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Wednesday, January 02, 2008

The Shumlin Spin Game

Cedar_creekshumlin It had been billed by Democratic State Sen. Peter Shumlin, the president pro tem, as an "informal" sort of  "conversation" with the press, but the crowd of attentive onlookers in the formal Cedar Creek Room at the Statehouse included hired-gun business lobbyists and organization reps, as well as the chairman of the Vermont Republican Party who had a young fella with him making a digital video of the event!

 Shummy said Vermonters are "frustrated with government" and want to see the legislature get results. How original, eh?

”So we’re gonna pass two energy bills, the first that creates an all-fuels, energy-efficiency utility and saves Vermonters money by reducing our dependence on oil, that implements many of the Governor’s Commission on Climate Change’s recommendations which really are extraordinary.
   
"The second piece is we want to pass a health care bill that expands Catamount so that any Vermonter can buy into it, have affordable insurance at an affordable rate."

Shumlin did not have an answer, however, when asked by reporters how Democrats would pay for it all and that omission drew the attention of Vermont GOP Chairman Rob Roper:

He said that a year ago and the economy’s only slowed since then. Any new program has either got to come out of something that doesn’t exist or existing programs.

"I think right now Vermonters are worried about, you know, staying in their homes, heating their houses, keeping their health insurance on money that they have or can they expect a huge tax increase?"

Sen. Shumlin also said there will be action in the session ahead on decriminalizing possession of 1/2 ounce of marijuana while increasing penalties for possession and sale of harder drugs like cocaine and oxycontin.

Actually, Shummy of Putney played down hopes for any significant health care reform progress, even though he said he personally supports moving toward a single-payer system like the rest of the modern civilized world where folks get better results for half the cost!

Take_back_rally_2 Sorry, Pedro, a lot of folks ain't buying it. We've had good intentions on health care for the last couple decades and our system is drowning in bureaucracy, deteriorating in quality and costing a bloody fortune.   
"Take Back Vermont Health Care," says Dr. Deb Richter, "is a network not an organization."

This is the sign that went up yesterday in front of her Montpeculiar home. Their website, she tells us, links hundreds of Vermonters including health care professionals, doctors and nurses who actually are determined to see real health care reform actually happen. They've had it with all the talk!

Despite the current lack of support from either the Republican Fifth Floor or the Democratic Statehouse leadership of House and Senate, Doctor Richter tells Freyne Land the inescapable reality is, "Our health care system needs major surgery."

"This movement is a work in progress and it's not going away," says Richter in a phone interview late Wednesday afternoon. "We’ll multiply in February, and just wait 'till March. We’re just gonna keep on growing."

The missing ingredients?

"Courage and leadership," says Dr. Richter.

H. 304, the bill sponsored by GOP Rep. Topper McFaun of Barre Town, the bill the GOP Guv and the Democrat Legislative Leadership both brush aside, would reduce premiums by 40 percent and guarantee that everyone - repeat: EVERYONE is covered for hospitalization. It would cut Vermonters annual hospitalization bill by $56 million, according to Dr. Richter. "A dedicated tax would pick up the tab."

"That's why it requires courage and leadership," says Richter, who emphasizes, "It is money we're already paying, but we'd be paying less!"

Shocking, indeed, eh?

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Comments

Sir Winston Thriller

I don't know what it will take to get real healthcare reform. I'd've thought that current high premiums and huge prescription prices would have broken the logjam. My employer pays 100% of the premium for our family ($800/month) for coverage that's great for catastrophes, but lousy for everyday. I need cataract surgery, but CIGNA says it is not needed, so I'd have to come up with over $3000 on my own. We can't afford the over $1000/month for my partner's HIV drugs; our plan only covers 50% of the cost, and nothing "experimental" or not on their formulary. If we could switch to Catamount, most of this would be covered, or available at an affordable rate.

We both have good jobs in high tech. We're college educated. We're the kind of people with the kind of jobs that the Governor likes to point out as necessary for Vermont to remain competitive. We pay our mortgage, taxes, and this year, almost double of what we paid last year for heating. Day by day we see our savings whittled away on copayments, lab fees, surcharges. Do we make a heating oil payment ($400) or see the door for what might be bronchitis, might be something else? ($50 copay, $200 labs, all part of the $5000 deductable for "premium" health care)

Do I bite the bullet and go out on disability, reducing my salary to 40% or so, but then eligible for Medicaid?

