THE VERMONT HOSPITAL SECURITY PLAN

THE VERMONT HOSPITAL SECURITY PLAN
By
Richard Davis

GUILFORD- Once in awhile a piece of proposed legislation comes along that seems so right, so sensible in many ways, that one almost begins to believe that it will pass on the first try. A bill introduced by Francis “Topper” McFaun-R- Barre Town with sponsors Michael Obuchowski-D- Rockingham and Hilda Ojibway-D-Hartford, The Vermont Hospital Security Plan, is such a bill.
Then political reality sets in. That is why this bill, H.304 has barely seen the light of day in three years. Things may be about to change. Thanks to the hard work of McFaun, who is perhaps the most non-partisan politician I have ever met, the bill may get a fair hearing when the new legislative session begins in January.
A fair hearing means that the chair of the House Health Care Committee, Steve Maier-D- Middlebury will schedule committee discussion and solicit public testimony early in the session when there is time to act. Then it will be up to the public to put pressure on their legislators to push the bill forward. Things can actually happen that way in Vermont if a critical mass comes together.
If there ever was a time for a critical mass to get results then it should happen with McFaun’s bill. The usual political barriers are still operational and that means that partisan politics, budget constraints and the art of perception over reality may win the day.
So what would this bill do? It would guarantee that all Vermonters have access to and payment for inpatient and outpatient hospital services. This would mean that whether or not you were insured, you would not have to worry about co-pays and deductibles if you needed hospital care.
McFaun got the state’s Joint Fiscal Office (JFO) to run some numbers and they have determined that insurance premiums could be cut by 43% if they allowed this new bill’s plan to take over. The tab for this plan would be $700 million, but we already need to raise $760 million in premiums, property taxes and out of pocket payments just to provide the current level of hospital care for Vermonters.
Estimates also indicate that if every Vermonter paid about $1300 a year they would have complete hospital coverage. Not everyone can afford that level of cost-sharing but even if people paid according to their ability this program could also be funded from other sources and still cost most people less than they pay now for hospital care.
Let’s say you have a decent insurance policy now and you pay $10,000 a year for two people with minimal out of pocket costs. That premium would be reduced to $5700 and you would pay an additional $2600 for hospital care. A couple would save $1700 a year and have even more financial security than most insurance policies provide. Anyone with a high deductible policy would save more and no longer live in fear of actually having to use their health insurance.
The bill doesn’t get into funding specifics but options include a payroll tax, income tax, cost-sharing measures, a value added tax, consumption taxes or an annual hospital fee. Most people would spend less than they do now for health care and health insurance. If things were set up well, then the hospital plan could dovetail with existing coverage.
Of course, all is not as simple as it sounds. This would be an incredibly complex undertaking and it would eliminate a few hospital jobs in billing departments because there would be a new and simpler system of financial administration.
The genius of this bill is that it could work financially if everyone pays according to their ability. My bias is toward an income tax dedicated to hospital care. Money needed but not raised in that way could be supplemented through some of the other measures already mentioned.
Consider some facts. The biggest chunk of health care cost is for hospital care. Half of all bankruptcies occur because of medical bills and 75% of those people who go bankrupt already have health insurance. More and more people, whether insured or not, are living in fear of what the next illness will do to them financially.
Imagine living in world that allowed us to think about dealing with our illness first instead of having to be consumed with how we will pay for our treatment. The hospital bill wouldn’t be a perfect cure for this problem, but it would be a good first step and we are still crawling when it comes to these issues.

An Update on Canadian Health Care

An Update on Canadian Health Care
Mimi Morton

I lived in Canada from 1970 until 1999 and had the benefits of its health care system. As a cancer survivor, I credit the Canadian system with saving my life. I can’t dredge up even one memory of bad care. Nonetheless, I know the system is flawed. As I was leaving Canada for the U.S., my Montreal surgeon, David Owen, told me, “Our system is broken.” He was referring to increased restrictions on his professional autonomy. The American health care system experiences restrictions of a different kind. U.S. insurance providers attempt to keep costs down by limiting patients’ claims rather than doctors’ protocols.

