Health Care Commission

Health panel meets four finalists for director's job today

August 9, 2005 | By John Zicconi Vermont Press Bureau | Rutland Herald

MONTPELIER — Vermont's Legislative Health Care Commission has narrowed its search for a director to four candidates, all of whom will be interviewed today behind closed doors.

Today is the first time candidates will meet with the entire 10-member commission.

The finalists have already spoken once to the commission's co-chairmen — Sen. James Leddy, D-Chittenden, and Rep. John Tracy, D-Burlington — and a variety of legislative staff who were charged with narrowing the field.

Interviews are expected to last about 90 minutes and will take all day to complete. No final decision is expected until later in the week, or more than likely next week.

"Those we are going to talk to (today) are all second interviews," Tracy said. "But even if we find the right person, it will take a few days to finalize things."

The director will help guide the commission to fulfill the Legislature's goal of providing universal access to health care for all Vermonters.

He or she will spend the remainder of the summer and fall working with the commission to develop health care cost-containment strategies, oversee economic studies to evaluate what taxes can be raised to pay for health care expansion, and draft legislation for the General Assembly to consider when it reconvenes in January.

Lawmakers gave the commission a two-year, $800,000 budget that includes money to hire up to three full-time employees, including the director. The director will be paid $80,000 to $100,000 annually, according to newspaper want ads.

Leddy said about 55 people applied. The field was quickly narrowed to about a dozen, and eight were granted initial interviews before the field was reduced to the four finalists, he said.

Two of the four candidates are from out of state, while one is from a consulting group that wants to run the commission, Leddy said.

"The consulting group is an out-of-state group, but with a Vermont presence," Leddy said. "The majority of their work is not in Vermont, but they do have a staff in Vermont."

Commission members would not discuss the identity of either the consulting group or the individuals under consideration. But Walter Freed, a Republican appointed to the commission by Gov. James Douglas, said all candidates appear to be qualified.

"My only concern is that they not hire political operatives, which they are not," Freed said. "If they were political operatives with an agenda they were trying to move, that would not be appropriate. But I don't see that."

Douglas has been critical of the commission, which he believes is an expensive Democratic tool designed to steer the health care debate in the direction of a government-run, single-payer system that he opposes.

Neither Freed nor Douglas' other appointee, former Republican Sen. John Bloomer of Rutland, get to vote on any issue facing the commission. Freed said he did not plan to attend today's interviews.

"I'm still perplexed why the Legislature would spend $800,000 on this kind of commission," said Freed, who is a former speaker of the House. "Maybe it epitomizes what is wrong with health care — it costs too much."

Democrats brushed aside the criticism, calling the director a necessary element to ensure health care reform options are thoroughly investigated. They hope a clear favorite will emerge from today's interviews so they can make a unanimous recommendation to Senate President Pro Tem Peter Welch, D-Windsor, and House Speaker Gaye Symington, D-Jericho.

Welch and Symington have the final say over who gets hired.

"Hopefully, there will be significant agreement on one candidate to make a recommendation," Leddy said. "Our hope is that we can (quickly) make an offer."

Back to the top

Purpose of Health Care Commission

Starting this summer and through July 1, 2009, the Commission on Health Care Reform shall:

