Healthcare

Will the state show its spine?

September 6, 2009, the Rutland Herald, by John Franco

There were a lot of outrages in the month of August regarding health care. There were Sarah Palin's death panels, fear-mongering about the president wanting to "pull the plug on grandma," right-wing protesters openly carrying weapons with thinly veiled placards encouraging the assassination of our first African-American president, and the "town meetings" with tea baggers shouting down opponents with the contradictory "keep the government out of my Medicare."

So it should probably come as little surprise with all that diversion going that our local medical-industrial complex took this opportunity to slip in with little notice two proposals to increase the already exponential growth of Vermont's health care spending.

The first was the request by Vermont's community hospitals to the state for a collective budget increase of nearly 8 percent. The context of this request couldn't be more outrageous. Over the last 10 years, the average annual increase in health care expenditures was 8.9 percent in Vermont compared to 7.1 percent for the United States. The share of Vermont's economy accounted for by health care is at highest recorded levels, 17.1 percent in 2007 compared to 16.2 percent nationally. The share of Vermont's economy devoted to health care spending is more than double than that of most of high-income industrialized countries. Growing health care costs at a time of shrinking payrolls due to the recession mean that in 2009 health insurance will take twice the bite from the payrolls of Vermont's insuring employers than Social Security takes in employer payroll taxes. The $20 million-plus cut in state spending just agreed to by the governor and legislators is equal to just one day of health care spending. One day.

There are plenty of grounds for state regulators to simply hold the line and cap spending at last year's levels. In 2009 the economy has contracted by 6 percent. Consumer prices are in deflation, with prices down by 2.6 percent over the past year.

They could simply ask the hospitals to do what the city of Burlington has been able to do accomplish with its employee self-insurance plan — hold the line against any increase in fiscal year 2010 through aggressive cost containment and wellness programs. That's right. No increase at all.

And there's the ever expanding bloat of administrative expense which accounts for 34 percent of every dollar spent on hospital care. The state could simply tell the hospitals to find the requested increases in their administrative budgets by working with the insurers — -from whom they receive the overwhelming majority of their income — to find a more cost-effective reimbursement system than tracking and invoicing every bandage and pill.

The second proposal was MVP's request for a 31percent increase in the premium to be charged to Catamount Health Care. This came after much ballyhoo from the Douglas administration in late June that neither MVP nor Blue Cross and Blue Shield of Vermont was seeking an increase and this showed that Catamount Health "is holding a steady course." What the June press releases neglected to mention was that the Douglas administration ignored Blue Cross' own quote of a $240 per month made to the Senate's health care consultant, Dr. Kenneth Thorpe, and instead allowed a premium of nearly $400 per month — 64 percent higher. This was higher than even the $352 per month charged by Massachusetts' Commonwealth Care, despite the fact that Vermont's per-person health care costs are 20 percent lower than those in the Bay State. And it was equal to the estimated 2010 national average individual cost for employer-sponsored insurance of $409 per month, despite the fact that Vermont's per-person costs are below the national average and the uninsured covered by Catamount are a younger and healthier population.

Now MVP wants a third more than that. With the Douglas administration now heading for the exits, MVP apparently figures it's time to cash in, especially before federal reform legislation replaces Catamount Health Care.

With all the talk about the urgency of "bending" the health-care cost curve, will the state show any spine this time around? We have had the most comprehensive cost-containment statutes on the books since 1991. But so far, the regulators have proved themselves to have been co-opted by the regulated.

So surprise me.

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Moving Single Payer Forward

Submitted by Martha Abbott on Thu, 2009-08-27 13:01
As I drove into the tiny town of Peacham, VT last Sunday evening, I found cars parked on both sides of the roads for as far as I could see. 600 people showed up at Bernie's town hall meeting on Health Care on a beautiful Sunday evening in August. And almost all of them were there with signs that said: "Single Payer!" Most of the comments and questions focused on the need for a single payer system.  There were a couple of people who said they disagreed with Bernie about health care. But no one yelled and there were no negative signs that I saw. Many of the comments focused on supporting the Single Payer bills in the Legislature this winter.  It was very encouraging to see this strong support. Bernie made it very clear that, although he would vote for a bill with the public option, he does believe that a single payer system is the only way to get the insurance company profits and bloated administrative costs out of the system.  He said he would support efforts to implement Single Payer in Vermont by working to remove any barriers created by the ERISA and Medicaid rules at the Federal level. So, perhaps we can assume that, after the DC debacle, the discussion in VT will finally move on to a serious debate about how to implement a single payer program in Vermont as a model for the nation.

