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By Senator Matt Dunne

My recent report on this year’s health care legislation generated a lot of e-mail from friends and activists who were concerned that I sounded enthusiastic about this bill, or that I thought it was the best we could do.  Those who know my position on healthcare reform know that I am disappointed with the legislation, but I thought I should clarify my position for other readers.

The biggest concern I have with this legislation is that it will not achieve the cost containment goals set out by the architects.  As a member of the Appropriations Committee and as someone who works closely with the business community, I have seen firsthand the devastating effects of dramatically rising healthcare costs.  On the public side, it is no longer simply a problem of keeping up with the costs of Medicaid.  Over the past year, the teacher retirement fund hit a critical point: it now pays out more in healthcare premiums than it does in standard retirement income. A couple of years ago, those same two lines crossed as our public institutions of higher education began paying out more in healthcare benefits than in salaries to their faculty. 

This leaves us with a very scary scenario for our state budget. Traditionally, we have budget deficits because our revenues fall during hard economic times.  We bridge those deficits by temporarily raising taxes or dipping into rainy day funds. Once the economy rebounds, we reduce those taxes and refill our reserves.

This time it is different. With no increase in beneficiaries or benefits but yet higher healthcare costs, we now have a state budget deficit even though our revenues are up. As a result, we are forced to make awful decisions in our annual state budgets.  Even though I am not afraid to raise revenue to ensure good services to people, I feel we must resist such proposals since the heath care costs will simply eat up those gains in the next year, leaving us taxed higher and yet back in a deficit position.

Businesses and the self-employed are feeling the same pinch.  Although average Vermont incomes may be up 3%-5%, healthcare premiums rising 10%-15% put people and organizations at a net loss. The bottom line is that the state, public and private, simply cannot sustain the current increase of healthcare costs, currently estimated to be about $1 million per day in Vermont alone.

My fear is that the current healthcare legislation will do very little to address this problem and contain costs.  While I believe cost shifts contribute to the cost of healthcare by hiding the true costs of our broken system, it is not the only driver.  Although covering more uninsured Vermonters through a state subsidized plan like Catamount does take us closer to universal coverage, I’m fearful that the overall cost of the newly insured will very quickly become unaffordable for either the state or the subscribers, or both. Without cost containment measures in place, the plan will potentially increase in cost for the state over time or, if we freeze the subsidy for Catamount premiums, the plan will become unaffordable for subscribers in a matter of a couple of years.

While the chronic care initiative included in the bill provides some hope for tackling a major driver of health care costs, the most optimistic estimates suggest that we might see the benefit of this approach in five years. With the healthcare cost crisis here today, I don’t know how we can wait that long to see if it will work.

There are no easy solutions to this enormous and complicated problem, but there are some good ideas not currently on the table. Early in the session I advocated for a global budget for hospital costs.  The idea is to get our arms around how we spend our resources at hospitals, create a cap with an annual cost-of-living adjustment, and empower the Commissioner of Banking and Insurance to adjust the budget as reasonable and unforeseeable circumstances demand.

The global budget concept was not embraced in the Senate Health and Welfare Committee, and my floor amendment last week was rejected.  I’m sure the Governor’s opposition, and the laudable desire to get something passed this year, contributed to the resistance.

There was some hope that came out of this amendment effort, as it was embraced by an unlikely coalition of supporters.  The original idea was developed in the House by Republican Rep. Topper McFaun.  When my amendment appeared in the Senate calendar, I received two congratulatory comments for pushing the idea forward.  One came from Dr. Deb Richter, a leading universal healthcare advocate, and the other from Duane Marsh, Executive Director of the Vermont Chamber of Commerce.  These are not your usual collaborators and yet their support suggests that the time for this kind of change has come.

As I mentioned in my last post, I do not share the view that the legislation as passed by the Senate does net harm. If made law, time will quickly tell how sustainable the proposal really is, or if the expected cost-shift savings will actually bend the healthcare cost curve. Although I agree with the bill’s supporters that changing the way we cover and manage chronic care is essential, this proposal produces few immediate cost savings.

While I am skeptical about the overall effectiveness of this bill, the current proposal is the only train leaving the station. I supported it as a small step toward fixing our system that also hopefully helps a group of uninsured Vermonters in the near term.  Until we have leadership in the corner office ready to take on the difficult issues of true cost containment, substantial simplification of reimbursements, and the central idea of universal healthcare, the healthcare crisis will continue to be with us in the years to come.

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From DarkSyde at DailyKos:

How long will Americans put up with the endless excuses and Republican blame game? About as long as it takes for a GOP screw-up to impact their own pocketbook or lives. And that’s exactly what is happening right now with energy prices. Understandably then, Republicans are terrified that their jig is up. High gas prices knocked Jimmy Carter out of office, a hardworking and intelligent man, despite being perhaps a little too ineffective at solving some serious problems that got thrown his way. You can imagine Republican anxiety over voter backlash on gas prices

Except in Vermont. Where, fairly or not, reasonably or not, whenever Vermont voters look at the high gas prices they don’t think of Bush and the Republicans. They think of Democrats.

And as much as it may create problems for Democratic State Legislators, some of whom have shown a dogged insistence on a gas tax hike that likely won’t even be in the final legislation (as if anybody outside the Statehouse ever seriously thought it would), who will this association hurt more than anyone?

