So, Governor Shumlin has announced he won’t be unveiling his financing plan for single-payer health care until after the 2014 election. Even by his lofty standards, it’s a formidable display of sheer political chutzpah, a full-on crotchgrab directed at anyone who might dare challenge him for re-election. “You’ll know my plan when I tell you my plan,” is what he seems to be saying. “You want some? Come get some!”
Okay, a bit of blogger’s license there. But look: if the Governor was in any danger whatsoever, do you think he’d continue to flout “the statutory requirement to present financing options in January 2013,” not to mention drawing the ire of Republicans and testing the patience of Democrats and Progressives who’ve advanced him a whole lot of credit for his promise of a workable single-payer plan? And the promise keeps on receding into the future. “Re-elect me, and then we’ll talk.”
No, he didn’t say that. Not exactly. But here’s what he did say on VPR’s Vermont Edition last Friday:
“I’m saying to my team, ‘don’t spend a lot of time getting committees that won’t even be the same committees working on something that isn’t going to be voted on anyway, and that we don’t have the answers for yet.'”
Which implies that he’s got a funding plan, or he’s close enough that he could unveil it this year if he wanted to, but ehh, why should he?
Why indeed. Must be nice to be bulletproof.
Apparently there were some second thoughts about the brazenness of his VPR statement, because by Monday he’d changed his tune:
“We’re not ready, it’s as simple as that,” Shumlin said at a press conference Monday.
… “All I’m saying is let’s get this right. That’s more important than meeting some arbitrary deadlines,” he said.
“Arbitrary” has, I guess, become a synonym for “statutory.” I’ll remember that when I see a speed limit sign on the freeway. You can almost hear the exasperated sigh in Senate Minority Leader Joe Benning’s reaction:
“I’ll have to confess it doesn’t surprise me,” Benning said Friday of the news that financing concepts had been put on hold.
Yeah, I don’t think it surprises anyone, Joe.
On the one hand, Shumlin’s move is politically savvy: He doesn’t have to subject his financing scheme to a full year of scrutiny and criticism, so he’s not going to. Sure, opponents will be able to attack his nondisclosure; but a defined plan would be a much juicier target. It could even create divisions within the Dem and Prog camps. (I’ve heard rumblings that some Progs are having second thoughts about single-payer because of how it might be structured and paid for.)
On the other hand, hubris is a terminal condition in politics: an excess of confidence leads to complacency, which in turn leads to carelessness (at best) or corruption (at worst). And that leads to defeat.
Back in the early 90s, Canada’s Conservative Party was a dead man walking. After the thoroughly corrupt Brian Mulroney years, followed by the brief and feckless Kim Campbell premiership, the Liberals had a stranglehold on power. But after 15 years of bumblef*ckery and scandal, the Liberals were out and the Conservatives were in. And now, Stephen Harper is remaking Canada in a very fundamental way. I don’t wanna see that happen in Vermont.
And this display of cockiness on the Governor’s part, although it won’t cost him a damn thing in the short run, is a bad sign for the future.
Shumlin talks about the “heavy lift” that will be required to enact single payer. Well, in the next biennium he’ll also be under the gun to deliver some sort of school-funding reform. You don’t think that’ll be a heavy lift as well? Dem lawmakers had best start hitting the gym. If they think the kitchen’s getting a bit warm now, wait till they tackle both of those issues at once.
It might be added that Harper’s own overreaches have set the table for the Parti Quebecois’ reinvention of the separation fairytale.
I predict that the drumbeat about the “message” sent to Montpelier in the form of school budget defeats on Town Meeting Day (even though 86% of them passed) will provide cover for the legislature to pass some sort of Supervisory Union consolidation bill in the current session. It’s the perfect cover for many legislators who attempted to incent consolidation through legislative bribery with Act 153 in 2010, and Act 156 in 2012. However, the damned Vermont voters apparently never saw the wisdom in the legislature’s consolidation plans, as only one of the many, many votes on consolidation passed and resulted in the creation of a “Regional Educational District”. Were a bill that mandates SU consolidation to pass in this legislative session, the Governor, many legislators and the Campaign for Vermont will all compete to take credit for having been responsible for the passage of “some sort of school-funding reform” thereby negating the need to address the issue in the next session.
Devastating Diagnosis – Green Mountain Care 2017
a prognosis by H. Brooke Paige
Vermont (January 2017) – Peter Shumlin’s socialist dreams of “universal, single payer healthcare” have mutated into a nightmare over the past five years. The utopian dream of healthcare for all was never properly explained nor fully understood by Vermonters. The working poor thought that it would be the “free care” that they saw those on welfare receiving. Most believed the promises that their healthcare providers and the level of care they were receiving would somehow continue – while the cost of care would be greatly reduced through streamlining and controls that the state and federal government would impose. Those who worked for large employers and government believed they would not be affected. None of these assumptions would prove to be correct
.
