MIDDLEBURY — The state’s top Democrats converged on Middlebury this Tuesday to exhort the party faithful to keep pressing for a single-payer health care system, the foundation for which was laid during the 2011 legislative session.
Those top Democrats — including Gov. Peter Shumlin, House Speaker Shap Smith and House Majority Leader Lucy Leriche — warned that further health care reforms will likely hinge on the party’s ability to maintain its large majorities in the House and Senate as well as hold on to the governor’s office.
“Without the work that you did last year, we would not have been able to elect Gov. Shumlin, a leader that would show the way (on health care),” Smith told a crowd of around 50 people who had assembled at 51 Main restaurant. “Remember that not only now and tomorrow, but remember it until Nov. 6, 2012, because we are going to need your help all the way there.”
Smith, a representative from Morristown, spoke of a chat he had with a lobbyist last week. He asked the lobbyist how the summer had been going.
“(The lobbyist) said, ‘I’m so busy. My phone is ringing off the hook. All these people around the country don’t know what you’re doing there, and they’re scared, and they are hiring me. I’m going to have the best year ever, next year.’”
That conversation, Smith said, provides further evidence that Vermont “is the focus this year. There are a lot of forces that are going to try to make sure that we fail (on devising a single-payer system). We need your help to make sure that we succeed.”
Smith appealed for volunteers to sign up and donate money to the Vermont Democratic Party House Campaign in anticipation of a challenging election year.
He credited two local lawmakers — Sen. Claire Ayer, D-Weybridge, and Rep. Michael Fisher, D-Lincoln — for playing a key roles in advancing last session’s single-payer bill.
Shumlin agreed with Smith’s assertion that Vermont’s single-payer effort will face considerable opposition from those who want to maintain the status quo. But he reiterated his contention that the current health care system is financially unsustainable.
He said Vermonters are on average making the same money (in terms of buying power) that they were 10 years ago. In the meantime, he said gasoline has been hovering at $4 per gallon and other living expenses have been on the rise.
“Here is where the rubber hits the road — you need to go where the expenses are, and that’s health care,” Shumlin said. “If we are the first state in the country where health care is a right and not a privilege, where it follows the individual and is not a requirement of the employers, were we use our health care dollars to reimburse the providers so they can be healthy and thrive … we all win.”
Shumlin said the state was spending $2.5 billion per year on health care 10 years ago, and that figure is now $5 billion. By 2016, the state will be spending $6.6 billion a year on health care, according to Shumlin.
“We have got to get this one right; we can and we will,” he said.
LOCALS EYE PROCESS
Members of Addison County’s medical community served notice on Tuesday that they will be watching the health reform process very carefully.
Dr. Diana Barnard, a palliative care physician with Porter Hospital, said she supports the notion of a single-payer system — provided it is implemented in concert with a universal budget through which resources are distributed in a way that is “accountable and that provides care that is commensurate with what people need.”
Barnard noted her job takes her to the homes of some very sick people who are requiring a lot of resources and reaching the end of what traditional medical care can do for them. She routinely helps patients and families make decisions on care options that not only meet their care needs, but also often save the system considerable amounts of money.
But, Barnard said only approximately 25 percent of what she does is actually billable. That has put Barnard’s practice in a tight financial situation.
“I want to know what your plans are for a single-payer health system that is going to be able to reward Porter Hospital for the kind of innovative approaches it is taking to support a practice like mine, which right now looks like a money loser,” Barnard said.
Shumlin acknowledged the current health care system is predicated on fee for service — a process that he said does not do enough to reward innovation.
“That is why we so desperately need reform,” Shumlin said. “We want to design a system where you and Porter get paid a fair amount of money for managing people’s health and healthy outcomes — not a broken fee-for-service system that’s not working.
“Our problem in Vermont is not the providers get paid too much; it’s that they aren’t getting paid enough,” Shumlin said.
The governor acknowledged that in the short-term, hospitals will need more support as the state transitions into a single-payer system. Hospital budgets are due by June 30 at the Vermont Department of Banking, Insurance, Securities and Health Care Administration (BISHCA). Current state law stipulates that the “Total system-wide, net patient revenue increase for hospitals reviewed by the commissioner shall not exceed 4 percent” for fiscal year 2012. But the law also allows hospitals, while calculating their budgets, to exempt hospital revenues and expenses associated with health care reform, expenses related to electronic records and information technology, new physicians practices, and “all or a portion of the provider tax.”
These exemptions could set the stage for fiscal year 2012 hospital rate-increase requests to BISHCA that could climb into the double-digits, local officials warned early this week.
“Hospitals are in a tough bind right now,” Shumlin said. “They are being asked to comply with a blueprint and they are not being given the resources to do it. The good news about the federal (health care) bill is that we believe we are going to be able to draw down potentially hundreds of millions of dollars to invest in the infrastructure that the hospitals and providers so desperately need to be able to move to a system instead of a non-system.
“We have got to fix the overall system before you can really expect hospitals to be able to contain costs.” he added.
REFORM IN PRACTICE
Dr. Michael Kiernan, an emergency room physician at Porter Hospital, expressed concern that redesigning the way health care is delivered could hinder medical decisions now being made successfully at the local level.
He called local, nonprofit hospitals a “gem of social engineering.”
“In a sense, we are owned by the communities we serve, and we answer to them,” Kiernan said. “We have to answer to our community and show that we are ferreting out the sources of error, infection and miscommunication. As a result, that little hospital down the road there is the safest place to be sick in this region.”
Kiernan said he was skeptical that lawmakers in Montpelier could design something that could be “better, smarter, faster and more responsive to this community than (the local hospital).”
He asked lawmakers to pause and think about the potential consequences of health care reform in “the same way we stop in the middle of surgery to make sure we are differentiating between diseased tissue and vital organ.”
Smith acknowledged that the 14 community hospitals in Vermont have become part of its social fabric. He added he does not anticipate that those hospitals will disappear.
“There is no doubt as we move forward that the voices of those communities and those institutions will be heard throughout,” Smith said. “There is change coming, but I don’t see it as a grand re-design by five people. I think it is going to be a re-design that incorporates the voices of Vermonters.”
Reporter John Flowers is at firstname.lastname@example.org.