If Americans are ever to develop a truly universal, publicly-funded system, it will not be any more perfect than the Canadian one. To preview conditions we might face if we make health care a right rather than a privilege, I wanted to check in with the Canadian system now.

World Health Organization statistics have consistently shown that health outcomes are better in countries that cover all their citizens rather than in countries that do not. But most Americans have also heard horror stories about Canada, the same ones we tell about our own system: big city emergency room chaos, long waits for referrals, overworked general practitioners. I wanted to transcend hyperbole and talk to Canadians themselves.

The system that I left in 1999 was overworked and fraying around the edges but it still delivered quality care. As Canadians like to say, when you have it bad, the system is good to you. Call it triage if you wish, but when everyone is served, the worst cases must be seen first. I experienced this preferential treatment when I had cancer.

I’d heard that the 21st century was bringing Canada closer to a two-tiered system: the original public system is still in place but private insurance policies are increasingly utilized, principally to expedite care. In fact, private insurance companies have never gone out of business in Canada. From the 70s until the ‘90s, I paid into and received supplemental insurance through my Montreal teachers union that covered such amendments as high-priced specialty medicines and private hospital rooms.

Beyond such add-on insurance, full-service private group insurance is available for those who can pay. Michael Bantey, a corporate lawyer in his 40s, told me he stopped using the public system when he joined his firm and now pays into their private group policy which he considers superior to what he could get publicly. “I pay to have an MRI or whatever to avoid the six-month wait.” For my interviewees, the wait for access is the single biggest drawback of the public system.

Leila Basen, a Montreal screenwriter, told me a variation on this theme. When her daughter suffered a painful sports injury to her knee, she opted for a private MRI because she assumed the wait “might be ten months if we went through normal channels.” Because her daughter was in great pain, an orthopedic surgeon saw her immediately and her surgery took place within a month. Basen has supplemental insurance through her writers’ union which covered drugs but not MRIs. While she was happy with the timeliness of her daughter’s care, she acknowledges that the system can be difficult to access.

“’Did you have to give them an envelope?’ That’s an expression you hear from older people in Montreal.” Basen explained that this mild form of bribery is sometimes used in order to “jump the queue.” (I had never heard of the practice.)

However, when Hanford Woods, a former colleague of mine in Montreal, decided on hip replacement surgery in 2006, he found the wait reasonable and he was able to schedule the surgery at his convenience, during his vacation.

Perhaps the most caustic story came from the youngest person I interviewed, Alex Fellows, a thirty year old artist and writer. “I was hit by a car in 1999 (when he was 22). I crashed the front windshield and dented the roof as I rolled over the top. Some old lady had run a stop sign. The impact knocked both my shoes right off and shattered my front teeth. In the hospital I waited on a stretcher for about half an hour in a hallway next to other people moaning on stretchers. Eventually they took my x-rays real fast and everything checked out o.k. I was ready to go home, even though I was having trouble walking. I wasn’t offered to sit down anywhere or what to do when I got home. I asked if I could borrow a slipper because I had no shoe and it was raining outside. They gave me a bunch of doctor hair caps to use as shoes and showed me to the door, where I had to call a cab. At home, I passed out with a crazy headache. (This experience was) nothing that would shock any African, but it’s bad seeing I pay all these taxes and it’s such a fast-food health system.”

Harold Rich, a sixty year old pediatrician at the Montreal Children’s Hospital would dispute Fellows’ story as representative of emergency room care. “We try to provide the best care for everyone,” he said. “Without concern for money. “ He acknowledged that budgeting issues are chronic but that overall, both children and their parents are happy with the level of care. He added, “We offer excellent intensive ambulatory care.”

