Burlington, Vermont - March 16, 2011
Vermont may be a small state, but when you're talking health care the numbers are big-- $5 billion a year in health care spending each year; a system that's growing 4 percent faster than the overall economy. Yet, not all Vermonters have access to health care, not all Vermonters have health insurance, and that's a fact that providers universally understand needs changing.
"We all realize we have to change that. We need to be leaner, meaner more efficient mousetrap," said Bea Grause, of the Vermont Association of Hospitals and Health Systems.
But not all of Vermont's 17 hospitals, roughly 2,500 doctors and 66 physician practices are sure that a government funded, single-payer health care system is the answer.
"To me, the bottom line is the government can certainly do a lot of things, but they don't provide health care," Grause said.
One of the biggest concerns is the financial sustainability of a taxpayer funded system. Can it weather a recession, and if not, what happens to Vermonters' health care benefits... Will they shrink or expand during economic turmoil?
"You don't need to look any further than what's happening to Catamount in the governor's budget... Think about that," Grause said. "That program has only been in existence for four years and it's running a deficit and they're proposing to fold it into the Medicaid program. If we are going to publicly fund some benefits, all health care benefits, you know something in between there... We have to make sure that whatever we are proposing to construct is financing sustainable."
Besides providing universal coverage, single-payer aims to cut costs through the elimination of administrative waste, and that's something that doctors view positively because it would free up time for patient care. Some support single-payer, some don't. The overriding concern is how much the state would reimburse providers-- both institutions and individuals-- for the care they provide.
"Obviously, though, I think everybody is concerned about how it's going to be paid for because if the reimbursement isn't adequate the access, the quality of the care, no matter if we have coverage or not, if there's nobody to see the patients and the high quality isn't there, then you've lost the whole thing," said Dr. Paula Duncan of the Vermont Medical Society.
Medicaid and Medicare already don't cover the full cost of care and Duncan says providers with huge overhead and hundreds of thousands of dollars in student loans may not be able to afford to do business here if payments drop even more.
"People are really worried," Duncan said. "Young people are really worried about whether they're going to be able to practice here because so many of them love it here."
A large cardiology practice in the state has already announced its closure due to state and federal health reform, will others do the same? That's the big concern with those who deliver the care. Health care experts say prevention is a means for controlling costs. Vermont already has a shortage of primary care doctors. What happens if that first line of defense is depleted even more?
So again, providers say a state run system-- whether it's one payer, two payers or three-- must be able to pay for the care that Vermonters expect.
"Because if we're not then what we're going to have, we're not going to have the infrastructure because physicians will not be able to afford to stay in Vermont and you'll see services go away. Patients will still go to get the services-- in New Hampshire, or Boston, or New York, or wherever else," Grause said.
Now, another big concern of Vermont hospitals is the five-member reform board. Under H.202, the single-payer bill-- that board will be in charge of just about everything involving health care, including all of the planning over the next 18 months. From controlling health care spending, to insurance rate increases, hospital budgets, the certificate of need process, and of course, the benefit package for Vermonters-- the task is huge.
So this is all a work in progress and providers say they plan to have a seat at the table over the next few years, as lawmakers and policy analysts seek more specifics on a single-payer health care system.
Bridget Barry Caswell - WCAX News
