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May 03, 2010

Health Care Rally Draws Hundreds to Montpelier

IMG_0913 The Senate Health and Welfare Committee is expected to vote out a compromise health care bill today, just two days after roughly 1000 people gathered on the Statehouse lawn calling on lawmakers to keep moving toward the creation of a universal health care system. Debate on the bill is scheduled in the Senate later today.

About 1000 people Saturday gathered in the sun, marching from Montpelier's City Hall to the State House chanting, "The system, get off it. Our health is not for profit."

The statewide rally was organized by the Vermont Worker's Center as part of its "Health Care is a Human Right" campaign.

The rally was larger than last year's health care rally, but this year attendees were celebrating some small victories.

While the national health care reform effort fell short of the single-payer system many at Saturday's rally hope to see the United State adopt, attendees were hopeful Vermont can design and implement the nation's first state-run single-payer system.

This year, the Senate and House have been working on various efforts to redesign Vermont's health care system. The House has taken a more proactive approach and called for specific reforms — all connected to the state's Blueprint for Health model, which aims at more preventative medicine. The Senate, meanwhile, wants to commission an analysis of Vermont's health care system and to have a consultant come back to the Legislature in January with three options on how to design, and implement, a universal health care system. One of those options would be a single-payer model.

By 2017, states will be able to opt out of the national system if they can get waivers from the federal government, but U.S. Sen. Bernie Sanders (I-VT) is working with colleagues to move that date up to 2014.

Sanders told the crowd Vermont should continue its efforts, even though there is doubt about whether it could receive the necessary waivers to implement a single-payer system. As more states demonstrate an interest in opting out of the federal system, it only gives Sanders and other single-payer supporters in the Senate more examples of why states should be allowed to experiment with other models.

"Vermont can lead the way," Sanders told an enthusiastic crowd.

IMG_0915Sanders was the only politician to speak to the full crowd, though several statewide candidates milled about throughout the day, including four of the five Democratic gubernatorial candidates Sen. Susan Bartlett, Matt Dunne, Secretary of State Deb Markowitz, Senate President Pro Tem Peter Shumlin. Racine was out of town this weekend.

Rep. Steve Howard (D-Rutland), a Democratic candidate for lieutenant governor, also talked with attendees as did Democratic hopeful for Secretary of State — former State Sen. Jim Condos.

Two of the secessionist candidates — gubernatorial hopeful Dennis Steele and lite guv hopeful Peter Garritano — also talked with rallygoers.

Other speakers said Vermont has come a long way since last year, when universal health care advocates gathered en masse on the State House steps. At that time, health care reform was not on the legislative agenda — at least not like it is this year.

Now, the legislature is poised to pass a sweeping piece of legislation aimed at overhauling Vermont's health care system.

"What a difference a year makes," said Jen Henry, a nurse and president of United Professions / American Federation of Teachers of Vermont. The union represents nurses and lab technicians at Fletcher Allen Health Care as well as workers at several other hospitals and colleges in Vermont.

"We wouldn't be here today, celebrating, if it were not for the hard work of thousands of Vermonters — many of whom came to the Statehouse to share their stories about our broken health care system," said Henry, alluding to a Statehouse hearing earlier this year in which hundreds of people testified.

Though S.88 is not perfect, Henry noted, it is still worth supporting and ensuring that lawmakers override a possible gubernatorial veto.

"We need to ensure that any new system works for us, and not for the special interests who are strongly trying to protect a broken system that is governed by greed," said Henry.

James Haslam, the director of the Vermont Worker's Center, which has been leading the "Health Care is a Human Right" campaign, said the organization is not simply going to let candidates vote for S.88 and then walk away.

The VWC has crafted a pledge for candidates to sign to put them on record of not just voting to support healthcare reform this year — and potentially a veto override vote — but to come back next year and make sure that they follow through and implement the system recommended by an outside consultant.