Identify and report emerging trends and behaviors among various participants in the health care system;
Assess the effectiveness of cost-containment and quality of care initiatives;
Establish recommendations to the Vermont General Assembly for demonstration or pilot projects designed to contain health care costs, improve the quality of health care, and to integrate systems of care that promote: community-based evaluation and planning, improved financial management, information technology systems that advance the management and coordination of health care, governance models at the community level, and patient responsibility for and participation in health care decision making;
Develop a plan for creating an integrated, regional delivery system and developing integrated systems of care that:
1. Reorganize the health care delivery system to improve coordination, reduce medical errors, and reduce redundant or unnecessary care
2. Improve the quality of care in terms of process and outcomes
3. Encourage alternative reimbursement mechanisms based on outcome-based payments to change the incentives for health care professionals and to control health care costs
Make recommendations to the Vermont General Assembly for a program to provide matching grants for long-term investments in health care systems, technology, and infrastructure in a manner that promotes the establishment of integrated systems of care;
Assess the feasibility of:
- a publicly financed stop-loss insurance policy for all health plans doing business in Vermont;
- a public health care program that incorporates the health benefits covered under workers' compensation policies;
- tort reform consistent with the findings and recommendations of the medical malpractice study; and
- a health care purchasing pool
Recommend alternative reimbursement mechanisms for health services that encourage cost effectiveness, improve the quality of care, increase efficiency, reward primary care practices that prevent chronic illnesses, avoid preventable hospitalizations, and reduce long-term costs to the system, including a global hospital payment to each hospital. A global hospital payment; an amount to be paid to a hospital by each health insurer, employer or the state for services received at that hospital by all individuals covered by a health benefit plan offered by or through that insurer, employer or the state, may be accomplished through negotiations between insurers or employers and hospitals, by requiring all public and private health insurers to pay for hospital services using this method to the extent permitted under federal law, or by another mechanism;
Receive input and make recommendations, generally, to the house committees on health care and ways and means, the senate committees on health and welfare and finance and the general assembly regarding the long-term development of policies and programs designed to ensure that, by 2009, Vermont has an integrated system of care that provides all Vermonters access to affordable, high quality health care that is financed in a fair and equitable manner; and
Cooperate and coordinate with the public engagement process to receive public input on a health care reform plan.
- The commission shall select, subject to final approval by the Speaker of the House and the President Pro Tempore of the Senate, the services of one full-time director and such other staff as is needed, and shall receive administrative, fiscal, and legal support from the joint fiscal office and the legislative council. The director shall have expertise in finance, planning, systems analysis, and processes involving weighing competing interests among parties. In addition, with the approval of the Speaker of the House and the President Pro Tempore of the Senate, the Commission may retain the services of one or more consultants or experts knowledgeable in health care systems, financing, or delivery to assist in its work and may request funding from the legislative budget.
- The commission may request analysis from the office of Vermont health access, the department of banking, insurance, securities, and health care administration, and other appropriate agencies. The agencies shall report to the commission at such times and with such information as the commission determines is necessary to fulfill its oversight responsibilities.
- The commission may meet as needed and members shall be entitled to compensation and expenses.
- The department of buildings and general services shall provide the commission with office space near the state capitol building in Montpelier for three individuals.
- To staff this commission, the legislature is authorized to establish three (3) new exempt positions; one commission director and two commission research/support staff in fiscal year 2005.

Back to the top

Cover Letter & List of Questions for Health Care Reform Proposals

115 STATE STREET
MONTPELIER, VT 05633
TEL: (802) 828-2228
FAX: (802) 828-2424

SEN. JAMES LEDDY, CO-CHAIR
REP. JOHN PATRICK TRACY, CO-CHAIR
REP. JANET ANCEL
SEN. ANN CUMMINGS
SEN. M. JANE KITCHEL
REP. STEVEN MAIER
REP. FRANCIS MCFAUN
SEN. KEVIN MULLIN
JOHN BLOOMER, JR.
WALTER FREED

July 26, 2005

The Commission on Health Care Reform, created by Act 71 (2005), is soliciting input on various proposals for health care reform presented to the Legislature during the 2005 legislative session. The Commission would like to learn more about each proposal. To assist in this effort, the Commission has prepared the enclosed list of questions and asks that each organization or individual with a health care reform proposal respond in writing to the Commission. Please address the questions separately and limit each answer to not more than 100 words. Supplemental materials may be filed as well.

In addition, the Commission would like to solicit verbal testimony on the various proposals at the next two Commission meetings. The first is scheduled for Wednesday, August 3, 2005 at 9:30 a.m., at the State House, Montpelier. The proponent of each proposal will be given 45 minutes to complete a presentation and then respond to additional questions by members of the Commission. Rachel Levin will contact you to schedule a specific time on August 3 or at the next meeting of the Commission.

Please submit your written responses to the enclosed questions to Rachel Levin, Legislative Council, via email (rlevin@leg.state.vt.us), if possible. If you have questions please call Robin Lunge, Legislative Counsel, at 828-6506. While we encourage responses to be submitted before your scheduled presentation, they may be brought for distribution at the time of the presentation.

On behalf of the Commission, we thank you for the invaluable expertise and perspective you bring to the discussion on health care reform in Vermont.

/s/ Senator Jim Leddy, Co-Chair | s/ Representative John Tracy, Co-Chair

A. How does the proposal address the principles adopted by Coalition 21 (and established as guidelines by the Legislature)?

(1) It is the policy of the state of Vermont to ensure universal access to and coverage for essential health care services for all Vermonters.

Who is covered by the proposed plan?
When will universal access be achieved?
What is the timetable?

(2) Health care coverage needs to be comprehensive and continuous.

What is covered by the proposed plan? (i.e. benefits)?
What is the timetable for achieving comprehensive coverage?

(3) Vermont’s health delivery system must model continuous improvement of health care quality and safety.

How is quality assured?
How does it impact the present organization and delivery of health care? (e.g., impact on providers, private and public insurers (including employers), payment methods, etc.)

