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April 01, 2010

A New Prognosis for Health Care Reform in Vermont

IMG_0851 Vermont's effort to move ahead on health care reform is getting caught in a tug-of-war between three gubernatorial candidates, all of whom have a say in how bills move through the state senate.

The Vermont senate’s gubernatorial trio failed last week to settle differences over a sweeping health care reform effort and hoped to come to a mutual agreement this week.

Instead, two of the senators want to amend the bill over the objections of a third.

Sen. Doug Racine (D-Chittenden), chairman of the Senate Health and Welfare Committee, has crafted a bill to design a system by early 2011 that gives lawmakers and the next governor a set of choices on how to implement and finance it.

Racine wants a three-to-five-person panel composed of non-political experts in charge.

"We like the board because it gives credibility to whatever is recommended by having some respected Vermonters involved in directing the work," said Racine. "It would also remove a lot of election-year politics, and the board, though appointed by political entities, would be free from directly engaging in politics."

Meanwhile, Sen. Susan Bartlett (D-Lamoille), who chairs the Senate Appropriations Committee, wants existing legislative committees to be in charge as a way to save money and ensure the governor doesn’t have too much say on the panel.

Senate President Pro Tem Peter Shumlin (D-Windham) is supportive of Bartlett’s effort and would like to redirect money from other health care consultants to fund the redesign.

“Doug wants big names to give it authority; I think that is totally unnecessary,” said Bartlett. “If we want movement, you want the legislature to own it and work on the plans as they are developed.”

Racine said he’s concerned the governor will veto any bill that doesn’t allow the administration to have at least one pick on the panel. “And, if he vetoes the bill, we’ll have to override it; otherwise we’re no further along than we are today,” said Racine. “I’d rather see this out of the political arena — why give it to a group of legislators who are all thinking about reelection this fall?”

The bill is currently in the hands of Bartlett and the Appropriations Committee, of which Shumlin is a member, since the bill includes an expenditure of $300,000 on a consultant.

A 30-page amendment to Racine's bill was being circulated today, and Racine expected his committee to take up the bill as early as tomorrow afternoon.

The amendment, in short, would do away with the board and put the control of the reform effort under the auspices of the existing joint health care committee.

"Susan and Peter do not like the board and would like the legislature to control it, and I'm not sure we're ready to give up on the board," Racine said of his committee.

In the end, Racine said, the full senate may have to settle the trio’s differences if a compromise cannot be reached.

News of the stalemate came as a group of young Vermonters urged lawmakers to keep moving forward on health care reform.

The Vermont Workers' Center led a statewide effort today dubbed "We Ain't No Fools Day."  The campaign is led by younger members of the VWC who have been active in the group's "Healthcare Is a Human Right" campaign and is designed to educate the public on the benefits of a universal health care system.

"We've heard a lot of misinformation and lies from the corporations who profit off our broken system of health care as they try to scare us away from real, fundamental reform," said Ainsa Potvin, who grew up in Stamford, VT.

A University of Vermont senior, Potvin said the health care plan she has at UVM has not been helpful in covering some of her more acute needs in the past four years. As a result, she's had to go without treatment for some ailments, and at other times was unable to secure an appointment at UVM.

Soon she'll be out in the world and is unsure if she'll be able to afford health care; she can't go back on her parents' plan.

"When my grandparents' barn burned down, the whole town came out to watch. But, when the fire was over, the whole town came together and helped build it up again," Potvin said. "Let's build up health care."

Another UVM student, Li Nguyen, said her stepmother, in need of a kidney transplant, had to return to her native Vietnam to get treatment.

The wait list in the United States for a kidney donor was years, Nguyen said, while in Vietnam it is months.

"I find it incredible that Vietnam, one of the most underdeveloped countries in the world, is going to be able to provide her with faster, and better, care," said Nguyen.

James Haslam, of the Vermont Workers' Center, believes handing off the work to a consultant will help insulate the process from politics. He is not convinced that allowing Gov. Jim Douglas — an opponent of so-called "public option" health care plans — a say in the reform effort is a good idea.

“Also, the timeline is short, and it’s going to be really hard, too, and this is a lot of work to get done quickly, and appointing brand new people who have to come up to speed on the issue leaves an obvious way for things to get delayed,” said Haslam.

A key question is: Can Vermont get the necessary federal waivers to create its own universal system?

A global expert on health care reform, Dr. William Hsiao, told lawmakers two weeks ago he believes it can. He should know; he used to work for Medicare.

Thanks to a provision in the law championed by Sen. Bernie Sanders (I-VT), states can chart their own courses to universal coverage provided they meet federal guidelines. That provision takes effect in 2017, and by 2014 states need to put in place so-called "health care exchanges." The exchanges are designed to pool consumers and force insurance companies to compete, and therefore to lower prices.

“Those opposed are going to say we can’t do it, but let’s face it, they have been saying that all along,” said Deb Richter, MD. “With that being said, it is clear that in order to get this done we are going to need real leadership in Montpelier...”

Given the current political tussle among three candidates for governor, one wonders if the trio should seek the prognosis of a different kind of primary care doctor.

Ms. Potvin can stay on her parent's insurance until she's 26 due to the new federal legislation (see here)

We can do it if we really want to. We can do it. If we can send men to the moon and get them back here safely we can have a health care system where 45,000 Americans do not die each year from being priced out of it or that does not bankrupt the sick. It's easy.

"the timeline is short... this is a lot of work to get done quickly"

It's odd that no one mentions how the federal health care bill that was just passed plays into any of this. "Getting it done quickly" gives the new legislation no time to prove itself (or not). The last time Vermont got something done quickly, they called it Act 60, and it's turning out to be a GD disaster.

My only question regarding a state single payer system is will MDs and specialists still want to come to VT? It is difficult enough to recruit MDs as many want high case volumes. Lower wages and/or higher taxes would only make it tougher. This would need to be addressed in any proposal.

I don’t want this to sound confrontational to Nguyen, but contrasting U.S. kidney transplant wait times to Vietnam is probably like trying to compare an apples-to-oranges. Incident and donor rates among many other factors need to be considered as well as the possibility of purchasing kidneys in Vietnam.

@Jimmy: In fact, as I note in the bottom of the post folks are talking about the federal health care bill, but those pushing for universal health care say it doesn't go far enough, and the fed bill has provisions that enable state's to carve their own path.

@El Guapo: Great question. A provision in the federal bill does increase the amount of loan forgiveness and provides additional scholarships to get primary care docs to locate in more impoverished as well as underserved areas. That may help. Additionally, there will be an expansion of the federally-qualified health care centers across the country, as well as Vermont. Those centers have been heralded - from Pres. George W. Bush to Sen. Bernie Sanders - as great ways to provide low-cost, preventative primary care medicine to people. The bigger question, and this is where most health care reform efforts in Vermont have stalled in the past, is curbing cost growth. Specialists are usually a target, and hospitals have often balked at "global budgeting" or being given a set amount per year to treat their patients rather than billing for each service.

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