Green Mountain Care (GMC) quickly acquired the resources of Vermont Blue Cross and Blue Shield (BCBS) as most of its insured became GMC clients. In the early days of the rollout, GMC and its promotional website Vermont Health Connect (VHC) failed to deliver healthcare for the small group of self-insured and the employees of small businesses targeted as the first clients of GMC. Governor Shumlin and his loyal minions on the Health Care Board, lead by a Burlington restaurateur, had no understanding of the healthcare insurance industry and were unprepared to handle even the most modest problems as they arose. While the Federal Government abandoned their hapless website contractor CGI-FEDERAL, Shumlin regrettably decided to continue with them “throwing good money after bad” eventually spending over $100 million of state and federal funds with CGI on a system that was politely described as “leaving a lot to the imagination” of the users. The plain truth was that the CGI system would never work – despite months of “tinkering” and additional monies wasted, the VHC website never reliably allowed users to: create accounts or access them, employers to edit or update their accounts (if they had been patient and creative enough to create one) nor could the system collect premiums and in the end could not pay for health care services incurred by its “insured” clients. In the end CGI was abandoned and the BCBS operating system, by default, became the GMC system.
Vermonter’s healthcare system is an unrecognizable husk of the quality network they enjoyed just a few years ago as the politician’s grand scheme, GMC, has decimated Vermont’s hospitals and healthcare practitioners – as well as the state’s economy at large. It is sad that there was no way, back in 2012, to foresee the full consequences that the progressive plans, designed by inexperienced, insistent social architects with big ideas but no understanding of the complexity of the healthcare system or the health insurance industry that financed it.
As the GMC system sputtered to life in 2014, many providers chose not to participate as a result of the anemic 105% of Medicare reimbursement rates which barely covered their out of pocket costs and failed to contribute toward overhead or capital investment costs. Within a year 20% of practicing physicians and specialist had retired, moved out-of-state or decided to limit themselves to “fee for service” patients. Nearly 50% of Vermont’s Oncologist and Cardiologist declined to participate in the GMC program. To fill the void, the Vermont Legislature hastily authorized nurse practitioners and LPNs to act as primary care providers without direct supervision.
Today, Vermonters receive their healthcare treatment and pay for services in ways unimaginable just a few years ago. For GMC participants who have their treatment denied by the GMC Review Board and those who have decided to pay the penalties instead of participating have found that many providers offer deep discounts for cash payment for services rendered. There are now many “fee for service” care facilities including: MedExpress, UrgentCare, Got-A-Doc, LabCorp, and Dynamic Therapy that offer extensive portfolios of services for walk-in patients on a first-come-first-served basis. Patients pay for services when rendered by cash or credit card with financing arrangements available for more extensive and costly procedures. While these new facilities, at first blush, seem questionable; most are staffed by highly competent and experienced practitioners (many are those that chose not to participate in GMC) and provide quality care. For those on a budget or in a hurry, Doctors on Call provides internet and phone consultations on routine and minor medical concerns, allowing many to resolve their medical issue on their own. Additionally, there are “premium” service providers like Concierge Medical which handle all the details for the medical needs of the wealthy – lining up the best doctors, treatment facilities and even arrange transportation before and after treatment, truly door-to-door service.
Possibly the most destructive aspect of the Green Mountain Care program has been the state’s scheme for financing its ever escalating costs. Governor Shumlin, for several years, obfuscated and then flatly refused to reveal the amount and sources of the funds required to finance GMC’s operation until well after his reelection in the fall of 2014. That December, the Governor finally revealed the three-pronged taxation plan required to generate the $2.9 billion necessary to fund GMC – including: 1 – a 25% payroll tax with employers paying 17.5% and employees having 7.5% deducted from their paychecks (the self-employed are required to pay the entire 25%), 2 – a 10% tax on all unearned income – capped at $200,000 per year and 3 – an increased healthcare claims tax raised from 7% to 14% – this tax, formerly paid by insurance firms, is now paid by the patients receiving the care. As soon as the Governor had announced the requirements of the “GMC taxes”, employers implemented plans to “scale back” their Vermont operations or leave the state in order to remain profitable. By summer of 2016; new layoffs in Vermont totaled over 15,000, including nearly a thousand from the healthcare industry as they scaled back in anticipation of reduced revenues from GMC.
Hospitals and medical providers, desperate for additional revenues, began to increase fees for services rendered in patient categories not covered by GMC, primarily: workman’s compensation injuries, auto accident victims and personal injuries paid for by liability insurance claims. Insurance providers immediately adjusted their rates to their insured by as much as 25%, worsening Vermont’s economic and business environment.
Vermont’s healthcare subsidies encouraged many lower wage earners to quit their jobs and sign-up for the broad spectrum of available social service benefits, since the new healthcare taxes in addition to state, federal and Social Security taxes resulted in significantly lower take home pay, insufficient to cover their living expenses.
