Category Archives: Health care reform

I gotta say, sometimes it’s just nice to live in Vermont

I have often been critical of Vermonters’ exaggerated perception of their own inherent virtue. We’re far from perfect on race relations; there are subtle forms of sexism here that I haven’t seen elsewhere; and, of course, our vaunted reputation for environmentalism is largely due to forces out of our control: small population, not much industry, and lack of exploitable resources. Based on how we’ve handled Lake Champlain, or the damage done when we HAVE had the opportunity to do so (the Elizabeth Mine, the PFOA contamination around Bennington), I contend that if there was a lot of coal under the Green Mountains, we’d be West Virginia North.

But while I contend that Vermont isn’t as special as we think it is, I readily acknowledge that it definitely has its virtues. We have two examples from recent headlines, where other states are pursuing destructive, hateful paths while we quietly handle our business in a positive manner.

Example #1: the Vermont House passes — with broad bipartisan tripartisan support — a bill that would guarantee women’s access to contraception even if that section of Obamacare is repealed.

Example #2: The Agency of Education issues guidelines for supporting transgender and gender-nonconforming students.

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The Property Tax Rebellion Has Been Postponed Indefinitely

It’s common knowledge that the people of Vermont are mad as hell over the high cost of public schools. And even angrier over the Legislature’s attempt to fix the problem. The situation was so dire that Governor Shumlin and Democratic leaders rushed through a fix to Act 46’s perceived unpopularities at the start of this year’s session.

Then came The VPR Poll, which showed an astounding lack of engagement with the issue. Here’s how I wrote it up:

As for Act 46, the school governance bill seemingly reviled by all — from conservatives who want tougher spending controls, to liberals who want no restrictions — most people are, well, ehh. Only 13 percent are “very familiar” with Act 46; 44 percent are “somewhat familiar”; and a whopping 42 percent are “not at all familiar.”

… Also, despite the Act 46 uproar, a solid 51 percent support Vermont’s efforts to encourage school consolidation. An underwhelming 29 percent oppose. 20 percent say “it depends” or “no opinion.”

One week later came Town Meeting Day, and the results add more credence to the poll. Josh O’Gorman of the Vermont Press Bureau totted up the numbers, and the conclusion may surprise you.

Around the state, voters approved 95 percent of school spending plans, and approved five merger plans by wide margins, according to unofficial data from the Vermont Superintendents Association.

All told, voters approved 231 of the 242 budgets offered Tuesday, creating a three-year trend that has seen fewer budgets defeated each year.

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The VPR Poll: Everything You Know Is Wrong

Previously in this space, I looked at The VPR Poll’s reading of the race for governor. To encapsulate: Phil Scott has a huge early lead, Bruce Lisman’s in the crapper, and the two Democratic candidates are still trying to build identities with a largely uninvolved electorate.

The poll is an important snapshot of the race — really, our first since last fall, when the field was still a work in progress. But even more interesting are the issues results, which campaign builders ought to be examining closely. Because the message, as Firesign Theater once put it, is

Everything You Know Is Wrong

Well, maybe not everything, but a whole lot of things.

Issues that are supposed to be driving forces in 2016? Eh, the voters don’t much care.

Positions that could make or break a campaign? Over and over again, The People fail to conform to conventional wisdom.

Darn people!

Generally, the poll depicts a populace that’s more or less okay with how things are going and not especially engaged in politics. This, despite an ongoing barrage of doom-and-glooming by Republicans and certain interest groups.

Examples: A broad desire to stay the course or go even further on health care reform; widespread acceptance of large-scale renewables; strong endorsement of Vermont’s efforts on climate change; healthy support for the state’s school consolidation efforts; and huge majorities in favor of modest gun-control measures.

After the jump: the details.

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Another nail in Vermont Health Connect’s coffin

The vultures are circling. The wolves are howling. The diminished corpus of Vermont Health Connect is crawling across a pitiless landscape; every time an oasis appears, it turns out to be a mirage.

Things aren’t lookin’ good.

I’ve been a strong supporter of Governor Shumlin’s health care reform plan — hopefully as a first step toward single payer, or at least universal coverage of some kind. I have bought and consumed every confident reassurance ever issued by the Governor and his minions. I have, unfairly in retrospect, mocked his critics as mindless partisans. I have allowed my hope to be renewed by fresh reassurances, most recently last fall, when the administration announced that VHC had met its performance benchmarks.

Today, not so much. Today I’ve turned a corner. I remain hopeful, but the confidence is gone.

The last straw was yesterday’s article by VTDigger’s Erin Mansfield, which began like this:

An independent expert on health care strategy advised the state to spend as little money as possible on Vermont Health Connect technology in the immediate future and instead use resources to evaluate alternatives to the exchange.

Frank Petrus, a senior managing partner at Connecticut-based Gartner Inc., told lawmakers the state should stop spending money to build new Vermont Health Connect technology, try to leverage investments it has already made, and commission a study that would take three to four months.

Basically, he wants to put VHC into hospice care. Stop trying to fix it, just help it “limp along a little while longer.”

Ugh. Yeesh. Aaaaaarrrrrgh.

This isn’t coming from a free-market ideologue, but a guy with unimpeachable bona fides:

Gartner has consulted for several state health exchanges, including Vermont Health Connect, and has a great deal of experience in public sector human services.

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Mr. Miller has a hissy fit

Here’s a new one in Vermont governance: a top state official refusing to “work with” a reporter who covers his beat. Strange but true. And he put it in writing!

