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| Articles Jump to editorial: Straight talk on health | Sharing the burden | Sharing the cost | A Better reform plan | Slow down reform Health care plan merits consideration | Find reasonable plan | The usual rhetoric EDITORIALS Preemptive attack July 20, 2005 Rutland Herald Editorial
The Douglas administration continues to charge that the Legislative Commission on Health Care Reform has its mind made up. It appears that the Douglas administration is the one with its mind made up.
It is apparent from a statement issued by Human Services Secretary Michael Smith on Tuesday that the administration has little interest in developing a system of universal access to health care. Instead, Smith has continued to attack the credibility of the commission in what would seem to be an act of preemptive political sabotage.
The commission met on Tuesday to begin its work laying the groundwork for a system that would move away from the present patchwork of private, public, hit-or-miss health care toward a system based on public funding. The commission includes two nonvoting members appointed by Gov. James Douglas — former House Speaker Walter Freed and former Sen. John Bloomer.
Smith moans that the commission has unfairly excluded members of the Douglas administration and that it is skewed with legislators who oppose Douglas' approach to health care. It is a curious complaint.
The Legislature is the body that writes the laws and the commission is a legislative creation, charged with helping put together the Legislature's program on health care. Of course, that means the commission ought to hear plenty from experts in the Douglas administration; the Legislature needs all the help it can get in developing the data and working out the mechanics of a new health care program.
There is nothing to suggest the commission won't hear from the Douglas administration. That doesn't mean it is appropriate or necessary for the executive branch to occupy seats on a legislative body. Certainly, Freed and Bloomer bring a great deal of credibility and experience to their role on the commission, and the commission would be well-advised to hear them out. Their critique of the commission's work may well serve as an advance viewing of the critique they are likely to face from the Douglas administration.
The Legislature takes health care reform seriously, which is why it appropriated a hefty budget for the commission's work. Smith has been taking potshots at that budget, saying it could have been well spent in a variety of other ways.
That depends. If the commission develops effective health care reform, it would be money well spent. For that to happen, it would be better for all concerned to take a positive view of the commission's work. It is by no means certain that the numbers will add up to justify the kind of system members of the Legislature envision.
Freed, Bloomer, Smith and others can make sure the commission is relying on honest numbers, or at least, they can define an opposing point of view against which to measure the commission's work.
It would appear, however, that Smith's preemptive attack on the commission's work is a means of distancing the Douglas administration from the outcome, laying the political groundwork for continued opposition. If Smith does nothing else, he will have given the commission an idea of the questions it must answer satisfactorily in order to build a consensus for its important work.
Straight talk on health
May 14, 2005 | Rutland Herald
The health care reform bill passed by the Senate Finance Committee this week establishes several key principles that legislators ought to keep in mind as they proceed through negotiations on a final bill.
One of the most controversial elements of the bill is the payroll tax that would pay for coverage provided to those without insurance. Gov. James Douglas doesn't like the payroll tax, preferring instead to tax those who already have health insurance. But the payroll tax does several important things.
For one thing, it halts the cost shift. Douglas proposes to cover those who lack insurance by pushing the cost of their coverage onto the policies of those who already have insurance. That worsens the cost shift that has already driven the cost of insurance sky high. An important goal of health care reform is to contain costs by spreading the burden to everyone.
The payroll tax would do that. It would apply to businesses that do not provide coverage and to their employees. The rate of the tax has been set tentatively at 3 percent for employers and for employees.
It would be an extra burden for employers, but they would be getting something in return: a healthier and more dependable work force. Employees who lack coverage for primary care would probably welcome coverage for a 3 percent tax. The Senate bill also exempts the first $25,000 of payroll to ease the burden on small businesses.
Some business groups favor the Senate bill over Douglas' proposal because it forces businesses such as Wal-Mart to do their fair share. To business leaders, it doesn't make sense to drive up the cost of premiums in order to cover for the failure of other businesses to provide coverage.
Business is coming around to the need to halt spiraling costs by establishing a system in which costs are shared broadly. Elsewhere on this page columnist Paul Krugman points to the enormous burden faced by companies such as General Motors and how General Motors in Canada favors the Canadian health care system.
Advocates of health care reform have worried that the Senate bill represents an unpalatable compromise, shying from the grand vision outlined in a bill passed by the House earlier in the session.
Sen. Peter Welch, president pro tempore of the Senate, said that the House bill provided a vision but the Senate bill provides concrete steps toward providing coverage for all. Specifically, the Senate provides a financing mechanism that is simple and understandable. The House bill envisioned a financing plan that would ultimately have replaced private insurance. The Senate bill does not preclude such an eventual result, but it takes action to provide universal coverage now without compromising the goals toward which the House is striving.
It is not clear that Douglas will sign on to the payroll tax. The Senate is working to lay out a plan based on the common ground that Douglas shares with the Legislature. The Senate plan would be based on demonstrated cost controls, which are the key to successful reform. It may be that so much in the Senate plan will be demonstrated to make sense that it will be hard for Douglas to back away from it. Sharing the cost May 5, 2005 | Rutland Herald Editorial
Controlling the spiraling costs of health care is one of the essential tasks of those seeking to reform the health care system. As senators look for ways to scale back the plan offered by the Vermont House, they need to beware of scaling it back so much that cost controls are lost.