The pledge reads:

"If elected, I pledge to ensure that every Vermonter gets the health care they need, in line with human right principles. I will do this by supporting the design and implementation of a unified health care system (as called for by S. 88, which:

• Shares costs and benefits equitably;

• Serves all Vermonters, regardless of their ability to pay;

• Does not allow for inequality in Vermont's health care with different tiers of access or coverage, and;

• Meets the five human rights principles of Universality, Equity, Accountability, Transparency and Participation."

Haslam said the Vermont Worker's Center will hold candidate forums around the state this summer and fall, as well as continue to survey Vermonters about the current health care system.

"It's amazing to think about where we will be when January 2011 rolls around and this time next year — with a lot of hard work — we will be celebrating the victory of putting in place the new health care system for our state. Let's do it!"

Did Jen Henry comment on retaining and recruitment of nurses in a single payer system? Thanks, Tom

Tom: No, she didn't say anything about retention or recruitment in her speech.

Yeah, they can work out little details like that after the fact.

Shay, Thanks. As you have probably guessed by now, it is a critical issue in the VT single payer debate that - as far as I know - has not been addressed by my fellow Dems.

Tom: I've sent an email to Jen Henry with your question and if I get a reply, I'll post it. Thanks for raising it. Cheers.

There are many issues that need to be address, though probably fewer than under the "system" we have. The problem is, people raise questions and say it can't be done. Well, it can. Maybe we can remove the cynicism from the equation.

I think the real problem is too many people saying "it can be done" without really having any idea whether it can be done, let alone coming up with specifics on how it would work. What they really mean is "at a very high level, it seems like a good idea, so I'll just assume it is and shout that assumption through a bullhorn."

What SPECIFIC impact would this have on medical professionals' compensation, and resulting retention of quality staff? How would out-of-state care be handled? What will the cost of creating and running the administrative system be? Until these and dozens of other questions are answered with complete specificity, no one knows whether single payer in Vermont makes sense.

@Jimmy: The Senate bill (S.88) would answer questions like the ones you pose before any system could be implemented. In fact, previous single-payer studies have examined those questions, too.

That said, while the single-payer approach is one model, there is also a multi-payer system and one or two other systems (that's being negotiated right now) the consultant must review before reporting back to the legislature.

It could be that one of those models, rather than a straight single-payer, will be a better fit for Vermont — or that the current model when you take into account the federal changes will suffice.

Or, the guv could veto the bill and we'll just have to hear the people shout through bullhorns for a few more years.

Shay, I understand all of that. I was specifically commenting on the single payer enthusiasts' exhortations, as did the post that we're currently commenting on.

"In fact, previous single-payer studies have examined those questions, too."

For Vermont specifically? Did they explore every angle of the issue as relates to this state? If so, I'd be interested to read them. As I'm sure you realize, many of the issues related to implementing a single payer system in Vermont would be very different from those in most other states.

@Jimmy: Got it - wasn't sure if you knew that S.88 doesn't actually implement anything other than a comprehensive design/analysis.

To your other question: Yes, for Vermont specifically. The Lewin report of 2001 was fairly extensive, but I can't recall if it delved into retention and recruitment issues or not. I don't think it did.

I do recall that it looked at various finance models, potential cost savings, reimbursement models/rates for MDs, and covering workers employed by out-of-state companies (noting that it would be hard to recoup parts of a payroll tax on those companies, etc.), among other key items.

That report was done by a single-payer advocacy group and is ridiculously high-level. Statements like "it is unclear whether $500 million can be removed from the health sector without slowing the adoption of medical technology or otherwise compromising the quality of care" are basically saying "we haven't really crunched the numbers." Someone needs to actually crunch the numbers.

The Vermont Healthcare Commission of 2005 (composed of members appointed by members who were appointed by both the legislature and the Douglas administration) also looked deeply into different models for providing healthcare.

The numbers have been crunched and re-crunched. Now the Senate wants to re-re-crunch the numbers again.

