Editor’s note: Rep. James Masland, a Democrat, lives in Thetford and has represented District 2 in Windsor and Orange counties since 1998. He was director of the Vermont League of Cities and Towns from 1991 to 1998.
[T]he Vermont Legislature is poised to begin the task of reviewing and evaluating the advisability a financing plan proposed by the administration for Green Mountain Care, a publicly funded universal health care system. Green Mountain Care is the statutory name for what is more commonly referred to as single-payer. Opponents are grasping at each piece of negative press as another reason to scrap it.
Following the November election, Vermont Republican leadership’s Dustin Degree described the election as a referendum on single-payer. More recently, Chris Graff has suggested that, for political reasons, Gov. Shumlin should shelve the idea, at least for a while. Further undermining confidence in government’s role in health care reform, it did not help that Jonathan Gruber, the MIT economist and architect of Obamacare, stated that the federal law’s passage was due to the stupidity of the American voter.
However cynical and outrageous Gruber’s comments, however misleading Dustin Degree’s and however limiting Chris Graff’s, what they have in common is that none of them actually has much to do with Green Mountain Care. True, the roll-out of the online marketplace, Vermont Health Connect, has been frustrating for many and nearly a train wreck in extreme cases. Exchanges in other states and the federal site have experienced similar problems. But remember, it was the online website technology that failed, not the health care policies themselves. That’s a key difference. The exchange is not Green Mountain Care, either in conception or implementation. It was never intended to be.
None of us should run headlong to vote for a bill regardless of the expense, but we should to commit to honestly wrestling with the administration’s proposal, evaluating how such a change would impact Vermonters’ access to care and determining how the change would impact the economy on all levels.
There are numerous reasons why health care reform can’t wait. The present fee for service system is financially unsustainable, too convoluted to deliver quality care, and too bureaucratic to ever bend the curve to contain costs. Examples abound. Doctors who maintain their own practices are reimbursed at one rate, while those employed by a hospital are paid at a much higher rate for providing the same service. Medicare and Medicaid underpayments, bad debt, and free care for those who cannot pay are costs that are shifted to those who pay with insurance premiums. This shift costs Vermonters some $384 million annually. The black box that coughs out prices for pharmaceuticals and determines what different hospitals are paid for the same procedures is so convoluted to be unintelligible. All of this contributes mightily to back office administrative costs and inefficiencies and does not deliver quality care, particularly to those who need it most.
From an employer’s perspective, the pre-Obamacare system led to predictable double digit annual premium increases and great uncertainty as insurance companies truncated coverage and shifted expenses to higher out-of-pocket costs in an effort to keep premium increases from going through the roof. Uncertainty of this magnitude makes it very hard for businesses to keep their budgets under control and diverts them from concentrating on production and innovation. It’s clear we cannot return to that model.
No one is promising that Green Mountain Care will solve all the bureaucratic nightmares is one fell swoop, but it is clear that it will provide tools with which fair minded people will be able to address these issues in a timely manner. What’s more, all Vermonters will receive health care regardless of income or social status. Hence, the first order of business for the new Legislature is to develop the financing that will make it work. It will not be easy by any means. None of us should run headlong to vote for a bill regardless of the expense, but we should to commit to honestly wrestling with the administration’s proposal, evaluating how such a change would impact Vermonters’ access to care and determining how the change would impact the economy on all levels.
The task seems daunting, but skeptics should remember the old adage that says, “every truly great accomplishment started as an impossibility.” The groundwork has been laid by those who have worked with the governor to devise his version on a financing plan. It’s high time for the Legislature to take the next step.