Earlier this week, Cornelius "Con" Hogan prepared testimony for a Senate committee (see the opposite page) in which he made the point that focusing on cost controls was the best way of focusing on the problem of access. Mushrooming costs have caused employers to scale back coverage, cutting people off from care. Hogan urges the Senate to be aware of the need to control costs in the near term or the entire system is in danger of collapsing.
The Senate is considering a plan that would offer primary and preventive coverage to people who do not have coverage from employers. The program would be financed through a 3 percent payroll tax on employers and another 3 percent on employees.
Employees who reject coverage offered by an employer would still have to pay the payroll tax, and so would the employer. Otherwise, their refusal to pay into the system would effectively shift the cost of care when they need it to those who do have coverage. This is one of the factors driving up the cost of premiums.
There is talk in the Senate of exempting from the payroll tax employees who refuse coverage because they are covered by a spouse's policy. But the creation of exemptions threatens to undermine the conceptual foundation of what the Legislature is trying to achieve, which is to make health care a responsibility shared by all, rather than a benefit tied to the specific circumstances of each individual.
When the cost of health care is shared by all, control of costs becomes possible. That is partly because the cost will be spread out more fairly, preventing people from being priced out of the system, as they are at present. Control of costs would also give us all a stake in a reasonable budgeting process requiring hospitals and other providers to live within specified limits.
As Hogan says, "A system of visible, managed, and authorized taxes, instead of invisible, unmanaged, not understandable, corrosive and unauthorized premiums and taxes, will go a long way in setting mechanisms in motion to control the rising cost of health care."
Opponents of the Legislature's efforts criticize its proposals as "government-run" health care. Government would not run the health care system, but it would provide a clear and orderly means of financing it. At present, administration consumes roughly one-third of health care costs, an enormously wasteful burden that we all have to pay. A simplified administrative structure could save hundreds of millions of dollars.
Instead of looking for ways to narrow the base of people paying for the new system by providing exemptions, the Senate should be looking for ways to give the system as broad a base as possible. Only then will the Legislature have discovered a system that allows us truly to share the cost, rather than indulging the illusion that each individual pays for his own care.
We discover it is an illusion when our mother or our husband requires a $50,000 operation and we learn whether the system will share the cost. It is only through sharing the cost that a modern health care system is possible. A Better reform plan Voice of the Free Press | April 29, 2005 | The Burlington Free Press
Senate Democrats have put forth a solid vision of health care reform for the 2005 legislative session, although the details remain to be seen.
Coming on the heals of a problematic House-passed bill that moves the state toward a government-controlled system, the Senate proposal would maintain the existing employer-based system but expand the coverage to most of the 63,000 uninsured Vermonters.
The Senate bill also focuses on important cost-control measures, including passage of a chronic care plan proposed by Gov. Jim Douglas, in a change to allow physicians to apologize for medical errors without threat of further legal liability. It also calls for studies to examine governance, economic impact and financing options for broader, phased-in reform down the road.
In general, this view of measured changes provides a good middle ground between the House-passed plan that goes too far and Douglas' proposal that doesn't go far enough. Douglas has called for taxing some insurance premiums to raise about $15 million to expand coverage to about 12,000 Vermonters, among other changes, leaving 50,000 Vermonters without coverage.
A potential sticking point in the Senate plan is the creation of a 3 percent payroll tax on businesses that don't provide health insurance, as well as employees who have no coverage. The roughly $39 million raised would be used to provide basic, preventative care to the uninsured. Companies that offer coverage and Vermonters with private insurance would not be affected. The impact of this tax is not clear. Many small employers have expressed an interest in insuring their workers, and this might provide that coverage at a price that won't bust the budget. However, some are already voicing concerns that the tax will place too big a financial burden on their bottom line.
It's also not clear how federal laws might affect any progress made toward reform. Within these constraints, it is hard for states, including Vermont, to figure out a global solution -- a complication Senate leaders acknowledge and insist they are ready to tackle.
Some Republicans have expressed a willingness to consider the plan. And while Douglas said Thursday that he is concerned about the payroll tax increase, he thinks the Senate plan is "constructive." In addition, the bill requires public input.
It's too early to gauge public reaction to the proposal, but it's likely to be more acceptable than the House bill. Sen. James Leddy, D-Chittenden, said "this is not a revolution." That's crucial because most Vermonters simply want health finding and avoiding adequate coverage, they don't want a revolution. Senate Democrats outlined their proposal in a press briefing this week and it was unfortunate that no Republicans were part of the discussion. The Senate would be smart to shore up bipartisan support, and Senate President Pro Tem Peter Welch made it clear he is already reaching out to the GOP.