The Legislature loves to study healthcare. They've been doing it for a decade or more.

one_vermonter, can you provide a link to any comprehensive study done on single payer in Vermont, in 2005 or at any other time? I think that the phrase "crunching the numbers" is used a little loosely when it comes to this issue. Single payer fans may actually believe that the Lewin report accomplishes that.

I gave you the specific name of one government appointed commission that did the research that you are asking about.

The work has been done. I've cited exactly where, exactly who and exactly when. You are now free to go to the state archives or the state legal library to look it up.

Not every state document has a URL.

Yes, I found the repository of every document generated by that commission (they were actually called the Vermont Health Care Reform Commission, but you were close enough). All of their work product, as well as all other documents related to Vermont's pursuit of health care reform, are indeed online. However, there's not a single document purporting to be a comprehensive study - even from a high-level feasibility perspective - of single payer health care in the state.

Now if you have knowledge of another document that represents this "crunching and re-crunching" that you speak of, feel free to give me the title and where it can be found - in the digital realm, a library or anywhere else. Otherwise, I have no choice but to conclude that like many of the people described in Shay's post who seem to "know" that single payer is feasible in Vermont, you're full of shit.

Jimmy’s Rules of Engagement:

1) Ignore any evidence which questions your assertions. Even when presented with specific information regarding where this information exists … deny that it exists. Deny. Deny. Deny.

2) Attack people who don’t agree with you. Attack them personally. Remember that profanity always bolsters your argument.

By refusing to offer a title or location for your magical document, you're not making a strong case for its existence. If you know of a document that answers my questions, then you must have read it, so it's somewhat mysterious that you can't remember what it was called or where it resides. As I've said, the entirety of the Vermont Health Care Reform's work product is online, and your magical document is not in that list.

Despite the strong evidence it obviously bothered you that I said you were full of shit, so prove that you're not. I'll make it easy for you to start: when you read this document, where were you?

I've been working on this isssue since 1979, when I was ED of VPIRG. I do know first hand than none of the consultant studies done since 2000, or even before then, are in any way thorough and comprehensive enough to provide sufficient information for the legislature to safely outlaw private insurance and pass 12%+ payroll taxes to implement a single payer. Period. e.g. How do you model what happens to jobs along the CT River that could easily move over to NH? Who pays the payroll tax to support those employees, since they are still Vermont residents? Let's not forget the the "savings" that are posited for the single payer are promised to come from "eliminating administrative costs." Well, I think that means eliminating jobs, right? No one has studied how many jobs will be eliminated, and what we will do to retrain and reemploy those people, how much that will cost, and, by the way, how we'll pay for their coverage.
I'm not arguing for the status quo; I'm saying that I think those are the kinds of questions that need to be addressed before you pull the plug on the current system, and no one has even talked about them yet.(And I seriously doubt they can be addressed in the next six months, which is the time frame for the S. 88 study...) One state going single payer in the midst of every other state being status quo is NOT comparable to a European or any other nation being a "single payer." The possible unintended consequences are manifold and potentially disastrous. Health care spending in Vermont is nearly $5 billion. This dwarfs the entire state budget. Putting even $2 or $3 billion of health care on to the state budget ought to be done very, very carefully, right? Can we all agree on that?

But my main concern about S. 88 is that I think most people still don't fully realize how very little change can be made at this point without Congressional approval, and how very unlikely that approval is. The passage of federal reform was a game-changer that dramatically turned the odds against Vermont's valiant single payer campaign.

According to BISHCA's latest health care expenditure (2008) analysis, here are the current sources of financing for coverage for Vermonters:

38% have private health insurance, regulated by the state
21% are covered by federally regulated employer self-insured plans and the federal employee health plan
16% are covered by Medicaid
14.2% are covered by Medicare
2.4% are covered by military
7.6% are uninsured

The state has authority only over the operations of private health insurance (e.g. BCBS, MVP, CIGNA); it cannot "order" self-insured employers (e.g. TD Bank, IBM and most every other large employer in the state) to use a particular fee schedule or method of payment - not without a specific Congressional waiver of federal laws. Same with Medicare, Medicaid, federal employee and military coverage.