We're not an isolated example. The family next door has no health insurance at all. Their fouth child's birth last May required a second mortgage. A coworker had to take a second job to pay for his infant daughter's cancer treatment.

We all pay for illness and health in our communities, whether by higher insurance premiums, higher bills from Fletcher Allen, or higher taxes to pay for those who can't. Affordable health coverage just isn't available to most of us in Vermont.

oy

Take Back Vermont Health Care? Poor choice of names. We'll hope they're smarter than that.

A Nother

"Do we make a heating oil payment ($400) or see the door for what might be bronchitis, might be something else? ($50 copay, $200 labs, all part of the $5000 deductable for "premium" health care)"

Yeah, that's life bucko. I have to make these types of decisions everyday. Why shouldn't you? Life offers no guarantees!

"The family next door has no health insurance at all. Their fouth child's birth last May required a second mortgage."

The family next door should have spent the money of birth control a few kids earlier. We've got one child and determined we couldn't afford more. Duh!

"A coworker had to take a second job to pay for his infant daughter's cancer treatment."

Yes, again dems da breaks. My son needed some expensive meds a few years ago so we did without the satellite TV. Big frickin deal if people have to pay their way!

JPC

Again, I love Symington and Shumlin holding hands with Douglas about how they are all going to work together this session and then go out and tell us what they are going to prioritize without hearing the State of the State. Yes work together when Douglas has raised other priorities that S&S seem to ignore. Same old politics we are going to work together as long as you follow OUR agenda. Roper needs to get his act together, the legislative leadership are everything by gift wrapping the ammo he needs to turn this back into a conservative state.

TwoCents

Ummm...maybe it's time to get active yourself Mr. Freyne. You seem to enjoy taking potshots from the sidelines. Why not actually work for the changes you seem so enamored with by running for office yourself? I'm sure this gig of traveling around and trying to be the center of attention is a good one, but don't you think it's time to put up or shut up? You are a Vermonter too, right? Just my humble two cents.

healthcare

It seems to me that the healthcare cost problem is somewhat tied to the fact that in the "old" days we (as a group) didn't have much in terms of day to day expenses. Now we do and we expect health insurance to cover this cost.

Insurance that was primarliy used for critical and abnormal problems is now expected to pay for what is commonday. That has resulted in the increase of premiums and co-pays because insurance can't foot the commonday bills while also providing coverage for catastrophic events. Although insurance companies can leverage volume to reduce cost, there is no free lunch and somebody has to pay the bill.

D. Lyd

Well said, Healthcare. That is EXACTLY the problem.

We are seeing the commoditization (is that a word?) of everything nowadays. It is ridiculous, for example, that gubmint is sending our vouchers for the proles to buy DTV convertors but most likely the pols think it is a guaranteed "right".

clar-z

Note to Shummy:
I don't want a new "all fuels" utility. I want the existing weatherization program fully funded.
Please do not create another bureaucracy. Stop reinventing the wheel. Validate what is already happening, build on it and don't call it "new".

Another Clavelle?

Dr. Deb Richter sounds like Pete Calvelle in his campaign for governor. She says..."we can cut hospitalization bills by 56 million.....a dedicated tax would pick up the tab..." So are we ahead? Sounds like we would pay the same,but just not call it healthcare cost.
Another genius comes out of the woodwork.

reality ranger

There are very good reasons why Doc Deb's bill, H. 304, isn't being taken seriously by people who are serious about containing health care costs.

Basically, the bill purports to "create" a single payer for hospital services. The cost of hospital services to be paid for has been pegged by the Joint Fiscal Office of the legislature at around $776 million/year. The way they came up with this cost is instructive about the very weakness of this proposal. First, no Vermonter who is covered by Medicare or Medicaid would be included, because Vermont can't include them without new federal waivers or action by Congress itself to give Vermont permission to use federal dollars.