Former Governor Shumlin had narrowly won reelection in 2014, in part because the impact of his Green Mountain Care and his ultimate prize of “single payer” were not fully understood. By 2016, Shumlin had realized that he had little chance of winning another gubernatorial race and attempted to best incumbent Senator Patrick Leahy in the Democratic Primary – failing by a wide 3:1 margin.
Ever the opportunists, Shumlin and his brother, Jeffery, refocused their Putney Travel Service to take advantage of increased interest in “medical vacations” brought on by healthcare treatment delays and denials by GMC. Putney Medical Vacations will soon provide complete packages that allow their wealthy customers to avoid the delays and the reduced quality of care in Vermont by arranging treatment “stays” in exotic venues that include: Bermuda, Costa Rica, Bangkok, Mexico and Cape Town where patients can save up to 70% under the expert care of orthopedic, oncological, plastic or general practice surgeons and enjoy recovering on the sun-soaked beaches of the treatment venue.
Governor Scott and the newly elected Republican Legislature are struggling with the consequences of GMC. Vermonters who cannot afford to avail themselves of “fee for services” treatment find long waits at the “public” hospitals – the state has been required to take over the operation of most of the formerly independent institutions, closing several smaller hospitals to control costs. Appointments for non-emergency hospital procedures now require waits of three to five months once they are approved by the GMC Board.
All of this could have been easily avoided. The initial concern over 40,000 uninsured Vermonters was discovered to be a gross exaggeration. When those who wished not to be insured (primarily the wealthy and young individuals) and those who chose to find care through social services (at the taxpayer’s expense) were eliminated from the equation , the actual number of uninsured individuals who wanted insurance coverage was less than 9,000. The biggest problem was that none of those involved in the planning of GMC had a thorough understanding of healthcare insurance or the financial tightrope that these firms walked to successfully balance the costs of care and premium rates while managing to remain financially viable. The “public financed” political/government alternative has proved to be a disaster of biblical proportions – out-of-control costs and radically insufficient care.
It is a shame that there is no way to reach back in time and inform Vermonters of the healthcare troubles in their future.
H. Brooke Paige, a historian and writer, is a resident of Washington, Vermont.
Devastating Diagnosis – Green Mountain Care 2017 as published in the WORLD, March 12, 2014
I have filed a public records request for drafts, reports, or memos concerning possible GMC financing plans with the Administration.
Whether a person supports the state run health insurance GMC approach or not, we need to know how it might be financed. We need to have time to vet the plans and to determine if they are sustainable. If they are not, we need to choose an alternative path to achieving the goals of quality, accessibility, and affordability for health care that we all share.
If the Administration invokes executive privilege to deny my request I will try to find a way to ask the full House to issue a legislative subpoena for the financing plan.
Speaker Shap Smith said last night that he would rather wait for the “right” financing plan. This despite the fact that this Administration continually presents tax proposals that the House finds unpalatable. Go figure.
Rep. Cynthia Browning, (D) Arlington
I predict a very rude awakening on state & national electoral landscape.
That numerous FOIA requests are needed to discover what’s really going on behind the well insulated padlocked mahogany doors alone speaks volumes. Better let the sleeping pups, ya know them there unwashed, lie, that they do not discover the greater lie – that it aint gonna work the way we have been “assured” & that our fearless leaders are lying like a rug. I for one do not need your “numbers” goernor all written in disappearing ink. I have a miraculously useful tool at my disposal. It’s called third-grade arithmatic.
Once again Shummy refuses to release “the numbers” & gives us the same old tapdance w/a little softshoe for added arrogance. What’s new? Plain fact of the matter is, in good old VT vernacular — this dog don’t hunt. And though Shummy & his merry band of medical-care mischief-makers keep telling us all is well I somehow find this unbelievable for the plain fact of the matter which is if it were – it would be extra-extra read all about it frontpaged complete w/all of the mind numbing details and including the head spinning numbers. Instead? Crickets. The only noise in the deafening silence are the results of the mysterious FOIAs & commentary thereof.
Grandiose experiment aka Shummycare costing millions upon millions & the rest of the vast millions being poured in aint over yet. And it won’t work — at least the way they say it will — reason being that we are a small state with too many carveouts. I dare say the carveouts vastly exceed the carveins by huge margins. As such, it cannot work. Third grade arithmatic says it all.
They include unions, Medicare, VA, Tricare (I think maybe VA & Tri are connnected somehow), Erisa, faith-based “unions” & large employers one of which oddly is the states largest employer — the State of VT — why aren’t they of all ppl included? Some of the aforementioned can never be carvedout by statute, which begs the question why would anyone want to be carvedout? Why aren’t they stampeding to get in on the ground floor of this fantastic societal benefit?