I was in the Statehouse last week and bumped into long-time single-payer health care advocate Dr. Deb Richter. I was very curious to get her “review” of the report by Dr William Hsiao which laid out health care reform options – particularly her sense of the value and viability of his third option, a “public-private” implementation of what he terms a “single payer” system (that would involve more than a single payer). I asked her to send her review along so that I could share it with the GMD readership.

Let me add before there are complaints, that I’m not trying to suggest to suggest that Richter or any other activist or advocate has a monopoly on gospel-truth (I, for one example, was opposed to the Richter-driven attempt to implement full coverage of ER hospital care as stand-alone reform, and was particularly troubled by the messaging campaign). Nevertheless, no one should argue that Richter isn’t the most committed, passionate, clear-headed and competent of single-payer advocates one will find anywhere.

Dr. Richter:

“Although I have some concerns about  the 3rd option, I understand why he (Dr. Hsiao) did the things he did. It is not a true single payer, that’s true. But it is a single spigot and the reimbursement rates will be uniform, making it administratively far less complicated for docs and hospitals. The Governor is likely to wrap them all into one in his plan anyway and hope for the best with the waivers.”

“I love the independent board (ED. NOTE: The ‘public-private single-payer plan’ would create a board made up of stakeholders to manage rates and other concerns, and pass those recommendations to the legislature for approval, rather than simply leave it all to the highly politicized budget process in the legislature). It has been used in the US in years past. The most famous for it’s effectiveness at cost containment in Rochester NY in the 80’s. They had an entity called a health systems agency that managed to keep costs 30% below the national average and 45% below the state average.”

“In sum, I am on board with the third option because it establishes a true health care system which makes health care a public good. One that includes everyone, is publicly financed, publicly accountable, and has an overall costs containment mechanism. This allows us to fix problems that arise.”

Richter also calls Hsiao a “genius” and indicates she has shared her concerns with him. Her underlying message was, whatever the particular analysis of any shortcomings to the Hsiao preferred model, the fact is that it would be the creation of a deliberate, functional system of health care, as opposed to the dysfunctional mess that has filled our lack-of-a-system vacuum. Any kind of reform is going to be more possible in the context of a true system, and this one – if not perfect – has a lot going for it.

To read the report, click here. For a good back and forth about the report, check out the VT Edition interview with Dr. Hsiao.