Controlling Education, or Controlling Education Spending?

Submitted by Morgan Daybell on Wed, 2009-08-26 09:35
Another legislative study committee is gearing up, looking again at public school funding. Per the Reformer:
Now the newly established committee plans to make recommendations, once again, to create a fair, and understandable, tax system that works for all Vermonters.
The article continues:
"Each year, we have seen as the Legislature tries to control education spending, it has required more and more control," [Committee member, former Rep., and Act 68 co-author Bob] Rusten said. "One thing we have to look at is, do we want to maintain local control or see the system go further and further toward a state-run system?"
That is the choice before the committee, and the legislature.  The single biggest step the VT Legislature can take to control cost without usurping local control is to pass H.100/S.88, a single-payer health care system. Does anyone suppose that is truly on the table?  Or instead will the legislature look at more ways to reduce local school board's abilities to set budgets, and reduce local voters abilities to vote directly on those budgets.  Maybe we'll have to hold three or five or ten votes before the state will recognize our budgets. And the way to get to "a fair, and understandable, tax system that works for all Vermonters" would be to ditch the residential education property tax.  Set a flat education tax rate for non-residential property, charge residents instead on income, and return the property tax to the town select boards.  No complex formulas, no CLA, no prebates.

Courage and Cancer

Submitted by Rep. Sandy Haas on Tue, 2009-08-25 10:25
How Courageous Must I Be? Obituaries regularly report that the subject died only after "a long and courageous battle with" the terminal disease. They seem to suggest that any failure to do such battle is not OK. I don’t like feeling pressured to be "courageous." And I don’t understand why I must undergo painful, stressful and possibly torturous treatments in order to have a respectable death. Too often those invasive treatments do nothing to prolong life; they simply make the final weeks more unbearable. Even when treatment does postpone the end by a month or two, it’s often at the cost of being able to enjoy the company of family and friends. The push to “do battle” is fed by the medical industrial complex which continues to spew out new gadgets requiring surgical insertion and a medical culture that insists even the most hopeless disease be treated aggressively. I have written before about the importance of making palliative care options clearly available. When my time comes, I want to hear what choices I have for the best quality of my final days. I do not want to be limited to the recommendations of those who sell procedures. To me, relying on a treatment specialist is like relying on a car salesman in choosing options. They always tell you more is better.

MVP seeks big rate hike for Catamount health program

August 25, 2009, VPR, by Bob Kinzel

(Host) There are signs that the cost of the state's Catamount Health Care program could go up dramatically next year because MVP Health Care has filed a 31% rate increase for its share of the program.

MVP officials say drug costs and increased use of the program are driving expenses much higher than expected.

VPR's Bob Kinzel reports.

(Kinzel) The Catamount Health Care program is administered by two private health insurance companies: Blue Cross and Blue Shield of Vermont and MVP.

Both companies review their cost structures for the program every three months and the next deadline for a possible rate increase is the middle of September.

Banking and Insurance commissioner Paulette Thabault says MVP is seeking a 31% increase in its Catamount rates and she says the size of the request came as a surprise:

(Thabault) "Yes it did it seem a little bit higher than we had expected. Our actuary is reviewing that rate right now and has some questions that are outstanding to the company and we're expecting MVP to be responding to those questions and ultimately the rate will be approved at some level."

(Kinzel) If a large rate increase is approved by the state, Thabault doesn't think it will necessarily result in higher premiums for the program. Instead, she says it's possible that the state will have to absorb most of these additional costs:

(Thabault) "Any increase is always a hardship but I think that the premiums for Catamount are still quite affordable and...I don't think that this will cause a drop off in enrollment. Whenever there's an increase there's going to be added pressures to the subsidized portion as well and so the state would experience that."

(Kinzel) Bill Little is the vice president for MVP Vermont. He says that MVP has not sought a rate increase since Catamount was launched roughly 2 years ago and he says there are two major factors driving this rate hike request:

(Little) "I think that for this population we have about 2500 members. We've seen higher utilization across all categories. I think particularly high has been the pharmacy area, so the drugs have been higher than regular medical."

