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Panel addresses single-payer concerns


Steve Kimbell, commissioner of the Vermont Department of Banking, Investment, Securities and Health Administration; Sue Andrews, executive director of the Bennington Free Clinic; Dr. Harry Chen, commissioner of the Vermont Department of Health, with hands raised; Dr. Richard Dundas, medical director of the Bennington Free Clinic. (Mark E. Rondeau)





Published in Bennington Banner on April 20, 2011


SHAFTSBURY -- Despite concerns about the remedy, most Vermonters now agree that something has to be done to reform the health care system, said Dr. Harry Chen, commissioner of the Vermont Department of Health, during a forum here Monday.


Some 47,000 Vermonters are uninsured and another 160,400 are underinsured, meaning they have insurance but very high out-of-pocket costs. Health care costs have been growing between 6.5 and 8.5 percent per year in recent years, during a time of virtually no economic growth. Between 2006 and what is projected under the current system for 2012, the cost of health care in Vermont will increase by $2 billion in six years.


"So there’s an astronomical growth rate," Chen said. "We have an unaffordable system that’s not fair to everyone and people who are not covered. We want to provide affordable care to every Vermonter based on the fact that they’re Vermonters. We want to detach it from employment. We want to make sure that there’s quality and we can get around to controlling costs."


Chen and Steve Kimbell, commissioner of the Vermont Department of Banking, Investment, Securities and Health Administration, took part in a panel discussion Monday at Cole Hall and addressed concerns about a House bill that sets up a process to establish a single-payer health system in Vermont.


The panel also included local primary care physician Richard Dundas, medical director of the Bennington Free Clinic. Sue Andrews, executive director of the Free Clinic, moderated the discussion. An attentive audience filled the upstairs meeting space in Cole Hall to capacity for the forum, which Andrews and state Rep. Alice Miller, D-Shaftsbury, organized.


Dundas said that since he came to Bennington to practice medicine in 1974, "the insurance business has been the bane of my practice, without doubt."


"The thing that I noticed over the years is that my overhead to run my practice increased dramatically. We started with just a few employees, and as the insurance companies became more demanding it turns out we had to hire a large number of employees to handle that burden," he said. "So it’s not only submitting the bill that’s a problem -- and that’s a different bill for every insurer -- there’s also the problem of getting prior approval from the insurance company."


Single-payer would help out primary care doctors by establishing only one payer to deal with, which would help recruit primary care physicians to Vermont, he said.

House bill H.202 -- still under consideration in the state Senate -- establishes a lengthy process for establishing a new system. "It’s not a rush job," Chen said. "It’s pretty thoughtful, actually."


A draft timeline handed out at the meeting anticipates the Legislature enacting the bill in May. In October, the chairman and membership of the Green Mountain Care Board will be appointed.


Kimbell said this board is modeled on the Public Service Board, and will over time change the way health care is paid for, define the benefit package offered by Green Mountain Care to Vermonters and recommend to the Legislature how to pay for it. Board members would serve for six-year terms.


"That will be a five-member board selected by a nominating committee made up of a range of legislators and health care experts who send qualified names to the governor," Kimbell said. "He names the board, subject to confirmation by the Senate."


In tune with the new federal healthcare law, the Affordable Care Act, House 202 establishes a health care exchange, which won’t go into effect until Jan. 1, 2014. The exchange will basically be a marketplace, which will provide comparisons through a Website, of plans from health insurance companies. Even with an exchange already set up, Green Mountain Care itself may not go into effect, at the latest, until the beginning of 2017.


Chen and Kimbell said that how the Green Mountain Care plan is funded has not yet been decided. The bill requires the secretary of administration to present a financing plan to the Legislature in 2013. "We haven’t decided how to finance this," Chen said. "It’s premature to worry about it."


"When we talk about financing, we’re already paying for that," he said. "It’s just a matter of are we going to pay for it the same way."


Savings are expected through reducing administrative costs by having one agent for health care payments, establishing a highly efficient and comprehensive computerized data collection and management system, and better managing patient care, paying for quality of care rather than quantity of care. Medical malpractice reform is also called for in the bill. In addition, estimates are that the federal Affordable Care Act will bring $340 million into the state each year. "Nobody’s really talking about cutting spending; we just want to get a lid on it," Chen said.


Kimbell agreed with Chen that the money is already in the system, it just has to be allocated better.


"We spend twice as much per capita than several other well-developed countries on health care and their populations are healthier," he said. "There’s plenty of money in the system. There’s a question of how we are using it and the behavior of the population and the waste we have for administrative tasks."


In coming up with the Green Mountain Care benefit package, the "floor" will be Catamount Health, which is "fairly generous," Chen said. The benefits plan will be put together by the Green Mountain Care board and voted on by the Legislature. Veterans and people on Medicare will have no change in their coverage. It has not yet been decided if private insurers can be part of the mix.


"The private insurers, their fate in the system is not yet decided. It would be allowable under the federal Affordable Care Act for us to contract with a single non-profit insurer to operate our exchange," Kimbell said. "But we can also allow more than one insurer into the exchange. And that’s a decision the Legislature is not going to make this year. We’ll await the financing study to see what makes more sense in terms of the number of insurers in the exchange.


"Some states, and it’s perfectly allowable under federal law, are going to have many insurers in their exchange," he said. "But our goal clearly is to get down to one payer, one administrative agent in our exchange."


Under Green Mountain Care, Vermonters will still be able to see the doctor they wish. As far as attracting and retaining primary care doctors and specialists in Vermont, "we do expect a shifting of resources in Green Mountain Care towards primary care and therefore away from specialty care," Kimbell said. "It’s not that we’re taking money away from specialty docs, it’s that if you do a better job of primary care you need less specialty care."


Chen admitted that officials don’t know for sure how the eventual plan will work in attracting physicians to Vermont. "We will keep a close eye on it. My gut is that it will be actually easier to find primary care physicians. I think we will have to keep a real close eye on specialists."



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Mark Rondeau - Writer, Editor, Photographer