But even leaving them out, the estimate, I believe, wrongly assumes that all self-insured health plans in the state will voluntarily jump into to a new state program. Right now, 1/2 of the dollars paid to Vermont hospitals for privately insured residents come from self-insured plans --- plans where the employer doesn't buy commericial insurance, but self-insures the coverage. (Pay attention, this next piece is very important). Federal laws prohibit states from regulating self-insured health plans. They are regulated, instead, under federal rules.

Therefore,Vermont cannot force employers who are self-insuring to participate in the Vermont single payer. That would include, for example, IBM, BankNorth, National Life, and pretty much any other employer with more than 500 employees or that is based out of state). This is a fact, and this law has been tested in court and upheld over and over. (It's known by the acronym ERISA.)In fact, just this week a federal court in California overturned a San Francisco ordinance that would have required employers to either insure employees or pay for employees to be covered under a city plan. Overturned, because ERISA prevents any entity other than the federal government from ordering what kinds of benefits employers must offer. (You see where I'm going here? You cannot make an employer join a single payer plan. An IBM isn't going to drop its worldwide plan for the employees in Vermont. They need uniformity of coverage, and that's what ERISA was designed for.)

So, If H. 304 passes in Vermont, we'll have a "single payer" for hospital services, but it won't include Medicare, or Medicaid or ERISA plans. That means it will cover about around 25% of the dollars spent in hospitals. 25%. Period. Hospitals will still need billing offices to bill for 75% of their revenues: to Medicare and Medicaid and ERISA plans. Oh, yes, and to bill the approx. $138 million/year in bills Vermont hospitals now issue for out-of-state residents getting care here.

And what billing office is going to created to pay for the $286 million/year spent on Vermonters in out of state hospitals?

Does this sound anything like a single payer to you? It ain't a single payer by any stretch of the imagination and H. 304 ain't going to save anyone any money.

The solution Dr. Deb is looking for can only come from the federal government. Not Vermont and not any state, can have a "single payer." It's the law and it's a fact. And it's why there isn't already a state that's done it. (DUH!)

As soon as the press (including the Man in Freyneland) get serious about challenging Dr. Deb and Topper McFaun on these problems, this faux "single payer" bill will continue to waste our time and energy.

We need serious discussions about the serious problems that we must address, single payer or not: can we afford all the hospital care we are getting already? How much waste are we paying for now? Can we afford to have every hospital in the state doing everything they all do now? How many surgeons, orthopedists, cardiologists and psychiatrists do we actually need, and are they distributed fairly throughout the state? Can we afford for every hospital in the state to have an MRI and CT scanners, churning out tests 24/7? Why are people in Chittenden county getting cardiac caths at a rate far higher than people living closer to Dartmouth or Maine Medical Center? Why are 68% of the admissions to Southwestern Medical Center originating in their Emergency room, compared to under 40% at Copley? Can we afford "world class medicine" provided by two top-notch medical schools when our state has a population smaller than the city of Cleveland?

Even if we could have a single payer, which I believe I've demonstrated we can't (without federal permission), we'd have to face these tough issues and more, but the legislature is spending its time, instead, on faux solutions. Let's put our time into the real beast: health care costs at the point of delivery, and lead the nation in a more sane direction that we can truly afford for the long run.

Douglas Supporter

I hope that we can all work together on these issues.

Peter Joes

Thanks twocents for your $.02. Peter is providing a great service to Vermont through this forum. This is the way he contributes. What do you do? Who knows, maybe he will choose to run for office someday. Till then, thanks Peter for what you do so well.

This forum is important because we can hear two sides and try to understand how come something that is "obvious" to ourselves isn't obvious to everyone. As a matter of fact the opposite is usually what is "obvious" and "only common sense" to people that think differently than we do.

Of course not all posts are so well reasoned - - but kudos to those that take the time to justify their positions and raise the level of discourse.

PJ

JPC

reality ranger, excellent well reasoned post. I encourage you to send a copy to S&S and Douglas as well. Maybe it can be nipped in the bud before our legislature wastes half the session to pass a bill that will cost the state a few million to send Sorrell to Washington so that the Supreme Court can tell us again that we have passed an unconstitutional law. Or at the very least maybe it will encourage them to look at other aspects and options.

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