While Rich admires his hospital’s clinical practices, he is critical of what he describes as the “unfriendly” hospital ambiance: unaesthetic waiting rooms, poor food. He thinks that creature comforts could be improved. “It’s just a matter of will.” Nonetheless, hospital budgeting also must work on a triage principle in which funding for drapes and furniture comes at the bottom of the list.

Susie Gruber, a fifty-seven year old Montrealer who worked for many years as a receptionist at a CLSC, Quebec’s system of neighborhood clinics, tells me that the system is crowded. CLSCs no longer accept walk-ins. “It’s getting harder to be seen by a g.p. if you don’t have one,” she told me. “And, yes, the office waits can be long.”

In spite of their honest impressions of the system’s limitations, all of the people I interviewed, with the exception of the corporate lawyer, said they thought the system’s benefits far outweighed its problems.

Leila Basin told me the story of her other daughter who suffers from a rare congenital heart condition and has undergone multiple surgeries. She currently is seen by a comprehensive heart unit at the Royal Victoria Hospital where all her health needs are treated in one place by a team of specialists. Basen is impressed with the level of care and the innovative holistic approach.

Canada and the U.S. share more than just a common border. There is a great deal of professional interface between Canadian and American doctors. Many Canadians (such as the heart specialist Basen’s daughter works with) have studied in the U.S. just as American doctors study and work in Canada . As we struggle to reform our chaotic non-system, Canada provides us with valuable experience.

Granted, my interviewees were all urban residents of one province. Different Canadian regions may experience different challenges. Overall, my interviews did not uncover evidence of poor care but they did show the stresses a system withstands, particularly in access to primary care and expensive screenings, when patient volume is increased.

We already know that the American primary care system is over-utilized and understaffed as more medical students opt for lucrative specializations rather than family medicine/preventive care. American medical schools will need to encourage a more humanistic ethos if we are to train doctors to enter our own version of a universal public system in which medicine is more than just a business.

New York Times June 11 Business of Health Care Section

??Worth the read???
The New York Times has published a special section on the business of health care on June 11.

Sicko

Michael Moore's new film "Sicko" is due for release on June 29. This can be an important tool for getting the word out about real universal health care and the need for single payer. Organize events around the showing of the film, leaflet outside movie theaters. Many of the organization involved with the HR 676 campaign with Healthcare Now are planning events around the country. Opportunities like this don't happen very often.
Here's a link to a recent Bill Maher interview with Michael Moore:
http://www.alternet.org/blogs/video/#52438

Welch Signs on to HR 676

Rep. Peter Welch has signed on as a co-sponsor to HR 676, Rep. John Conyers-D-Michigan, Expanded and Improved Medicare for All Act. In addition, Welch has also signed on to three other bills aiming to promote universal health care. They are HR 1841, HR 15 and HR 506.

