Healthcare

Burlington Telecom trying to find its proper place

October 14, 2009, the Vermont Business Magazine, by Kevin Kelley

The “public option” has emerged as a topic of debate in Vermont – not (yet?) in regard to health insurance, perhaps, but in the telecommunications industry.

A publicly owned telecom utility has been operating in Burlington for the past three years, and several towns around the state, grouped into consortiums, are moving to establish similar entities that would offer telephone, cable television and Internet services to their residents and businesses. FairPoint, Comcast and other private telecom companies don't like having to compete with these government-supported enterprises – for many of the same reasons that private insurers are fighting to prevent Congress from creating a public alternative in the health-care sector.

But a big private provider such as Comcast does have the financial firepower to outgun a small municipally-owned competitor such as Burlington Telecom (BT). And that threat has led BT to try to keep sensitive information secret – a stance that, in turn, has ignited controversy over a public entity's obligations to disclose financial data to the public.

Absent full disclosure, concern has grown in regard to BT's stability. Worries about its ability to manage a heavy debt load and to achieve profitability have rippled beyond Burlington's borders as a result of news reports that have raised questions about BT's financial health.

Some residents of eastern Chittenden County, for example, have used doubts about BT's status as a basis for opposing a public telecom option in their area, says John Doty, a telecom specialist in Westford who favors building such a system. He likens the push to develop citizen-controlled telecom utilities in rural Vermont to the establishment 75 years ago. Back then, co-ops brought electricity to places that private utilities had left unserved because sparse populations made infrastructure buildouts appear cost-ineffective.

Even after Comcast and FairPoint complete their own state-mandated buildouts in his area, Doty notes, “There will still be holes that will leave some people without access to a good network.” It would also be “nice to have a choice of providers,” Doty adds.

Ideological arguments like those heard in the national health care debate are being made by opponents of government-funded telecom operations. Such perspectives were presented in a Wall Street Journal article in March on efforts in eastern and central Vermont to establish a public telecom network with federal stimulus money.

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Ah, are we really bombing the moon?

Submitted by Rep. Chris Pearson on Fri, 2009-10-09 12:00
Yes, yes we are. NASA, in all its wisdom, has decided this could be the best way to determine whether or not there is water beneath the surface of our lonely night light. I guess I should be glad the Obama administration is taking drinking water issues seriously but this seems extreme to me. Given our dramatic national debt and frightening economic times is this really the best use of community resources? Obama the candidate was really good at poking fun at this sort of whacked out priorities. How quickly the tune changes. To me this is the latest egregious example that we spend too much on our military (half our federal budget according to True Majority). Tell ya what, I'll trade any and all of the moon-bound and middle-east bound rockets built in my name for another million or two covered in the upcoming health care proposal. Who's with me? Which reminds me, apropos of nothing, what's up with Howard Dean trying to be the face of real health care reform? Where was he as governor when many in the legislature pushed for single-payer? The disconnect between campaign rhetoric and governing priorities is all too ugly. Maybe it's just too much to ask political leaders to follow through on their platform. I know reality interrupts those snappy campaign slogans, but principles seem so pliable these days. Every human has his and her flaws. But bombing the moon? This hardly passes the straight face test. Apparently we've already missed the rocket launch on that one, lets hope Congress steps up to dance with common sense as the health care bill hits the floor.

Will Just Any Bill Do?

Submitted by Rep. Sandy Haas on Tue, 2009-10-06 13:04
As Congress lurches toward a health insurance reform bill, it's distressing to realize just how low the bar has been placed. Single payer was never even considered (though everyone recognizes that the savings in administrative expense would be huge). The intermediate step was going to be an expansion of Medicare. But that too appears to be off the table. Now we hear that it’s important just to pass a bill – any bill. Don’t worry, we’re told, if it’s a bad bill, we can amend it later. This is the voice of Democratic leadership. So the signals are clear. Any sell-out to the insurance companies or drug companies will be okay as long something gets passed. But there are other alternatives. Sen. Sanders has proposed allowing the states to experiment. Since there are so many questions about what will and will not work, his idea seems like the best compromise. It would satisfy both the need for reform and the call to move more slowly.