Dramatis personae: Lawrence Miller, chief of health care reform; and Erin Mansfield, health care reporter for VTDigger. Miller wrote a hot blast of an opinion piece in response to Mansfield’s recent article about the latest wave of problems with Vermont Health Connect, and here’s the opening paragraph:

The most recent exchange story is an extremely slanted piece of journalism. It does not tell the whole story of Vermont Health Connect, accuses me of lying, and creates an inaccurate perception. This particular column follows repeated factual inaccuracies by VTDigger’s health reporter, adding the new feature of character assassination. I give up. I will not work with her anymore.

Digger, for its part, “stands behind the accuracy” of Mansfield’s story.

I don’t know who’s right and wrong here. Maybe she overemphasized the negative, which is often the case in journalism. Non-news is, by its nature, not news. When something works, we don’t write a screaming headline about it.

But Miller’s version doesn’t pass the smell test.

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Phil Scott, blowin’ in the wind

I realize that our universally-liked lieutenant governor is new at this whole “leadership” thing. He’s unaccustomed to taking strong stands and providing firm direction. But if he wants to be Governor, he’d better start practicing. Because right now, he’s displaying the opposite of leadership on the issue of paid sick leave. And the Democrats caught him in the act.

For those just tuning in, paid sick leave almost got through the Legislature in 2015 despite the anguished howls of the business lobby. Phil Scott has been right there alongside them, raising heartfelt concerns about the impact of paid sick leave on small business.

This year, paid sick leave looks certain to pass, with some modest tweaks designed to soothe the tender sensibilities of the bizfolk. And here comes our own Braveheart, triangulating his way to the winning side.

“I like the direction it’s going, and I’m happy to take a position on it once it’s out of committee,” Scott said.

The Democratic Party took note of this and pounced. Here’s a fun Twitter exchange, screengrabbed for your amusement.

Dem/Scott Twitter exchange

Oh, snap!

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The problem with Shumlin’s latest brainstorm

On Monday, the Shumlin administration unveiled its proposed all-payer system, which would supposedly remove the perverse incentives driving up health care costs and, as the Governor is fond of saying, “pay our docs and our nurses and our health care providers for keeping us healthy, not for the fee-for-service system that we currently have.”

Sounds like a plan. But is it?

I’ll tell you this. If I was a doctor and the Shummy system goes into effect, I’m going to stop seeing overweight patients. Because contrary to the Governor’s sunny prescription…

“… doctors and hospitals would receive a set of payments for frankly keeping us alive and healthy and feeling good,” he said. “Obviously that puts huge priority on preventive care, on eating right, on exercising, on getting off the smokes, on doing all of the things that we know we should be doing.”

… the truth is, obesity is almost incurable. It doesn’t matter how much prevention and wellness support you provide, the vast majority of overweight people are never going to lose significant amounts of weight.

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Just what we needed: More bad news on Vermont Health Connect

The headline says it all, thanks to Erin Mansfield of VTDigger:

VERMONT HEALTH CONNECT IS GOING BACKWARD, STAKEHOLDERS SAY

The “stakeholders” are Blue Cross Blue Shield of Vermont and Vermont Legal Aid, an unlikely pairing to be sure. BCBS is calling for an independent review of the troubled health care exchange, and Legal Aid is fielding scores of complaints from “frustrated consumers.”

“We’re going backwards,” said Trinka Kerr, the chief health care advocate for Vermont Legal Aid. “Towards the end of last year, we were making progress. You could get things straightened out relatively quickly, and now things are more complicated than they used to be.”

Some of Governor Shumlin’s high-profile declarations of victory are now looking inoperative. The “change of circumstance” function, which was supposed to be a benchmark for VHC, had to be taken off line because it simply wasn’t ready to handle the workload. And as a result, the backlog is back!

Yes, VHC has a backlog of change orders numbering about 4,000. To put that number in perspective, VHC has a total of 33,000 customers who buy individual policies through the website.

Now, I stopped being good at math in about the seventh grade, but to me that looks like the backlog amounts to 12 percent of all customers served. Which is, in a word, dreadful.

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Oh, about that other thing happening Thursday…

As we all eagerly await the arrival of Our Benevolent Overlord Donald J. Trump and the potential shitshow of a rally in a 1400-seat theater for which more than 20,000 tickets have been issued, there’s another high-profile political event tomorrow in Vermont. That would be, of course, Peter Shumlin’s sixth and final State of the State address.

He’s set the stage with a self-congratulatory website chronicling the progress made during his tenure. It’s chockablock with conveniently-limned graphs designed to emphasize the positive markers, sometimes sacrificing the nuance of truth in the process. And he has said this last year will be a process of consolidating the advances of past years, not an occasion for new initiatives.

Which would seem to imply a somewhat minimalist address. That makes sense, given his status as a lame duck dependent on the cooperation of Democratic lawmakers who will be campaigning without him in November. However…

Peter Shumlin isn’t exactly a shrinking violet. He has used past S0S addresses as springboards for major policy initiatives. Would he really go out with a whimper, not a bang?

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The Governor prepares a soft landing

Is Peter Shumlin starting to act like a lame duck? It would seem so. To judge by this week’s paltry trinkle of news, he looks to have one eye fixed on the past and the other on his post-gubernatorial future. And he’s already given up on fixing one major debit in his administrative ledger.

As VPR’s Bob Kinzel reports, Shumlin opposes any tax increases to pay for Vermont’s burgeoning Medicaid bill, but he doesn’t want to cut eligibility or benefits either. In fact, he’s washing his hands of the whole mess.

“I don’t know which governor is going to get to solve this problem,” he added. “But I hope a governor gets to solve it soon.”

“…once I’m safely ensconced in the private sector with my lissome new bride,” he might have added under his breath.

Yeah, screw the 2016 session. The Governor, you see, proposed a Medicaid fix last year and the Legislature ungratefully rejected it. So he’s done his duty, and hereby washes his hands of the matter.

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