April 21st, 2006

Your Wish is VDB’s Command: Healthcare Update

by Philip Baruth

A few days ago, Liz in Waterbury dropped me an email with the subject line, “A Request for Healthy Enlightenment.”

Nearly deleted as spam, the note turned out to be a very heartfelt request for information — information on public policy of all things:

“I’m a regular reader of your blog, and by rights I should be more up to date than I am. But I find I’m a little muddled on what’s really happening with healthcare under the GDGD (gol-durned golden dome). Can you provide one of your wonderful posts, or point me to someone else’s? Somehow the Times-Argus news coverage isn’t really giving me enough info.”

It was a good question: could I do one of my wonderful posts on the fight in-progress up in Montpelier?
I thought about the question a lot. Well, actually, only the words “wonderful posts.”

But finally the answer was no.

Why? Because I didn’t know the first thing about the current state of play. But I do, however, know people who know people who know about it. A lot about it.

So what follows is Senator Matt Dunne’s response to Liz’s question. Currently running for Lieutenant Governor, Matt has been dubbed “The Cheetah” by VDB, in recognition of his swift, lean, and hungry campaign operation.

I’ll assume that Matt gets your vote, Liz, for going to these lengths. And by the way, your internet provider bounced back my response to you.

(Maybe Matt could look into that for you as well.)


Healthcare Legislation: Current State of Play
Senator Matt Dunne

Last Friday the Senate passed what could be called a conciliatory and solid step toward healthcare reform.

Acknowledging the fact that the Governor is not interested in systemic changes that could lead to lasting cost-containment, the bill that began in the House and was then fine-tuned in the Senate accomplishes three major goals: expanded coverage, pushing large employers to cover their employees, and better ways to manage the cost and quality of chronic care.

Here are some specifics on how these three goals are met through this piece of legislation, the passage of which will be negotiated in the coming weeks by House and Senate leadership and the Governor:

1) Catamount Health Plan — Expands coverage opportunities by creating a state-subsidized, but privately administered, healthcare plan that has sliding scale premiums for Vermonters that are currently uninsured.

About 20,000 additional Vermonters are estimated to be covered, with some costs subsidized by an increase in the cigarette tax.

2) Everybody Pays, Everybody Covered — Many mid-sized Vermont employers who cover their employees have started to realize how unfair it is that some larger multinational companies do not provide coverage.

When the uninsured get sick and go to the hospital but are unable to pay, the costs are shifted to the premiums of those providing healthcare. The legislation would require those companies who do not cover their employees to do so, although it would exempt the first three full-time equivalent employees (to help very small operations and new start-ups) or individuals who can get coverage through a spouse.

3) Pay for Performance and Chronic Care — Chronic care, services for illnesses that afflict someone for a year or more, make up 80% of our total healthcare expenses. Moreover, the way we reimburse for chronic care does not encourage procedures that actually lead to healthier patients, but instead encourages hospitals to administer procedures rather than promote lasting cures.

This piece of the legislation provides the framework for changing the way we deliver and pay for chronic care treatment, to reward health outcomes and to suggest best practices for handling chronic diseases. While the savings won’t be realized until down the road, this section has the greatest potential for cost savings in the long term.

The debate on the Senate floor last Friday was educated and cordial.

The bill passed by an overwhelming and bipartisan margin with few amendments, despite continued signs of opposition by the Governor. His resistance, oddly enough, continues to be articulated through his focus group-tested mantra that we are creating a “Canadian-style, government-run system,” despite the fact that such a concept was never under consideration.

Now we hear he is displeased that our plan only requires the option of contracting Catamount Healthcare to a private insurance company, as opposed to mandating privatization of the service, even if an alternative plan for self-insuring through a collected risk pool (like General Electric or the municipalities smartly do) and then contracting out the administration to a private company, would save Vermonters money.

Ideology overcoming efficiency? Or an attempt to find any excuse to oppose the legislature’s efforts at even some minimal reform?

With premiums rising at double-digit rates and healthcare costs statewide rising at $1 million a day, there isn’t much of a choice but to support this bill.

While no one can declare “mission accomplished” or that we are leading the nation with systemic reform with this bill, it does take us in a positive direction, reduces some cost-shifting, and creates a framework for reforming government reimbursements to hospitals in future sessions.

To paraphrase Republican Senator Phil Scott’s statement on the floor last week, there is something in this bill for everyone to dislike, and many are concerned that it will not actually contain costs.

But for Vermonters, to do nothing is untenable.