Hiding Health Care Spending

Submitted by John Bloch on Mon, 2009-10-05 12:43
There are curious and more curious things as we dig through the rubble of the non-health-care system. One of the most curious items is trying to figure out costs and how to meet them with a State single payer system (which 73% of Vermonters favor, and which an overwhelming number of Doctors support). One can not even get a figure of how much individuals are paying in premiums or how much companies are paying in health insurance premiums for employees. Yes Virginia, we do have a Banking and Insurance Department. However, their story is that they either do not have such data or that is proprietary in nature. Are we not talking about money that is being used to offer health care to the citizens of Vermont (though to be sure not all of them)? Why is this data crucial? Because when the wail goes up that we can not afford any new taxes to finance a comprehensive health system for all Vermonters, we can point to the very large portion of the needed funds that are already being spent and not covering large numbers of Vermonters. Banking and Insurance should cough up the numbers so effective planning can begin to take place to stop this train wreck that we call health insurance.

Dubie will run for governor

October 2, 2009, the Burlington Free Press, by Nancy Remsen

MONTPELIER — With an e-mail sent Thursday morning, Lt. Gov. Brian Dubie ended a month of speculation about his political future by announcing his candidacy for governor in 2010. His decision gave him the Republican nomination.

“It was a big decision,” Dubie explained in an interview at his Statehouse office. He cited the problems the state faces because of the recession and the rigors of a gubernatorial campaign as factors he had to weigh before deciding to run for governor. “It is going to be a difficult time for our Legislature and our next governor,” Dubie said.

Dubie's run means a scramble for his job

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vt. Buzz: Read e-mail announcement from Dubie adviser Susie Hudson
“And it is going to be a huge commitment for my family,” he continued, pointing to a photograph of his wife and four children under glass on his conference table. “Everyone in the family feels it is the right thing to do.”

Dubie said he hadn’t considered running for governor in 2010 — until Gov. Jim Douglas rocked Vermont’s political world with his Aug. 27 announcement that he wouldn’t seek re-election next year. “It certainly was a surprise to me,” Dubie said, noting he learned of Douglas’ decision only a few days before the announcement.

The Vermont Republican Party quickly embraced Dubie’s candidacy Thursday, and other Republicans who had talked of running for the top job declared their support for Dubie instead.

“Vermont couldn’t ask for a finer individual to step forward,” said Rob Roper, chairman of the Vermont Republican State Committee. “Brian Dubie is a pilot, a soldier, a farmer, a husband and father. It is his deep and sincere commitment to these roles in his life that has made him such an empathetic and effective public servant. He’s the real deal, and the people of Vermont know it.”
Opponent unknown

Dubie won’t know his Democratic opponent for nearly a year. Three Democrats already have made their candidacies official: Sen. Susan Bartlett, Secretary of State Deb Markowitz and Sen. Doug Racine. Two others — Senate President Pro Tempore Peter Shumlin and former Sen. Matt Dunne — say they may jump in the race, too.

Dubie said it took time to examine the challenges of what is sure to be a hotly contested race and then the job of governing in such trying times. He said he also had to figure how a full-time campaign and potential election to the state’s top job would affect his career. He is a pilot with American Airlines and a member of the Air Force Reserve.

He said he has discussed the options with both employers. Should he win, he would likely take a leave of absence from the airline. He might be assigned different duties in the Air Force Reserve or retire, he said.

Garrison Nelson, political science professor at the University of Vermont, suggested it took Dubie a long time to make up his mind about running because of the implications for his career — essentially giving up jobs he loves.

“Jim Douglas must have leaned all over him to get him to run,” Nelson said.

Dubie is the Republican Party’s best prospect in the 2010 gubernatorial race, Nelson said. Republicans need a strong candidate to break the jinx of recent history, Nelson added. Since 1960, he said, every change in governor has brought in an officeholder from a different party.

