Health Care

Smith: Does anyone know where we’re headed on health care?

(Mike Smith is the host of the radio program “Open Mike with Mike Smith” on WDEV 550 AM and 96.1, 96.5, 98.3 and 101.9 FM. He is a regular columnist for VTDigger and a political analyst for WCAX-TV and WVMT radio. He was the secretary of administration and secretary of human services under former Gov. Jim Douglas.)

Let’s take a quick look at health care in Vermont nowadays:

• The state’s largest health insurer, Blue Cross Blue Shield of Vermont, is asking for an average premium hike of 12.7 percent for qualified plans established by the Affordable Care Act. This increase would affect about 70,000 Vermonters. The wages of Vermonters are growing only at a fraction of the requested premium increase. Don George, the president and CEO of Blue Cross Blue Shield of Vermont, acknowledges that these premium increases — the largest in recent years — are unsustainable and place a heavy burden on working families and small businesses.

• The University of Vermont Health Network continues to expand its presence in both Vermont and New York through affiliations with, or acquisitions of, other hospitals and physician practices. Critics say Vermont could be left with fewer choices, or perhaps a single choice, of health care providers. The network says scale is important to achieve efficiencies while delivering quality services and that affiliation is a much better outcome than closing local hospitals or physician practices.

• Patients are waiting months to see physicians, particularly specialists. Some physicians are leaving Vermont because of the state’s low reimbursement rate for Medicaid patients. And some medical providers are reimbursed for services at a lower rate than providers who are affiliated with hospitals.

Kevin Mullin
Kevin Mullin was named to the Green Mountain Care Board recently as chair. File photo by Erin Mansfield/VTDigger
• The Green Mountain Care Board went for months without a full complement of members. It has yet to decide whether to allow a new for-profit surgical care facility in Chittenden County. Advocates for the facility say it is needed to meet surgical demand and that it can provide certain procedures at lower costs. Critics, including existing nonprofit hospitals, say the facility does not conform to the requirements under the permit process and will create excess capacity, resulting in higher medical costs.

• Most agree that our mental health system is in crisis and circumstances for those needing services are getting worse. Inpatient beds are full, and people in crisis are finding themselves in emergency rooms, sometimes for days.

• And politicians promise that the all-payer model will reduce health care costs, but details have been scant as to how much and when. To most Vermonters the descriptions of the all-payer model might as well be delivered in Latin. Terms like “payment reform,” “delivery system reform,” “fee for service” and “population health” all cause confusion, if not outright skepticism. No state official has been able to clearly explain how the all-payer model is a benefit to individuals and why it should be implemented.

In fairness, there has been notable progress too. First, we have a system that delivers high-quality services. Second, our uninsured rate is low. Most Vermonters have access to health insurance through various state and federal government programs, as well as through their employers. Third, hospital budget increases have slowed in recent years. And we’ve achieved some success on combating chronic diseases.

Still, the challenges outweigh the achievements.

What is perhaps most disconcerting to many Vermonters is that no one in state government has articulated a clear vision — in understandable terms — for how these challenges are to be met.

What is driving continued increases in health care premiums? A 12.7 percent premium increase would indicate that more attention is needed to abate these cost drivers.

Is consolidation in a health care system good or bad? Has there been sufficient study at the state level regarding the future impacts of a consolidated health care system? Is it occurring by happenstance or according to a plan? And what happens if we get it wrong: Is there an alternative plan?

Senate President Pro Tem Tim Ashe, D/P-Chittenden, described recent consolidations of physician practices with a larger hospital system this way: “We’re watching the slow disappearance of independent practices, but I’ve never heard anyone say that this furthers the health care interests of the state of Vermont. Or that it is the policy of the state that these practices ought to be owned by a larger facility. Our regulators have let it just happen without showing much concern about the impact on patients, prices or access. It’s a modest piece of the Vermont health care pie, but it’s telling that regulators have turned a blind eye to this decline.”

What does our health care delivery system look like in the future? Is it mostly a nonprofit model, as it currently exists, or is it a mix of nonprofit and for-profit health care entities to meet future needs?

What is the all-payer model, and what does it mean to the average Vermonter? When does it start achieving the cost savings that state officials have touted?

And what future impact will technology have on the delivery of medical services and the cost of health care in Vermont?

These are all forward-thinking questions that need forward-thinking answers.

In recent years, Vermonters have endured failed or fumbled attempts at reform. And the trust of Vermonters was broken when state officials misled the public about the seriousness of problems with Vermont Health Connect, or when they were bamboozled about the benefits of health care reform by consultant Jonathan Gruber.

Now is the time for leaders to step up and give Vermonters some assurance, in language they can understand, about how they are going to address their concerns in future health care costs and direction.