(4) The financing of health care in Vermont must be sufficient, equitable, fair, and sustainable.

How much does the proposed plan cost?
How is it financed?

(5) Built-in accountability for quality, for cost, for access and for participation must be the hallmark of Vermont’s health care system.

How will costs be contained?
How much will the proposed plan bend the spending curve?
How is it governed?

(6) Vermonters must be engaged, to the best of their ability, to pursue healthy lifestyles, to focus on preventive care and wellness efforts, and to make informed use of all health care services throughout their lives.

How will the proposed plan encourage healthy lifestyles and a focus on wellness?

B. How do you get there from here? What are the immediate steps you would take to move in the direction you envision and what would be the impacts that you would expect to occur?

Back to the top

Panel for health care reform must be bipartisan

July 22, 2005 | By Sara Gear Boyd

I had to chuckle at the irony of House Speaker Gaye Symington's July 8 op-ed, in which she defends the Legislature's bill condemning Vermonters to a government-run, bureaucrat-controlled health care system financed by huge tax increases on employers and the working poor.

Her punch-line was, "Access to health insurance does not assure access to health care." Anyone paying close attention to the current health care crisis in Canada would be stunned by her choice of words because they nearly echoed the Canadian Supreme Court's justification for unanimously striking down as unconstitutional Quebec's "universal" health care scheme – the very scheme liberal Democrats like Symington want to emulate here in Vermont.

The Canadian Supreme Court was more honest than Speaker Symington about the true consequences of government-run health care. They put it this way: "Access to a waiting list is not access to health care."

And that is the problem with the Democrat approach to health care reform. The bean-counters in Montpelier do not care if you have true access to health care. Their idea of victory is when they can say that, technically speaking, there is "universal access" to a government health care system.

Think again if you believe "universal access" means you will get access to high quality care when you need it. Universal access to a system is a far cry from universal access to care. Instead, as the Canadian Supreme Court – arguably one of the world's most liberal judicial bodies — pointed out in its ruling, "The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care."

Die as a result of waiting lists for public health care? Yes. Canadians wait an average of 18 weeks – 4 and a half months – for vital treatments like surgery, and there is a severe shortage of doctors, nurses and advanced, life-saving technologies. And for the privilege of enjoying universal access to waiting lists Canadians pay nearly half their earnings to the government in the form of taxes.

That is not the type of reform Vermonters are clamoring for, and that is the reason Gov. Douglas courageously vetoed this disastrous plan, and is instead promoting reform programs that protect true access to high-quality health care while reducing the costs that prevent too many Vermonters from enjoying the peace of mind that comes with health insurance.

Dr. Albert Schumacher, president of the Canadian Medical Association, called the court's ruling "a stinging indictment of the failure of governments to respond to the mountains of studies that show we need real action on our health care system."

Tell it to the Democrats in the Vermont Legislature who are attempting to block an honest discussion on health care while harshly criticizing anyone who wants to think twice before forcing thousands of Vermonters into a substandard, government-controlled system of care while charging taxpayers Act 60-style payroll and income tax hikes.

During the legislative session, they refused to give Gov. Douglas even a half day of hearings on his reform plan and completely ignored another Republican proposal to allow Vermonters to purchase the same low-cost health insurance available in other states.

Now they have established yet another costly commission heavily stacked with proponents of a Canadian-style system. They are going to pay a consultant $100,000 and they have denied Gov. Douglas even a single voting member.

Instead of looking to bring Canada's failed system to Vermont, legislators could look to other states right here in America that allow high quality health insurance options at a fraction of the cost Vermonters are forced to pay. The best way to increase access to health care is to make health insurance universally affordable.

Take Ohio, for example. A family of four can purchase a health insurance plan there for just $362 a month with a $2,500 deductible. In Vermont, a similar plan will cost the same family over $1,000 a month with a $3,500 deductible.

Allowing Vermonters to purchase health insurance out of state – just as we allow them to purchase prescription drugs from outside the country — is an option that should get a lot of attention from a commission looking at health care reform. But it will not, unless the Democratic leadership starts getting serious about working together to find a solution all Vermonters can agree on.

In order to salvage what little credibility they have left, Speaker Symington and Senate President Pro Tem Peter Welch need to make this a truly bipartisan commission and give the executive branch the equal representation it deserves. It would be a mistake to waste nearly $800,000 in taxpayer money to make this the encore presentation of the failed, partisan approach Democrats undertook during the legislative session.

Sara Gear Boyd is the former majority leader in both the House and Senate.

Back to the top

Vermont Initiative for Universal Health Access

EMAIL: wsavt@wsavt.com