Nelson suggested Dubie hasn’t proven his ability to win a statewide race on his own. He lost his first bid to become lieutenant governor in 2000 against incumbent Racine. Nelson attributed Dubie’s success in his four subsequent runs for lieutenant governor to the “substantial coattails” of Douglas. In 2002, Nelson noted, Progressive Anthony Pollina and Democrat Shumlin split the liberal vote, which allowed Dubie to win with 41 percent.

Douglas disagrees with Nelson’s assessment, arguing Dubie has won four statewide races against “credible opponents.”

“Vermonters like him,” Douglas said.

How does he compare?

Several of Dubie’s potential Democratic opponents suggested a Dubie administration would be more of the same — and Vermonters want change.

“He has worked closely with Douglas all these years,” Markowitz said. “Vermonters are looking for new leadership.”

Racine suggested it would be odd for Dubie to try to separate himself from the policies of the Douglas administration now: “He has always stood there next to the governor. He hasn’t had much to say. He has been very supportive of the governor and his policies.”

“I don’t think that Brian Dubie will be a carbon copy of Jim Douglas, but I don’t know what he will be,” said Martha Abbott, chairwoman of the Vermont Progressive Party. “We will be finding out who he really is.”

Dubie doesn’t see himself as a Douglas clone. “Where it makes sense, I would continue Douglas policies,” he said, citing as an example the Douglas administration’s health care initiatives.

In other areas, Dubie suggested he would set his own course: energy policy, for instance. Dubie also said he hoped to build a better relationship with the Legislature than Douglas has had. He said the budget deadlock in the spring “was a real missed opportunity.”

Dunne, a potential Democratic challenger who lost a 2006 bid to unseat Dubie, paints his former opponent as more conservative than Douglas — and many Vermonters.

“My social agenda has always been to find common ground,” Dubie countered. Referring to two hot-button social issues, abortion and same-sex marriage, Dubie said, “Those issues are behind us.”

Rep. David Zuckerman, P-Burlington, argues Dubie’s views on social issues — opposition to abortion and gay marriage, for example — should be factors in the election: “It does matter in that there are unforeseen situations down the road. Is the governor going to stand up for diversity in our schools? Is the governor going to be silent on education around reproductive freedom in our schools?”

Zuckerman, who helped shepherd a same-sex-marriage bill to enactment this year, added, “I’d like to have a governor going to Washington who says we need these rights extended to our people nationally.”

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Obama and the Youth Vote

Submitted by Rep. Chris Pearson on Fri, 2009-09-25 11:31
When the millions of first-time voters who came to the polls wanting change and excited about its new messenger wake up to find global warming undeterred, health care unsolved, college still very unaffordable, wages still too low, and women still lagging men in paychecks, how will they respond? I fear they will turn away from the political process instead of rolling up their sleeves to help the whole thing lurch forward. I fear the romance that surrounded Obama's elecion makes it likely voters will experience a sense heartbreak. As understandable as that reaction would be, it's simply not an option. The health care debate is rightly on the front burner. This has been bubbling for decades and the staggering costs coupled with the inhuman consequences of our current policies have brought it to a head. Of course, we aren't likely to see an effective resolution despite Obama's determination to be the last president to deal with this issue. Further below the radar we have the more terrifying threat of global climate change. I say below the radar because while it is creeping into our conscious, and is particularly present for young people I talk to, it's still not seen as a front and center battle for society. Last week I noticed a blurb in the news about fish in the Potomac having "confused" reproductive organs: "In hunting for things that might have killed the bass, Dr. Blazer stumbled across something odd: more than 80 percent of the males she examined were growing eggs inside their testes." see full story here. In fact, this phenomenon wasn't kept to the bass population, but spread across hundreds of species in the Potomac. Holy shit! I'm no genetics genius, but something tells me this is a problem for humankind. Which brings me back to my initial point. We need active involvement at every level of the political process if we're going to see a just and sustainable world. We simply have too much vital work to get done that we can't let people get so discouraged that they turn away. Trick is, we need enough victories that people get the sense the political process can deliver. I hope the climate bill that passed the US House can be that victory because even if the greatest health care bill manages to get enacted it won't take effect for years. We need action and we need it now. The risk of discouragement among a whole generation of first-time voters is very real and very dangerous. Please Congress, give 'em something to be proud of.