(Kinzel) Little says MVP has already filed an amended rate plan with the state but he declined to say what it was. He says he expects to be engaged in some active negotiations with the state to reach a final number:

(Little) "The reality of it is that this is a process that typically results in a certain amount of back and forth between BISHCA's actuary and MVPs actuary. And it's an iterative process that we will come up with a number which is appropriate and very defensible."

(Kinzel) Blue Cross officials say they're just beginning to review their Catamount experience and they don't expect to make a decision about any possible rate hike for several weeks.

For VPR News I'm Bob Kinzel.

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Healthcare and Civil Society

Submitted by John Bloch on Mon, 2009-08-24 11:13
Once again I am on a quest for reason and support for our fellow citizens of this State. It seems that every time that hardworking folks gather together they are told by the powers that be that they are engaging in a class war. Well we have been in the middle of a vicious class war ever since 1970. Now that every bit of benefit has been wrung out of wages for working people the last bastion small though it be is now under assault--that of employer provided health care. Those who control capital cry that they cannot be completive unless they shed the cost of health care. All the while, since 1970 millions of dollars have flowed into the controllers of capital's pocket from the ever-increasing productivity of the workers.  Until now, the American worker is the most efficient of any worker in the world and works a longer workweek than those in any other industrial country. So what is really going on? Is this the last grab for total wage power? Have the workingmen and woman lost all sense of justice? We know that justice has never been a concern with the controllers of capital. No, none of the above. What is afoot is the big lie and working people have in part come to believe this. The big lie is that we cannot afford a civil society with rules and process that benefit all in a common bond. We in Vermont are so very fortunate to have Senator Sanders and the Progressive Party fighting this big lie.

The difference between 'care' and 'insurance'

Submitted by Martha Abbott on Tue, 2009-08-18 11:24
We must distinguish between government-provided health care and government-provided health insurance. If you are in the military, you receive government-provided health care. The doctors are employed by the military and are paid military pay. You, the soldier, are treated by whatever doctor is working that day. (Everyone I've spoken to in the military says they get excellent care. However, this is not what is being proposed.) If you are on Medicare or Medicaid, the government pays for your care, but they don't provide it. You are free to choose your doctor, hospital, etc. The public option that is being proposed as part of the Obama health plan is government health insurance, not government health care. The doctors will not be employed by the government. As our health insurance "company," the government will negotiate prices with private doctors, hospitals and drug companies to get good rates because the government will be representing a large group of people. The term "single payer" simply means that the citizen-patients would all be in the same group, all in the same insurance risk pool. One entity would process the paperwork and issue the payments. It could be a nonprofit entity like Blue Cross/Blue Shield. It could be Medicaid, which has proved to be very efficient with low overhead, or something else. But all the claim forms would be the same. Currently, half the staff at doctor's offices and clinics spend all their time dealing with insurance companies and preparing paperwork. We would still choose our doctors and our hospitals.

Progressives eye Dem candidate

August 17, 2009, the Brattleboro Reformer, by Chris Garofolo

BRATTLEBORO -- Members of the Vermont Progressive Party say they might support a Democratic gubernatorial candidate in 2010, but there’s a catch.

The Progressives are trying a new political tactic that could unite them with like-minded liberals and Democrats in Vermont by standing behind three key issues that both parties could champion. If the move is successful, Progressives hope to bring the two sides together under one candidate in a campaign against current Gov. James Douglas, or the Republican challenger if Douglas decides to not seek re-election next year.

Brattleboro Progressive Mollie Burke, serving in her first term in the Statehouse, said Democrats and Progressives need to continue collaborating to achieve political success in upcoming elections. Other local Progressives echo that statement.

"I think we need to build a coalition to change administrations, we need to work together in that direction to achieve a common goal," said Rep. Sarah Edwards, P-Brattleboro.

Martha Abbott, chairwoman of the state’s Progressive Party, said in an announcement on Aug. 10 that they hope to stand behind a candidate who demonstrates strong support of the following:

-- A single payer health care plan for the state where the single payer is not private insurance companies.

-- A strong voice against Vermont Yankee nuclear plant’s continued operation.

-- A reasonable solution to the financial problems with the state pension plan and the unemployment compensation system.

"Since these are the most important issues facing Vermonters in the next election, the Vermont Progressive Party may feel compelled to offer a candidate of our own if no such candidate emerges from (among) the Democratic candidates." she said.

