August 2014 John McClaughry Destination Single Payer History movement began c1987 Legislation dramatically failed in 1994 Douglas vetoed another bill in 2005 Enacted as Act 48 of 2011 after presentation of Hsiao Report ID: 254448
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Vermont Health Care Briefing
August 2014John McClaughrySlide2
Destination: Single Payer
History – movement began c1987Legislation dramatically failed in 1994Douglas vetoed another bill in 2005
Enacted as Act 48 of 2011 after presentation of Hsiao Report
Will come to life in 2017 (if Federal waiver is obtained)Slide3
Single Payer Features: Green Mtn
Care“Health care is a human right” – Shumlin
“Health care is a public good” – Act 48
Universal – every Vermonter in
Centralized government control – GMC Board
Care is free at point of service (but 87% AV)
All costs paid by taxpayers (but 87% AV)
Global budget controls costs
“Payment reform” to replace fee for serviceSlide4
Model: Quebec Medicare
Province controls all health care - RAMQEverybody in (except military and prisoners)Care is free at point of service – flash card
Doctors and hospitals mostly private
Doctors and hospitals price controlled
Global budget controls costs
Private contracting forbidden (until 2005, when Supreme Court overturned)Slide5
Results of Quebec Single Payer
Government rationingLong waiting times for treatmentMaddening bureaucracies
Demoralized doctors and nurses
Shabby facilities (restricted investment)
Obsolete technology (restricted investment)
Aggressive unionization
Much higher taxationSlide6
Green Mountain Care Board
5 member board has full control over doctors, hospitals, and prices etc.Power over collective bargainingPower to determine “essential benefits”
“Payment reform” ($45 m HHS Grant)Slide7
Vermont Health Connect
Insurance Exchange created under ObamaCare act ($170 million HHS grant)
Mandatory for Small business (<50) now, larger business (>50) in 2016
Can select from GMC approved plans
Delivers income-tested tax credits to defray
premium costs
Disappears in 2017 when GMC terminates health insurance
Rollout completely bungledSlide8
Single Payer: Exceptions
Hsiao Report promised $580 m in “savings” But GMC won’t be single payer: excludes Medicare, FEHBP, Tricare, and almost certainly self insured companies – in all, 50% of lives
Query: can “savings be achieved with half-single payer?
Hsiao insisted on no-fault medical malpractice coverage; scrapped early by Shumlin administration Slide9
Single Payer: Medical Impact
Hsiao Report assigned $50 million a year of “savings” to pay MDs and RNs to stay hereThe idea of those “savings” has long been abandoned
Limiting payments to MDs and RNs to stay within “global budget” means doctor shortage
Fewer providers, less technology, long waiting times = reduced quality of careSlide10
GMC: Key unanswered questions
Financing: how raise $2 billion to pay for?Eligibility: how prevent Vermont become the Shrine of Lourdes for the sick and poor?What happens when providers use up their “global budget” allocations?
Will DHMC and Albany Med Center
etc
accept cut rate payment for VT patients?
Which hospitals will be closed?Slide11
Resources
See handout for “Basic resources for understanding educational finance and health care issues”See handout for “Informed Citizen Questions on the Issues of 2015”
For state fiscal issues, visit Joint Fiscal Office (
www.leg.state.vt.us/jfo
)
Visit
www.ethanallen.org
for reports and commentaries on current state issues