The Public Option

Submitted by Rep. Sandy Haas on Tue, 2009-09-15 10:29
As an advocate for single payer health coverage, I have been ambivalent about the "public option" idea. Yes, making Medicare-type coverage available to anyone who wants it is better than nothing. But incrementalism can be a threat to true reform. I believe that adopting a public option will make it less likely that we ever get to the single risk pool and single administrative structure necessary to treat everyone fairly and at reduced cost. However, it now appears that we could end up with a compromise even worse than the status quo. Last week the President signaled his willingness to give up on the public option, but he affirmed the need for mandatory health insurance. Wow! Insurance companies must be drooling. 46 million new customers will be required to purchase their “insurance products.” And taxpayers will foot the bill for many of those “products.”

Democrats Lost Leverage From Start in Health Care Debate

September 15, 2009, the Washington Independent, by Mike Lillis

Democrats pushing for a government-backed insurance option as part of their health reform strategy are finding out the hard way that, by taking single payer health care off the table early, they have little leverage now to force a strong public plan.

Unlike the Republicans, who adopted the strong conservative position of resisting almost every Democratic reform proposal from the start, Democratic leaders ruled out the liberal single-payer proposal early in the debate. Now in search of a centrist compromise, GOP leaders have plenty of room to maneuver, while Democrats are left facing proposals that either dilute the public option or eliminate it outright. Indeed, the Senate Finance Committee is expected on Tuesday to unveil long-awaited reform legislation promoting the creation of private health cooperatives, not a public plan.

For many health reform and patient advocates, the developments have been a disappointment. After gaining both the White House and large majorities in Congress this year, the Democrats have made comprehensive health reform their top domestic priority. On the campaign trail last year, then-Sen. Obama came out in enthusiastic support of a strong public insurance option to compete with private insurers as a way to control premium costs, which are skyrocketing. In Congress, Democratic leaders in both chambers also gave clear endorsements to the public option. Even conservative Democratic Sen. Max Baucus (D-Mont.), who chairs the Senate Finance panel, promoted such of plan in a November 2008 policy paper detailing his “vision for health care reform.”

Republicans have adamantly opposed such a plan. But they’ve also had the advantage of knowing for months that Democrats wouldn’t push for anything more liberal. In August of 2008, for example, Obama said that the best option for health reform might indeed be single payer — which would eliminate private insurers in favor of government-backed, Medicare-style insurance designed to provide universal coverage. But he also conceded that it would be too difficult to launch quickly.

“People don’t have time to wait,” he said.

In May, the White House’s top health official told lawmakers that single payer coverage “is not something that the president supports.”

In the House, Democratic leaders held just one hearing this year on single payer, almost as an afterthought. And Baucus, for his part, ignored single-payer supporters until June, when Sen. Bernie Sanders (I-Vt.), the only upper-chamber lawmaker to support single-payer health care, set up a meeting between advocates and the Finance chairman.

The message to Republicans was clear: Single-payer health care would be off the table from the start.

By choosing the public option — not single payer — as the left-most negotiating point, Democrats left themselves with few places to go but toward more conservative proposals for insurance reform, experts say, including the co-op model and a system of triggering public plans only if private insurers fail to meet certain cost and coverage targets. In the blood sport of congressional negotiating — which dictates that you over-ask, and then move toward your goal during the subsequent bartering — Democrats were asking merely for the public plan they wanted in the final bill. The move, some experts say, provided Republicans with greater leverage to fight the public option. Sen. Kent Conrad (D-N.D.), a lead negotiator for the Finance proposal, has said bluntly that a public plan can’t pass the Senate. Even Obama, in a speech on Capitol Hill last week, walked back his support for the proposal by not insisting that it be included in the final reform bill.

