no to participation in Vermont’s health database without any penalty, financial or otherwise, a right they are currently denied.
• My friend Keith Smith, M.D., runs an outpatient surgery center in Oklahoma City with fees posted online that are one fifth to one tenth the average at hospitals nationally. As it stands now, the Green Mountain Care Board, through the certificate of need process, can deny applications for larger outpatient facilities like Dr. Smith’s that might successfully compete with big hospitals like Fletcher Allen Health Care. Amend the law to prevent state officials from blocking competition in Vermont’s medical marketplace.
In multiple conversations with Republican candidates for the House and Senate, I find receptivity to patient rights as outlined above. When I make the case to incumbent Democrats, they will not agree to any meaningful restrictions on state authority in the medical context. At a recent health care forum in Middlesex, I had the opportunity to ask gubernatorial candidate Dan Feliciano to take a stand on all of the above legislative proposals. Dan said “Yes” to all four proposals without hesitation or qualification. Incumbent Democrat Sen. Ann Cummings was in attendance that day. When I asked her who I should hold accountable, as a voter, for the failure of Vermont Health Connect, she answered, “All of us.” Holding a supermajority means the power to force through a political agenda not desired by many, but it also means there is no one else to blame for bad outcomes.
So far, my patients who purchased coverage on the state exchange have been massively inconvenienced, but I have been able to intervene to protect them from the adverse clinical consequences that could have resulted from the the state’s mismanagement of insurance benefits. In the next stage of implementing Vermont’s single payer system, errors in judgment by state officials mean patient deaths, because medical financing decisions have real clinical consequences, especially when patients cannot realistically opt out of the system. Remember that the Democrats’ slogan is “Single Payer,” not “Single Patient.”
If you are not satisfied with the state’s performance in implementing its health exchange, then a vote for Dan Feliciano will send a powerful message to Vermont’s Democratic leadership. A vote for Dan also sends a message to Vermont’s Republican leadership that health care policy needs emergency attention, something that Republican candidates for the House and Senate already understand. And if Dan Feliciano wins, then I will have someone in office to call upon who is motivated to help me to help my patients.