Former state Sen. Kevin Mullin, R-Rutland, was recently appointed chair of the Green Mountain Care Board. This panel is the omnipotent overseer of health care in this state. It will fall mainly on him to articulate this vision, but Gov. Phil Scott will have enormous responsibilities as well in shaping the future landscape of health care in Vermont.

I reached out to the new chairman in an email asking questions that were designed to get a sense of where he sees health care going. I didn’t get a response before my deadline. But he has only been on the job for a few weeks, so it is understandable that he probably hasn’t been able to collect all the information he needs to make a definitive statement on direction.

Vermonters have been extremely patient in waiting for state officials to give them a glimpse of their health care future. So far, that clarity has been lacking. No doubt patience is beginning to wane, and it is the responsibility of the governor and the Green Mountain Care Board to provide some insight, in a language that all Vermonters can understand.

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Mike Smith

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  • James Rude

    The best description of Vermont’s health care quest can be found in “The Trip to Abiline paradox”. We all seem to be buying the notion that it is government that needs to lead the way to “fix healthcare”, yet very few are happy with the results. The more we mess with it the worse it becomes.

    https://en.wikipedia.org/wiki/Abilene_paradox

  • Robert Ronald Holland

    “The high costs and poor performance of the U.S. health care system, and Vermont’s, stem from five factors: 1) Lack of overall leadership, 2) Lack of necessary information for sound decision-making, 3) No ethical means for limiting health expenditures, 4)Individual rights uncoupled from personal responsibility, and 5) federal control.” Don’t expect the leadership to tell you that they are the problem.

  • Tyler Samler

    It’s not just pharma and providers…

    Malcom Sparrow at Harvard talks about $330 billion in billing fraud in our “for-profit” insurance industry, annually. It’s a bureaucratic nightmare. Hundreds of $ billions is spent on things that have nothing to do with health care: overhead, underwriting, billing, sales and marketing departments, huge profits and exorbitant executive pay.

    There’s also the fact that 1/3 of Americans are obese, and another 1/3 are over-weight. The lack of “care” for health in our country is pervasive. The apathy is exacerbated by smart phone addiction, 8 hours of screen time, bombardment of media – pushing toxic and frivolous products (mostly to children) – and lack of value for education.

    • Jeffrey Kaufman

      Now you’re talkin’ !
      Remember, though, Medicare (government insurance and administered) suffers over $60 billion in fraud annually as well.

  • Gary Murdock

    Escalating cost and a constant state of crisis management; The result of the explosive growth of a national welfare program…also known as Medicaid. These rate and cost increases are simply the balance due on Medicaid accounts, passed on to those who are not on it. Spin it any way you want…blame pharma, blame Trump and his evil horde of republicans…blame everyone but the real reason…Obamacare and progressive policy.

    • Tyler Samler

      Do you think welfare costs are more burdensome than the cost of corporate welfare?

      • Gary Murdock

        Meaningful dialogue requires that one stay on subject. Lobbing the same old stale cliché’s from the play book when confronted by the inconvenient truth does nothing to advance an understanding of the issues, rather it breeds rampant ignorance and the inseparably linked progressive policy.

      • Jeffrey Kaufman

        No one should be given public money they don’t need. Neither Medicaid, Medicare, Social Security, nor Welfare were ever intended at their outset as global programs. They were for a small segment of needy people.
        Today people seem to believe the expansion of those federal programs is required. It is not. They need to be pared back with reason, judicious care, honesty and economic forethought. The unintended consequences of those programs are severely damaging our country. They have also perverted the thinking of people who have come to believe they are entitled to the public’s largess. My tax dollars are not given so any political party can use them to advance their political agendas nor keep their party in power. The limited federal government our Founders set up for us was limited so the government did not run out of control as it has. Our governments, federal, state, and local must also get out of the business of being in business !

  • Moshe Braner

    The good news is that health care will never be more than 100% of the GDP. The bad news is that it is already 20% of the GDP.

    Seriously, this train is clearly careening towards a wreck. What nobody is willing to say is that we cannot afford all the health care, procedures, devices and drugs that can be invented, especially when those who sell it are free to set any astronomical prices they desire.

  • Tyler Samler

    Clinton’s old news… but you’re not wrong!

  • Jeffrey Kaufman

    Truman’s view of Medicare was global, but he couldn’t achieve it.
    LBJ’s Medicare was restricted to those over 65 who were being denied private insurance coverage. Roosevelt’s original “social security” was fully self funded by payroll taxes, safely housed in the social security trust fund, and was intended as a retirement benefit for those who contributed. Only years later did it provide benefits for dependents and spouses. Of course, we know that the trust fund was raided to relieve the general fund; and new immigrants who may have never worked in the US nor contributed by paying ss tax now receive these benefits.

  • rosemariejackowski

    In Canada they have less profit, less paperwork, and less political influence. Or maybe Canadians are just smarter than we are.