Quentin Young, national coordinator with the Physicians for a National Health Program, a single-payer advocate, said greater congressional support for single-payer coverage early on would have given Democrats greater sway to press their public option proposal now in the face of Republican opposition fueled by August’s town-hall protests.

Not that all Democrats are resigned to defeat. House leaders have promised a floor vote on a single payer bill, introduced by Rep. John Conyers (D-Mich.), which has 86 co-sponsors. Young said the vote, the first of its kind, “in a way legitimizes single payer,” which has never had a vote in the chamber despite decades-worth of proposals endorsing it. Young also theorized that Democrats were forcing the single payer vote in order to “put something up to the left of the administration with hopes of pulling some Republicans to the center.”

Julius Hobson, former lobbyist for the American Medical Association and now a senior policy analyst at the Washington law firm Bryan Cave, pointed to another reason that the single-payer vote is significant: It might rally support from some liberal Democrats who are threatening to oppose the final bill if they deem it to be not progressive enough. The vote, Hobson said, “doesn’t allow any of the various factions to say they didn’t get a shot on the floor.”

The comments arrive as the so-called Gang of Six, a bipartisan group of Senate Finance Committee members, continue their slow negotiations in search of a bill that can win support on both sides of the aisle. Baucus told reporters Monday that he expects to unveil the legislation Tuesday. Last week, Baucus released an 18-page draft summary of the bill, which proposed the creation of regional health cooperatives, but no pubic option. Tuesday’s proposal is expected to offer the same.

Some key Republicans, however, are already voicing doubts that the Baucus bill will attract any GOP support.

There remains the possibility that Democrats could somehow ram a public option provision through the Senate. Indeed, Sen. Tom Harkin (D-Iowa), who was recently named to replace the late Sen. Edward Kennedy (D-Mass.) atop the Senate Health, Education, Labor and Pensions Committee, vowed over the weekend that the Democrats’ final bill would include a public option.

“Mark my word — I’m the chairman — it’s going to have a strong public option,” said Harkin, who as recently as this summer reiterated his long-time support for a single-payer system.

Still, following Kennedy’s death, the Democratic majority in the Senate fell to 59, meaning that party leaders will need to entice at least one Republican to defeat an almost certain GOP filibuster. All eyes are on moderate Sen. Olympia Snowe (Maine) as perhaps the most likely Republican to stray from the party line on health reform. Yet over the weekend, Snowe reiterated her opposition to the public option, telling CBS’ “Face the Nation” that “there’s no way to pass a plan that includes the public option.”

Neither single payer nor the public plan are as unpopular among the public as some on Capitol Hill and K Street like to portray. Indeed, a 2007 poll conducted by The Associated Press and Yahoo found that 65 percent of Americans support adoption of “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” A more recent poll, conducted by the Kaiser Family Foundation in July, found that 24 percent of the public “strongly favors” single payer, with another 27 percent “somewhat” favoring the proposal.

Furthermore, a study released Monday by researchers at Mount Sinai School of Medicine found that 63 percent of doctors support the public option, while another 10 percent favor a single payer system that would eliminate private insurers altogether.

Young, who practiced medicine for 61 years before joining Physicians for a National Health Program in 2007, said his group sides squarely with the 10 percent. The public plan wouldn’t accomplish the Democrats’ coverage and cost-containment goals, he said, because it would leave in place the private insurers who “account for virtually all the problems we’re confronting.”

“It’s funny that both the conservative critics and the liberal supporters [of the public option] argue that it’s a stepping stone [to single payer],” he said. “We don’t believe it.”

