From Washington Post's Ezra Klein:
Peter Shumlin, the newly elected governor of Vermont, has a plan for health-care reform: Rather than repeal it, he wants to supercharge it. His state will set up an exchange, and then, as soon as possible, apply for a waiver that allows it to turn the program into a single-payer system. You can read a summary of the plan here (Word file). I spoke with Shumlin this morning, and a lightly edited transcript of our conversation follows.
Ezra Klein: The report (PDF) prepared by Dr. William Hsiao offered three options for Vermont: single payer, a strong public option and a form of private-public single payer. My understanding is that you're backing the third option. What separates it from a traditional single-payer system?
Peter Shumlin: Single payer means something different to everyone. The way I define it is that health care is a right and not a privilege. It follows the individual and not the employer. And it’s publicly financed. The only difference between single-payer one and single-payer three in Hsiao's report is that in single-payer three, the actual adjudication of payment is contracted to an existing insurance entity. So the state doesn't have to set up a new bureaucracy to run it. His modeling suggests that’d be more economical. It's a minute difference.
EK: And why go to a single-payer system at all?
PS: In Vermont, this is all about cost containment. There are 625,000 people in Vermont. We were spending $2.5 billion on health care a decade ago. Now we’re above $5 billion. And we project we’ll be spending a billion dollars more in 2014. This is where everyone has failed in health-care reform. And this will go after three of our main drivers of costs.
First, Vermont spends 8 cents on every dollar on administrative costs, just chasing the money around. That’s a huge waste of money. Second, we’ll use technology to conquer waste. You'll get a Vermont medical card, and everyone’s medical records will be on that card, so you’ll go into a doctor’s office and they’ll know what the last doctor did to you. That helps avoid duplication of services. And the last piece, the most challenging, is remaking the payment system so providers are paid for making you healthy, not for doing the most procedures.
EK: Single-payer systems often lose on the ballot and in the legislature. No state has successfully managed to pass one into law, much less implement it. And the objection that usually stands in the way of these projects is that I'm happy with my health-care insurance, and I don't trust the government to create something new and put me into it. How do you answer that?
PS: I suspect I’m the only politician in America who won an election in this last cycle with TV ads saying I was going to try to pass the first single-payer system in America. This election was a confirmation of my judgment that Vermonters are tired of enriching pharmaceutical companies and insurers and medical equipment makers at the expense of their family members. The reality in Vermont is that there are not very many Vermonters who are happy with the current system. We’re losing our rural providers. Our small hospitals are struggling. And Vermonters are lowering their coverage and paying more and more for it.
EK: How will the funding work? Right now, a lot of money comes from employers. What happens to their share?
PS: Where health care has failed is in designing a cost containment mechanism that works. That’s the really hard part of our job. So I’m asking us to spend the next 12 months designing the tools for cost containment. Once we do, we'll figure out how to structure the way we pay for it.
EK: One of the things you asked of Dr. Hsiao was to preserve provider incomes. How can you do that while cutting costs? At some point, doesn't lower spending also mean fewer doctors or hospitals or lower incomes?
PS: The reason Vermont has the opportunity to be the lab for a different kind of change is that we don’t have a lot of high-paid physicians in Vermont. We have a lot of low-paid physicians. We have rural providers who’re making less than they did when they graduated from medical school. Our cost driver is not that we have a lot of physicians running around in Mercedes-Benzes. It’s waste in the system.
EK: How will this interact with other systems? Let's say I have Kaiser Permanente. I come to Vermont and break my leg. What happens?
PS: Nothing different than what happens right now. You’d go to one of our providers' offices, and they’d bill Kaiser for that one. No different than if you break a leg in France or Switzerland. Radical as this seems to Americans, the rest of the world has figured this out and gotten it right. We keep getting it wrong, and we’re paying for it.
From PNHP's Official Blog:
"Although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report emphatically confirms the superiority of the single payer model in ensuring that everyone is included while containing health care costs." Full report – William Hsiao, Steven Kappel and Jonathan Gruber (138 page PDF):
Read William Hsiao's statement and PNHP's analysis here.
Way to go Vermont!
FOR IMMEDIATE RELEASE
January 18, 2011
10:18 AM
MONTPELIER, VT - January 18 - Flanking Gov. Peter Shumlin at a Statehouse press conference, the Vermont congressional delegation today announced federal legislation to let states in 2014 provide better health care at less cost.
A provision by U.S. Sen. Bernie Sanders (I-Vt.) in the new federal health care law allows states to propose pilot programs in 2017. Now Vermont's congressional delegates – Sen. Patrick Leahy (D), Sanders, and Rep. Peter Welch (D) – have drafted a bill to authorize federal waivers three years sooner. Sanders will introduce the bill in the Senate for himself and Leahy, and Welch will introduce the bill in the House.
Sanders said, “At a time when 50 million Americans lack health insurance and when the cost of health care continues to soar, it is my strong hope that Vermont will lead the nation in a new direction through a Medicare-for-all single-payer approach. The goal is clear: quality, cost-effective health care for all Vermonters. This is essential not only for the wellbeing of all Vermonters but for job creation. We must do all we can to lower the crushing costs of health care that are now devastating Vermont businesses and their employees. I look forward to working with Sen. Leahy and Rep. Welch to get the appropriate waivers and flexibility for us to go forward toward a single-payer system.”
Welch said, “When Vermont innovates, the nation often follows our lead. Providing Vermont and other states with the flexibility to build upon health care reform will result in better care and greater access at a lower cost. Allowing us to become a laboratory for innovation and excellence will help Vermonters, while once again allowing us to lead the way.”