Peter Welch.

The price of gas is already shaping up to be a major election issue — second only to Iraq. All the economic spinning and framing done by the GOP hasn’t affected Americans unease and uncertainty towards our economic future for one major reason, and that reason is the price of fuel. Democrats running for federal office everywhere are capitalizing on this. It’s a tailor-made issue that resonates across the middle and working class demographic, and Dems are getting advice across the country to run head-on against the Party of big oil on this issue.

Except in Vermont. Where due to some in the House digging in their heels, in the free association word game of politics, when voters hear “gas prices” they are, for the moment, thinking “Democrats.”

As President Pro Tem of the Senate, Welch had the positioning and the good sense to get that tax out of the Senate bill, which gives him a leg up on getting the albatross off his neck. But it’s still an albatross, because most casual voters don’t make the distinction between the Dems in the two bodies.

In fact, the Senate’s quick rejection of the gas tax allowed for some creative thinking. Matt Dunne’s “gas guzzler” surcharge — essentially an environmental luxury tax — made for great copy. But legislators are loathe to create new revenue tools for their policy toolbox, preferring to tweak the tools they already have.

And in the mechanical sense (setting aside creativity like Dunne’s and the “vision thing”) this makes good sense. A straight line is the shortest distance between two points, and the shortest distance between the two sides of the revenue gap was a measly $.04 gas tax.

But just looking at it from the policy perspective – as much as the policy wonks in the legislature want desperately to believe otherwise – is not looking at the whole picture. The shortest distance between me and my car in the driveway is a straight line, but it goes right through a thorn-laden rose bush. So rather than get ripped to shreds, I go around (where was superstar political consultant Bill Lofy on this??)

So Welch is starting a tough race with a disadvantage unique from other Dem candidates for the US House. He needs to get some distance from the session and his team needs to work to refocus culpability where it truly belongs – with Bush and the national corporate croney GOP leadership – before he dare mention gas prices on the stump.

On the upside, nobody in Vermont handles the press better than Welch’s campaign manager, Carolyn Dwyer, so that’s a plus. Although I’ve expressed concerns on this blog about Welch’s tendency to monologue and drift off message (as well as concerns about what that message is), it’s reasonable to assume that public indications, such as the Doyle Poll, which showed the race at a dead heat set off alarms among Welch and his team at least as much as they scared me (and I went into a freakin’ panic), so I’m guessing there’s been a lot of work on those matters. Time will tell.

In the future, though, some in the House might find they get more mileage for being bold, truth-telling leaders by digging in and getting stubborn on ideological issues (such as the National Guard/Iraq legislation that was abandoned at the behest of Dubie II), rather than sterile bureaucratic ones (such as insisting on increasing a high-profile regressive tax that hits people right in their most fundamental sense of fiscal security during an election year – all because it neatly fills a revenue gap). They’ll be doing themselves and their team a favor.

Cross-posted at Rational Resistance

I’m passing along a message I got from the ACLU on illegal spying today. Naturally, I think it’s very important to stop Congress from doing nothing about it in the guise of pretending to do something, so please take the opportunity to contact Senator Leahy today.

In addition to using the phone numbers listed you can comment directly by using this link

To Our Friends in Vermont,

This week the Senate Judiciary Committee is considering two bills that would reward President Bush’s illegal actions by allowing the National Security Agency (NSA) to continue spying on Americans in violation of our laws. These bills are being pushed through even though Congress has failed to learn key facts about the program.

Senator Leahy sits on this committee and can stop both of these bills dead in their tracks.

We need you to call Senator Leahy right now.

In Burlington: (802) 863-2525
In Washington, DC: (202) 224-4242

  * Tell him to oppose both Senate Bill 2453 and Senate Bill 2455. Congress needs to get the facts about the NSA spying program before making it legal.
  * Both bills would have the effect of whitewashing the illegal NSA domestic spying program. Conservatives and progressives agree that this program should not be made legal.
  * Congress has a duty to get the facts, not help the Bush administration cover them up. The Senate Judiciary Committee must uphold its responsibility to the Constitution and the American people by opposing these misguided bills.
  * Tell Senator Leahy to get the facts about the warrantless NSA domestic spying before making it legal.

Calls are needed to several members of the Senate Judiciary Committee. Please take a moment and forward this email to your friends and family who live in Vermont, New York, Pennsylvania, California, Ohio, Iowa, South Carolina, Kansas, Wisconsin, Delaware, Oklahoma and Illinois. They can look up their member’s phone number here.

ADDITIONAL DETAILS FOR YOU:
S. 2453, a bill written by Senator Arlen Specter (R-PA), would supposedly restore judicial review of wiretaps, but the law already requires judicial review and the president has ignored it. Senator Specter’s bill would allow the courts to approve programs of surveillance, diminishing the Constitution’s requirement there be probable cause that an American is doing something wrong before their communications can be seized. 

S. 2455, a bill written by Senator Mike DeWine (R-PA), would also attempt to rewrite probable cause to allow warrantless surveillance of Americans’ calls and emails without evidence that they are conspiring with suspect terrorists. It would make judicial review of wiretaps optional and would reduce the amount of information the president is required to give Congress about the program. 

Sincerely,
Signature
Caroline Fredrickson
Director, ACLU Washington Legislative Office