Welch said his colleagues have presented an outline for reform that appears thoughtful and measured. The hard work of the find-tuning that concept into specific legislation will be challenging, but hopefully result in balanced reform that meets Vermont's needs. Slow down reform April 20, 2005 | The Burlington Free Press Democratic leaders in the Vermont House are ramming sweeping health care reform legislation through their chamber as early as today that could hurt the states economy, greatly expand the size and scope of government control of the health care system, and ultimately do much more harm than good.
Vermonters want help finding and affording reasonable coverage. Businesses want help providing insurance to workers. And the sky rocketing costs of health care must be brought under control.
This bill moves the state far beyond those basic needs, on a course toward government-controlled, single-payer health care. For the sake of the state -- and their own political well-being -- House Democrats would be wise to slow action on this legislation.
The House Health Care Committee would be serve it's chamber by crafting a more moderate reform plan that addresses those real health care concerns without the threat of bigger government and billions of dollars' worth of new taxes.
The 2004 governor's race provided a peek into voters' wishes, Gov. Jim Douglas, who ran on modest health care reform platform, won by a solid majority over Democratic challenger Peter Clavalle's much broader proposal.
House leaders argue their bill generally calls for studies and public testimony from average Vermonters on what sort of reform makes sense for this state. That is somewhat misleading.
The legislation actually suggests the state move toward a single-payer system in which a government authority -- created in July -- would provide insurance for basic and preventative care. People who want additional services could purchase private coverage to meet those needs.
There is no price tag spelled out in the bill, but even it's supporters agree it will cost hundreds of millions, if not billions of dollars to implement. There is no funding source identified, but increasing the payroll and income taxes are the likely options.
Even if offset by premium reductions, these tax increases would hit ordinary Vermonters who are already taxed enough.
Most Vermonters have health insurance, and while they want help meeting premiums, they don't want to lose their existing coverage. This plan threatens that security -- and puts Democrats from moderate counties at risk at the polls next year.
Although the House plan goes too far, Gov. Jim Douglas and the Republicans aren't offering an adequate alternative. Douglas' proposal is a first step worthy of discussion, but leaves tens of thousands of Vermonters uninsured.
Health care reform ought to expand coverage to more of the uninsured; including incentives to help small businesses cover employees; find ways to ensure that private coverage is affordable and adequate; and hold down health care spending through healthier-living incentives and cost control measures. It might be phased in to control the price tag; it must leave the state's budget balanced.
That is the sort of reform Vermonter's are seeking when they went to the polls last November.
House leaders would be wise to pull back this legislation and begin looking for a more moderate reform plan that best serves Vermonters.
Health care plan merits
consideration Voice of the Free Press | April 17, 2005 | The Burlington Free Press
About 63,000 Vermonters lack health care coverage. Many families have insurance but struggle to afford the premiums or pay for adequate services. Small businesses are finding it difficult to provide coverage for their workers. And health care costs are rising much too quickly.
Those are the key pieces of the health care crisis.
Yet, reform plans coming from Montpelier are either too broad or too timid in scope. Vermonters are still waiting for a balanced, affordable and concrete proposal to be presented that will make a real improvement in their lives.
The House Health Care Committee has approved a gigantic plan for reform that resembles a government-run, single-payer system. Under the bill, basic coverage would be provided by the state, but supplemental services would be added by consumers using private companies. Although details would follow public hearings throughout the year, the bill creates in July a government agency to oversee the plan, putting this solution on a fast track.
The biggest stumbling blocks for the plan are its expense and public opposition.
Supporters can't say specifically how much the proposal will cost, but admit it will be hundreds of millions of dollars. That will clearly mean a huge tax increase. Even if that cost is offset by premium reductions, that level of taxation is not in the best interest of the state or its residence.
And our hunch is the public doesn't believe that bigger government is the answer to Vermont's health care woes. Most Vermonters have coverage and don't want to lose it; at the same time, they want their premiums lowered and increased access for those who now have no safety net.
The House committee would be wise to work a little longer scaling back this legislation into something that ensures more Vermonters have affordable health care coverage, and employers can offer coverage to their workers without breaking the bank.
At this point, however, the Republicans haven't put forward a solid alternative. Gov. Jim Douglas's proposal falls short of serious reform.
The governor called for taxing premiums on non profit companies to pay for coverage for about 12,000 uninsured Vermonters. His roughly $30 million plan would create a pool of individuals and some small businesses to lower their rates, and provide tax credits to small businesses that offer health care to workers.
Any plan that leaves 50,000 Vermonters without coverage doesn't begin to address the problem. This is the easiest sell politically, but Vermonters would still face many of the same difficulties.
These two sides should work together to craft a plan that falls in the middle.
It should be noted that Coalition 21, a credible group of business representatives, health care experts and advocates for disadvantaged Vermonters, are meeting regularly to find a solution. The breadth of their membership will hopefully lead to a reasonable plan, which is expected by next fall. Douglas and lawmakers should pay close attention to this panel's work.
Lawmakers and the governor need to remember that even the best plan won't pass muster if the public feels it's too big, intrusive or expensive. Nor will it win support if it doesn't solve the problem. The very best proposal is balanced and affordable.
The usual rhetoric
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