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Building a State health care system

Submitted by John Bloch on Mon, 2009-09-14 09:24
I suspect that what I have to say on the subject of the common good of the State of Vermont will be disregarded on one of two counts, that I am a dreamer, or that it is old age remembering a time that never was. The plight of folks in the state who are working low wage jobs or have no jobs at all bear the heaviest burden regarding the cost of health care. Given that we are already spending enough in total health outlay to provide health care for every woman, child and man, it puzzles me that we have not acted in spending these resources more wisely and in a more humane manner. For if we all have needed health care, both preventive and restorative, we are a stronger more productive State. So why do we insist on continuing the same old same old? Fear and greed lead my list as to why we do this. Fear that we are not able to rearrange the resources that are already being spent to be more productive.  The greed of drug, medical equipment and specialists to say nothing of hospitals that have learned to game the system and do not want to learn a better, more productive manner in the medical card game. We will not be able to continue this juggling act much more, for we are set to go broke. Some will continue to get millions, many will get no health care, and the rest of us will get care that is beyond the middle class earning capacity to pay for it. Is it not time to stop this insane game and redesign the system in the State? Now that the president has announced the go-ahead for test States doing the job quite differently than the present state of affairs, we need and ought to pressure the legislature in January 2010 to build such a system and have it in place to start July 1, 2010.

Will Obama's Healthcare Plan Help Me?

Submitted by Meg Brook on Fri, 2009-09-11 09:58
I tuned in to President Obama's joint address on healthcare and listened for the details that might address my concerns with his plan. For those of you who missed it or prefer something in writing here is the bulleted version of The Obama Plan. While I was very pleased to listen to my president and hear a well-spoken, clear, intelligent and understandable speech, and I believe he understands the crisis the USA is in due to lack of coverage, I still have some grave concerns about his plan which is supposed to provide "stability and security" to all Americans. As someone who has been without health insurance since deciding to stay at home with young children I was particularly interested in what options I would have. Of course the details weren't laid out too specifically but it was reiterated there would be affordable options for everyone. Obama also alluded to people having to take an option if it was available. Does this mean if I don't have health insurance I will be fined? The huge question I have is: "What is affordable?" Catamount is supposed to be affordable but I can't swing the monthly fee to join, besides it has so many limitations on services that it wouldn't alleviate any of my routine and preventative costs. According to the National Coalition on Health Care "the average employer-sponsored premium for a family of four costs close to $13,000 a year, and the employee foots about 30 percent of this cost." The Milliman Medical Index says: "A family of four covered by employer-sponsored health insurance now incurs $16,771 per year in medical expenses, which represents a 7.4% increase over 2008 costs." Either of these amounts are unaffordable for many families. I often hear talk of families making $80,000 or more and how the bill will impact them. I want to know; "How will the proposed plan impact families making $25,000 or $50,000 a year?" The Republicans have put their feet down that a public option should be off the table but Obama still included it in his plan. My fear is this option will fail because of all the other options and many restrictions placed on it limit the pool of participants too much. It's my understanding that insurance, when distilled to the most basic, works because their are healthy and sick people on the same plan. If the plan ends up being the only option for those who have no other option, people without jobs, those with very minimal or no incomes then the plan will have too large a pool of health needs to make it cost effective. I am not convinced that Obama will be able to find the balance that keeps this option viable and attractive enough that healthy people will join on their own. When I look at all the other countries with healthcare for their citizens one common feature is they have simplified the system. Obama did talk about looking into beaurocratic waste and streamlining some practices but by doing nothing to limit the number of different health insurance plans available it will be difficult to reduce much of the huge time requirement I've heard doctors' complain about. When plans have different types of coverage it forces doctors, at least those who really want to help their patients, to search for a way to get a treatment, test, opperation or other proceedure covered. Their offices spend a huge amount of time on paperwork and phone calls to ensure they will get reimbursed for treatment. This time suck is making it very hard to keep medical costs in control. The history of providing all citizens with healthcare is long, political and heated. For those who like details and historical articles you can read all you care to know in this interactive New York Times article. President Obama is far from the first president to prioritize healthcare, to say "the time is now", and to work to bring all elected officials together for the good of the country. I hope his skills as an organizer will help him facilitate the conversations ahead and that the USA will finally join the modern world and offer affordable and accessible choices to all its citizens.
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