Healthcare Debated

by Amy Kolb Noyes

MORRISVILLE - Everyone agrees affordable, accessible healthcare is a
goal worth striving for in Vermont. The question that remains is how to
achieve that goal. It is not a new debate in our state, but it is one
that is gaining new momentum in the weeks leading up to next month's
start of a new legislative session.
Last Tuesday, November 30, well over 100 area residents turned out to
the Morrisville VFW to take in a Forum on Health Care Access, Quality
and Cost sponsored by the Copley ethics committee. While many came out
to hear Governor Jim Douglas tout his healthcare plan, the governor
backed out of the commitment sending instead John Crowley, the state's
Commissioner of Banking, Insurance, Securities & Health Care
Administration.
The forum was scheduled to begin at 5 p.m. Shortly thereafter Copley
president and C.E.O. Warren West took the podium, touting the importance
of holding an open discussion on the future of healthcare in Vermont.
Rolling with the punches, he opened the forum by introducing Cambridge
physician Dr. Deb Richter, the only one of the forum's three speakers
who had arrived thus far.
"We have three speakers here tonight, one of which is here," West
chuckled. "We hope the other two will show up or it's going to be the
Deb Richter show, which would be alright."
Dr. Richter is founder of Vermont Health Care For All, and is arguably
the state's most vocal advocate for a single-payer health care system.
She delivered a well-polished Power Point presentation that she's been
using to educate Vermonters about the single-payer option.
Attendees at last April's healthcare forum held at the Wolcott Town Hall
are familiar with Dr. Richter's facts and statistics. Her argument for a
single-payer plan is largely based upon the results of the Lewin Report,
a 2001 study conducted under the Dean administration. That study
suggested Vermont could implement universal healthcare for the same
amount of healthcare dollars Vermonters are now spending. Dr. Richter
claims Vermonters could maintain their choice of healthcare providers
and receive, on average, better coverage through a single-payer
universal healthcare system.
Dr. Richter argues the cost of covering currently uninsured or
underinsured Vermonters would be covered by reducing administrative
expenses under a single-payer system. Statistics show 31% of healthcare
costs in the United States are administrative costs, while 69% covers
clinical care. In Vermont, that equals $780 million dollars spent on
healthcare administration annually. Dr. Richter claims the amount spent
on healthcare administration could be reduced by half under a
state-sanctioned healthcare system. The system would be funded through a
combination of payroll taxes assessed on employers and employees.
"What unites us is we all want the healthcare. We all want high
quality," said Dr. Richter. "What divides us is how to pay for it."
By the time Dr. Richter had completed her presentation, a second speaker
had arrived. Vermont Association of Hospitals and Health Systems CFO
Mike Del Trecco was next at the podium. He spoke of the problems in the
current healthcare system, including inadequate reimbursements through
Medicare and Medicaid. Other complications include over-burdensome
paperwork requirements for billing, record keeping and more.
Del Trecco spoke of three initiatives that have been devised to tackle
these problems. He said they have instituted a quality initiative, a
technology initiative and a finance initiative. By electronically
linking the state's healthcare providers, Del Trecco said the state
could see significant savings in administrative costs. While they are
working to identify the problems with Vermont's current healthcare
system, Del Trecco said the Vermont Association of Hospitals and Health
Systems is not backing any one plan or initiative to repair those
problems. He suggested neither plan being presented that evening
provided all the answers, but suggested a combination of approaches
might accomplish improvement to the system.
Around 6 p.m., just as Del Trecco was finishing at the podium, BISHCA
Commissioner Crowley came through the door. He apologized for his
tardiness, saying the Governor only asked him to fill in at 4:00 that
afternoon. Crowley outlined the governor's plan, but offered little
details beyond what was presented at the Lamoille County forum held last
April.
Crowley explained the governor is in favor of consumer choice, financial
stability and short- and long-term efforts to bridge the barriers to
affordable and accessible care. He said the governor's plan is threefold.
First, Crowley said the governor is proposing to expand the premium tax
paid by insurance companies to create a "reinsurance pool." The expanded
tax revenues would be set aside in a separate pool to help pay large
dollar amount "excessive claims." Crowley said the pool would allow
insurance companies to keep premiums down for the "non-group" market of
people who purchase individual insurance policies.
Crowley said the second part of the governor's plan is to provide small
businesses that provide health insurance to employees with "refundable
tax credits." He explained the refundable credits allow business owners
to collect the money even if they don't have a tax liability to which
the credit could be applied. He said the governor will suggest employers
purchase high deductible policies for their employees, which come with
lower premiums.
Third, Crowley said the governor is proposing providing employees
subsidies of between 40% and 60%, depending on income, to pay premium
costs, and subsidies to cover a percentage of the deductible on high
deductible policies.
The evening concluded with a question and answer session where panelists
addressed questions from the audience. When Crowley was asked how the
governor plans to reduce the administrative costs highlighted by the
previous two speakers he indicated the administration is open to
suggestions. He responded, "The governor is all ears, so to speak. He's
not ruling anything out."