Health Care in Vermont...Looking Ahead

OPED - Con Hogan - Health Care in Vermont...Looking Ahead - 5-06

The legislative session is over, and the dust is settling, and it's time to think ahead a little. The question on the table is what will happen to Vermont health care now that the Governor's bill is now becoming law.

The bill was preceded by two years of intense debate about health care in Vermont. And, Vermonters had the opportunity to weigh in quite personally during the public hearings held across the state by both the Administration and the Legislature last fall.

One of the key initiatives of the over 100 pages of the Governor's bill is a move to more managed care for those Vermonters afflicted with chronic disease, such as diabetes. Some have estimated the percent of health care costs attributed to those who suffer from chronic disease to be in the order of magnitude of 80%. This sounds like a very good idea, and had the acceptance of almost all in the political process. It was first proposed a year ago by the Governor, and then as a result of a legislative health care consultant from away, gained currency in the Legislature this year.

However, there are a couple of big problems. Too much of this policy was sold on the idea that it would save considerable sums of money in our overall health care costs. But this policy depends on certain things to be workable and effective. First, it must cover all Vermonters with chronic disease. However, the bill only covers some Vermonters, specifically those on Medicaid. Secondly, success on this front will depend on major breakthroughs in communications technology among physicians and other care givers, and the State of Vermont. Such technology is many years away because of its expense, the training requirements for physicians and their office personnel, and the development of a massive registry of Vermonters, by the State, who have chronic disease.

The promise of overall control of health care costs that was echoed by key legislative leaders is just not in the cards. It will be at least five years, and perhaps even ten years before such cost control evaluations will be possible. The increasing flow of evidence in places that have tried managed care for chronic disease, such as in Florida and California, is showing clearly that the promised savings from this approach are illusory. In Florida a recent report by the Florida Auditor's office indicates that barely 10% of the promised savings have been achieved. And in California, a key private sector provider of these services has backed out of their commitment, simply because there is no money to be made. In other words, the promised 'savings' are not there. Yet the bill in Vermont was essentially sold on the idea of major avoided health care costs down the road.

Also, assuming the best case, that we will see a moderation of overall health care costs within about 5 years (which no one really believes) the overall cost of health care in Vermont will have about doubled from current levels in 5 years. And, most of that increase will fall on those who are now experiencing the fastest increases in health care costs, namely business and their employees. This is not a good prospect. The result will be even an more rapid increase in the number of people and businesses in Vermont who will simply drop or weaken their health insurance because of the uncontrolled rising expense. In real numbers, health care premiums for non governmental sponsored health care will increase from about an average of $11,000 today to an order of magnitude of $20,000 five or so years from now.

And that brings me to the 'Catamount Plan' a key part of the new health care bill.

Yes, the bill does provide ways and means for covering a maximum of 25,000 uninsured Vermonters over the next few years. But the rapid rise of the uninsured will more that offset this gain. In effect, Vermont will not be gaining on the coverage front, but will be churning to simply keep even at greatly increased cost and even more complexity added to the current non-system. The intentions of the Legislature were good, but the result was not.

These fundamental shortcomings will become clearer over the next months, and serious criticism will come from several directions, including the business community, who will see that they will continue to bear the brunt of the unrelenting cost increases, the good doctors of Vermont, who will begin to understand the nature of the remarkable reach of the governmental bureaucracy of registries and practice requirements into their offices and practices, and most importantly, by the general public who will soon realize that their plight of increasingly unaffordable health care has not been addressed. For the general public, this will be a particularly bitter pill because of their very clear plea in the fall hearings that their biggest worry about health care is the clear and present danger of current cost increases.

The only real winners in the bill are the up to 25,000 of the 65,000 Vermonters, who presently do not have health insurance, but who now may be able to obtain coverage.

All this in sum is certainly not worthy of the political rhetoric that accompanied the passage of the Governor's Bill, where we heard language such as 'historic', 'seminal', 'major reform', 'bipartisan achievement', 'universal access' and so on.

The one prediction I am most sure of is that unrelenting rising health care cost will put the need for true health care reform once again on the agenda, both in the coming elections, and increasingly on the minds of Vermonters, as they realize that the Governor's bill will not make a noticeable dent in controlling the cost of health care.

I truly hope that I am wrong.


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