Editor’s note: This commentary is by Ron Holland, an emergency physician and policy analyst who lives in Irasburg.
[O]n April 1, VTDigger reported that health care spending per Vermonter consistently has been lower than per capita spending nationally. The following day, the Green Mountain Care Board wrote to all major Vermont legislative leaders that “Vermonters spend less per person on health care than the per person amount in the U.S. as a whole.”
Viewing Mount Mansfield is both a qualitative and quantitative experience. No matter whether you view it from Winooski, Williston, Charlotte or Irasburg, its image is consistent.
At the Green Mountain Care Board hearings on July 23, Ethan Parke of Montpelier reported that Consumer Reports finds that Vermont has the seventh highest health insurance premium for a comparable policy (Vermont $622 vs. average all states $506). A similar analysis by United Benefits Advisors finds Vermont ranks fourth highest at $607 with average for all states being $510. If Vermont’s health care costs are less than the national average, why are health insurance premiums higher than the national average?
In a recent study by the RAND Corporation of 25 states, Vermont ranks fourth highest in per capita costs for a standard outpatient visit and hospitalization. If Vermont’s health care costs are less than the national average, why are per capita costs for standard hospital services higher than the average for 25 of 50 states?
In the 2017 release of Center for Medicare Services (CMS) measurements of per capita personal health care costs by state, for the year 2014 Vermont ranks fifth highest at $10,190, 21.4% of Vermont’s gross state product. For the same year, the GMCB reports per capita personal health care costs of $7,150 (eighth lowest in the U.S.) at 14.7% of the gross state product. In 2014, the U.S. per capita personal health care cost was $8,045. The difference in measurements of CMS and the GMCB amounts to $1.9 billion in 2014, 6.7% of the Vermont gross state product. If Vermont’s health care costs are eighth lowest according to GMCB measurements, why are they the fifth highest according to CMS measurements?
Viewing Vermont’s health care costs from four credible independent perspectives outside of Montpelier finds them to be among the highest in the nation in clear contrast to the view from Montpelier.
You may now suspect that I am questioning the accuracy of the GMCB measurements of health care costs for Vermont citizens. I am.
In his farewell address to the nation on Jan. 17, 1961, President Dwight D. Eisenhower stated that “the only defense against the Military-Industrial Complex is alert and knowledgeable citizens.” In 1980, Arnold Relman editor-in-chief of the New England Journal of Medicine, named the “health industrial complex” and cautioned against its takeover of the U.S. health care system. Like President Eisenhower, he named an informed public as the safeguard against a health care system focused on its financial well-being rather than patients’ health and the efficient provision of care.
When the opacity of the health care system is further obscured by inaccurate measurement of its costs, the political influence of wealthy health care providers (health care spends more on lobbying in Montpelier than any other interest group) has permeated our political structures that are now effectively serving health care corporations rather than Vermont citizens.