Without specific Congressional action, in other words, Vermont controls only 38% of coverage in the state (and that's only control over the insurance company; not over the employers/employees who buy that coverage). And if you don't have everyone in the same purse, you don't have a single payer, you won't have the "savings" of getting rid of billing offices, etc. There's no point in designating one carrier as the "single payer" when you only affect 38% of the people in the state. (Oh, and it's not clear that the federal law that gives states the authority to regulate health insurance includes the authority to put them out of business.)

Yes, Sen. Sanders will try to move the "waiver" date up to 2014, but let's remember that even with 60 votes, the Dem senate leadership couldn't give the states the option of offering a public option in 2014. The idea that Congress would pass a bill giving Vermont waivers from several federal statutes AND authority to control the expenditure of over a billion dollars now spent in Vermont on Medicare, Medicaid, military and federal employee funds ... Hmmm. See what I mean?

I know all about having hope and fighting for causes, but I also don't want to see us wasting our time and precious state funding ($300K for the study) that could be invested instead in real improvements in health status. Like I said, a year ago when this campaign started, it might have been "hopefully realistic," but now, after recent federal action, I don't see any "real" at all.

@Tom: I did follow up with Jen Henry this week and asked her to respond to your question. She replied, and then I neglected to post it here. That is, until now.

Here is her response to your question (which I cut and paste in my email to her):

"The information I have read states that the majority of medical professionals compensation will remain unchanged, with the most change happening between the average income of an MD or RN and those who currently have significantly higher salaries working in specialty areas. The decrease
in administrative overhead will result in more financial resources and more people will have access so visits for health care will increase which will increase financial resources as well.

It is our hope that hospital resources would be shifted to ensure competitive salaries, since the Executive Officers salaries are more than their counterparts at Johns Hopkins, Massachusetts General and Dartmouth. With Dr. Estes making over 1.4 million in 2008. (990's available on Guidestar)

The ability to recruit and retain is a complex equation that includes wages, benefits and working conditions. As a union we have worked on wages and working conditions and have been able to decrease our nurse vacancy rate to less than 2% at a time when the national average was 18%. Benefits are always challenging because the best benefits are often very costly - to employers and employees. As healthcare employees, we pay significant annual benefit costs, copays, co-insurance costs, and deductibles. For a part-time LNA, secretary, kitchen staff person, housekeeper, or other important support professionals the cost of FAHC health insurance takes a significant chunk of each paycheck and if you need to utilize FAHC services, the additional costs are staggering.

In our opinion, if the same gifted, talented individuals that have created a system that generates such significant profits for executives can put their energy into creating a system that eliminates the administrative waste and covers the people of Vermont throughout their lifetime, not tied to employment change would not take so very long!

The other details must be worked out....I know that readers hate that response, but the system must be put into place and must evolve as the challenges become more clear and the needs of the people change.

That's all very vague.

"It is our hope that . . ."

"In our opinion, if . . ."

"The other details must be worked out . . ." What "other" details? There was not a single detail stated. Therefore, ALL the details are the "other" details that must be worked out.

I'm guessing Jen Henry wouldn't have been too happy having her response directly following Jeanne Keller's comment. It really drives home that it amounts to a long way of saying "I don't know how this would work. I'm going to guess everything would be great, but no one has really looked into most of it." At least wrt economic issues, with all due respect you can't say that you've figured out part of it. If you haven't figured out the whole picture in great detail, you haven't figure out any of it, it's all interconnected.

Jeanne's comment, on the other hand, is excellent. It efficiently and comprehensively articulates many of the concerns that some of us have been quietly harboring since the single payer screeching has ramped up.

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