Legislative Update

The first year of this legislative biennium will be coming to an end soon. The big question is, “What happened to move health care reform forward?”. The simple answer, “Not much.”
Health care committees dealt with bills to fine tune the Catamount health bill that passed last year. It was their belief that the best they could do this year was to set the stage so that the plan has a chance to work.
Susan Besio, the state director of implementation for the plan, is doing a superhuman job of coordinating and executing all of the pieces. If you want to keep updated check out the web site: www.hcr.vt.gov.
Jim Hester, former Vermont boss for MVP health insurance, was appointed director of the Health Care Commission. He is a consummate list maker and detail person. Hester seems to have a solid grip on things and he has a vision of how things should play out. He is making an effort to reach out to all the players in the Catamount drama. Stay tuned.
As a side note, as of this writing, it is not clear if the pharmaceutical bill making its way through the legislature will pass. Even if it passes, I suspect the Governor will veto it. The bill is a remake of the comprehensive bill that many of us worked on a few years ago; the bill to control drug prices and the practices of pharmaceutical companies. If it passes it would be landmark legislation. Sadly, the press has pretty much ignored this critical piece of health care reform.
The Catamount insurance product is slated to go into effect on October 1 and the timeframe for enrollment will begin about 4-6 weeks prior to that. The cost of the policy is still a moving target but we do know that the full cost of an unsubsidized policy will be very close to $400 a month per person.
Benefit details have not been revealed but we do know they have to be at least as good as what Medicaid offers. That is good coverage.
Even though coverage may be good it won’t help all of those Vermonters who still won’t be able to afford insurance under Catamount. That is why VCCH and others are pushing for changes to the plan. We want to see the one year waiting period eliminated. The plan forces you to be uninsured for a year before you are eligible. We also want to allow self-employed people such as farmers and artists to be able to buy in or be subsidized.
Will we get what we want? Maybe. Here’s where the hope lies. The Health Care Commission held a public meeting on April 24 to hear what the public wants for next steps for Catamount. About 50 people attended the hearing and the usual spectrum of opinion was aired, but with a twist. VCCH brought two of the people it featured in its newspaper ads (view them on our web site: www.universalhealthvt.org). It was a refreshing wake up call for legislators to hear from “real people”.
The Commission plans to hold similar hearings around the state this summer and fall to hear what Vermonters want changed in the Catamount plan. We will keep you updated with schedules and information on our web site.
The best case scenario is that all of the information gathered at these hearings will be turned into legislation to expand Catamount. That legislation will be introduced at the start of the 2008 session and be ready for implementation by the end of the first year of the life of Catamount.
Don’t forget that we still have a formidable obstacle to expanding Catamount and making it work. For all of his rhetoric, Governor Douglas will only support measures that conform to his right wing ideology. Catamount expansion will not make him happy. That means we may have to wait until the next election before Catamount will be able to fulfill its promise to become more than what it is now.
Your voice will be important in the process. VCCH hopes we can help your voice become strong by all of us working together.

From Rep. John Conyers

From Rep. John Conyers Blog:

We Need Real Universal Health Care Coverage
Submitted by JC on April 23, 2007 - 11:54pm.
The health care crisis we face today affects everyone, overwhelming America's workers and businesses. Many low-wage earners do not receive health benefits and cannot afford insurance. Higher salaried workers know that the cost of their health insurance may lead to the next round of layoffs.
More than 46 million Americans lack basic health care coverage. Millions more face high deductibles and staggering costs leaving essential care out of reach.
We can no longer seek gradual reforms or provide insurance companies with financial incentives to solve the problem. The time has come for a single payer national health care system that provides complete care to all Americans.
Since the 2006 elections, we have heard plenty of new voices calling for universal health care. Unfortunately, many of these claim to be universal health care, but are merely bandaids to the problem.
One proposal has the federal government giving billions of dollars to insurance companies to cover the uninsured. Other proposals only cover children or shift the entire burden of healthcare to employees in the form of health savings accounts.
Unfortunately, patchwork fixes like these will not work. The only way to provide a lasting solution to our health care crisis is through single payer universal health care. We must not let the movement toward universal health care be co-opted by proposals that serve to enrich those seeking to extend the status quo at the expense of true reform.
To address this need, I have introduced H.R. 676, the United States National Health Insurance Act. My bill would create a single payer universal health care system by strengthening and extending the Medicare program to cover all Americans.
Please help me enact this important legislation by signing this statement of support. We must have real reform through a single payer universal health care program if we are to solve our nation's health care crisis.

Health Care Financing Study

A health care financing study was published in early March as part of the mandate for studies in the health care bill related to Catamount. It is dense, boring and not worth a lot but it does offer some very interesting statistics relating to health care finanacing and to a single payer plan specifically. This is the study that Gov Douglas refused to participate in and there is a letter in the documents confirming that. The report is at the Health Care Commission web site: http://www.leg.state.vt.us/CommissionOnHealthCareReform/Memo-Health%20Care%20Financing%20Review%20-%20Final%20Draft%20031307.pdf