Leahy said, “While some in Washington are trying to turn the clock back on health reform, Vermont instead is moving forward. This state waiver bill will give Vermont and other states the choice to go above and beyond what the federal health care law does by devising their own reforms. Vermont has always been a leader in health care quality and access, and this bill will give our state the flexibility we want to offer Vermonters the best care and coverage while controlling costs.”
Shumlin said The Affordable Care Act “will bring Vermont critical money to make our health care system work better and to cover some of the uninsured. We want to do it better and faster than the federal law contemplates. We want to control costs and cover everyone. I am so pleased that our congressional delegation supports us in this effort, and I thank them for introducing this important legislation. This is just the beginning of this process, and there are other waivers we will need to get it done. If we work together, I am convinced we can persuade the federal government they should not stand in our way."
This press conference came one day before a report is to be delivered to the state Legislature by William Hsiao, the Harvard University economist, outlining health care options for Vermont that could require a federal waiver to be implemented.
The new national health law will provide insurance for 32 million more Americans and make other significant strides, but Leahy, Sanders and Welch said Congress and the Obama administration should let states make additional improvements.
Under their bill, states would be able to seek U.S. Health and Human Services Department approval to implement pilot health care systems beginning in 2014. To qualify, state plans would have to be at least as comprehensive and affordable as the federal model and cover at least as many people. States could not offer lower quality or less affordable coverage. A single-payer system like Vermont is considering or any other state initiative could not cause the federal government to incur more costs.
The waiver provision also requires HHS to create a coordinated process so states in a single application also could seek waivers already available under Medicare, Medicaid, and the children’s health insurance program.
A fact sheet on the new "State Leadership in Healthcare Act" is available here.
Source: Common Dreams
A Little Good News: "As Peter Shumlin was officially sworn in as governor of Vermont, there was and is great hope that at least in one state we may see passage and implementation of a truly universal, single-payer healthcare system."
by Laura Flanders
What's it got to do with Congress? Merely this: there is such a thing as the courage of conviction. How many times have we heard that progress comes through conciliation? It's the ubiquitous refrain of political "framing" and "spin-meisters."
"Go to where the middle is." How many anti-war activists, anti-poverty, pro-single-payer advocates have been told that progress comes from hugging the middle, not pushing the edge? You hear it now in Washington, around healthcare --- or the budget.
Civil Unions, passed in 2000 in Vermont, didn't satisfy fair-minded Vermonters. They'd pushed from the edge to Civil Unions, still wanted marriage equality, and they weren't going away, and they continued to work and to push. A veto threat from Vermont's governor didn't discourage the backers of same sex marriage.
By Susanne L. King, M.D. - Berkshire Eagle Online
Sen. Bernie Sanders, a Vermont Independent, has just introduced a single-payer health care reform bill into the United States Senate. This legislation stands in sharp contrast to the reform models offered by the White House and Sen. Max Baucus, which are similar to our current Massachusetts reform. Unlike Massachusetts, the Sanders bill would eliminate the many private insurance companies and create a "single payer" to administer health care funds.
Single-payer health care would save American taxpayers $400 billion in administrative costs, says Sanders, which would be enough money to provide health care coverage for everyone in our country. Sanders is a senator who knows how to save money at a time when taxpayers are paying billions to keep AIG afloat.
As we know from our Massachusetts experience with health care reform, preserving the role of private health insurance companies does not lead to universal coverage or contain rising health care costs. The Massachusetts reform program has not been affordable for the individual or for the state, and access to health care continues to be problematic, with nearly a quarter of the state's residents saying they had difficulty getting care in 2008.
The provisions of Senator Sander's bill are: (1) universal coverage; (2) comprehensive benefits, including mental health, dental and prescription drug coverage; (3) patient choice of doctors and hospitals; (4)fully-funded community health centers to provide access to care for the 60 million people living in rural and other underserved areas; and (5) resources for the National Health Service Corps to train 24,000 new health professionals to address the shortage of primary care doctors and dentists.
Massachusetts continues to have a critical shortage of primary care doctors, and providing health insurance for the uninsured through our current program has only made that deficiency more visible. Having health insurance in Massachusetts doesn't guarantee health care if you can't find a doctor when you are sick. Others with insurance can't get care because they can't afford their co-payments and deductibles.
Sanders' program would be paid for by taking the current sources of government health care spending, and combining them with modest new taxes that would be less than people now pay for insurance premiums and other out-of-pocket expenses. Four hundred billion dollars would be saved annually by eliminating insurance company profits and overhead, as well as the paperwork that burdens doctors and hospitals.
Dr. Uwe Reinhardt said at a hearing before the U.S. Senate Finance Committee, "We have 900 billing clerks at Duke (a 900 bed university hospital). I'm not sure we have a nurse per bed, but we have a billing clerk per bed. . . it's obscene."
Doctors and hospitals are sick of the paperwork and the health care dollars that don't go for health care delivery. And everyone hates the intrusion of insurance companies into health care decisions. A poll published in the Archives of Internal Medicine found that 64 percent of doctors in Massachusetts now support single-payer health care.
Sen. Bernie Sanders' legislation is a bold step forward. Five hundred physicians in Massachusetts have signed a letter to Sen. Kennedy, asking him to support a single-payer reform similar to Sanders' bill. Kennedy supports universal coverage, but would leave the current dysfunctional system of multiple insurance company payers intact. Kennedy has said, "Health care is not just a commodity . . . to be rationed based on the ability to pay. It is time to make universal health insurance a national priority, so that the basic right to health care can finally become a reality for every American."
Unfortunately, leaving the current system intact would not save the $400 billion now lost to administrative expenses. We ask Sen. Kennedy to listen to Massachusetts physicians and reject the lobbying forces of the profit-driven insurance industry. We also ask him to join Sen. Sanders in sponsoring the only solution for health care reform that will cover everyone at a cost we can afford. Susanne L. King is a Lenox-based practitioner.
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