"The three issues that were highlighted are ones that I agree with, they are worth pursuing, not only for the rest of the country, but for Vermonters," said Edwards. "The question is how do we achieve those goals? It’s clear we need a new administration."

What is also important, according to Burke, is that the issues remind the center of debate going into the next election cycle, especially when health care reform is a hotly contested topic around the nation.

"I think what the Progressive party is trying to do is keep (these) issues on the table, such as single payer health care," said Burke.

But if the Progressives do not find a Democratic candidate they like, they will likely run their own -- essentially splitting the left-leaning vote between the two parties.

In last year’s three-way race, Progressive-turned-Independent Anthony Pollina squeaked by Democrat Gaye Symington in the voting booth, but both candidates’ votes combined would not have been enough to defeat the four-time incumbent Douglas.

As of Aug. 15, no Progressive has publicly expressed interest in a gubernatorial run, but it is still early in the process. "We’re not gearing up any campaigns or anything yet," said Morgan Daybell, executive director of the Progressive party. "But if there is nobody out there championing these issues, than we may feel compelled to run our own candidate."

Douglas won more than 50 percent last November, but with his lowest re-election numbers, meaning a three-way race (while dividing undecided residents at the ballot box) could potentially result in legislative vote, said Daybell

Democrats were manhandled by Douglas in 2004 and 2006, however a three-way race could send it to the Legislature for the final decision, he added.

If no candidate receive more than 50 percent of the popular vote, under Vermont law, the election is put in the hands of the state’s Democrat-controlled Legislature.

Some of the Democratic gubernatorial candidates have already started courting Progressives to ensure more votes next Election Day.

Last weekend, State Sen. Susan Bartlett, D-Lamoille, spoke to roughly 50 Progressives in Newport. In May, Sen. Doug Racine, D-Chittenden, spoke to a similar group in Barre.

Both Racine and Bartlett, as well as Secretary of State Deb Markowitz, have announced their candidacy in the hope of taking over the executive branch. Racine lost to Douglas in the 2002 campaign.

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Sanders put on the hot seat as hundreds turn out to debate health care

August 16, 2009, the Rutland Herald, by Josh O'Gorman and Patrick McArdle

While people debated passionately — sometimes with raised voices — the discourse mostly was civil when independent U.S. Sen. Bernard Sanders held a pair of public meetings Saturday in Rutland and Arlington to champion health care reform.

By 9 a.m. in Rutland, a line stretched from the doors of the Unitarian Universalist Church, down West Street and around the corner to Cottage Street, with many in the throng holding signs, most in favor of overhauling the nation's health care system.

Perhaps in anticipation of the hostile crowds at similar meetings nationwide in recent weeks, police officers with Vermont State Police, Rutland City and Rutland County Sheriff's Department kept an eye on the crowd.

"We've been monitoring the situation since Monday," said Officer T.P. Tuttle with Rutland City Police, one of 20 police officers at Saturday's event. "People have the right to say what's on their mind, and we have to expect that and just absorb it. We're not expecting any violence, but if there were violence, we'd have enough personnel to handle it."

Shortly before 10 a.m., the doors opened to the church and the crowd filled the 200-seat sanctuary, with about as many people left outside to sit on folding chairs in the sun or seek shade beneath trees or beside adjacent buildings. During the nearly two-hour meeting, Sanders raced back and forth taking questions from people inside and out, with the public address system allowing both crowds to follow the debate.

"You've all seen the TV and the meetings and the people trying to shout down other people, but that is not what the state of Vermont is about," Sanders said as he attempted to set a civil tone for the debate.

While the debate was mostly calm, many in the crowd appeared to be convinced that the proposed health care bill advocates the creation of "death panels" to decide what sort of health care the elderly should receive and how and when they should die.

"Let me tell you a thing or two about the so-called 'death panels.' They can't take it out because it ain't in there," Sanders said, a statement that drew outraged shouts from the audience. "I understand you're angry, and you should be angry, but do you really think that in the United States of America we would have a president who would say we should kill off old people?"

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Progressives prepare for 2010 gov's race

August 14, 2009, VPR, by Bob Kinzel

Vermont's Progressive Party says it would support a Democratic candidate for governor in 2010 if the candidate meets a few criteria. VPR's Bob Kinzel talks with Anthony Pollina, a former Progressive gubernatorial candidate, about the party's litmus test for labor issues, health care and Vermont Yankee policy.

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