Category Archives: Health care reform

For health care expansion and SSBT, a long road ahead

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Last week brought some relatively cheery news for fans of better access to health care and of the sugar-sweetened beverage tax. The House Health Care Committee passed a fairly wide-ranging bill that would help close the Medicaid gap, provide more assistance to working-class Vermonters seeking health insurance and encourage more primary care providers, among other things. To pay for all that, the Committee opted for a two-pronged approach: the revised 0.3% payroll tax proposed by Gov. Shumlin, plus the two-cents-per-ounce tax on sugar-sweetened beverages.

A good package, a nice bill. But is it a meaningful step, or simply a McGuffin? When you read between the lines of Committee chair Bill Lippert’s statement, and see the slightly shopworn look on his face, well, you start thinking the latter.

I have no illusions that what we propose will be a final product at the end of the session, but it was our responsibility… to identify and articulate priorities that could make a difference now and could be investments for the future, even in a time of tight budgetary constraints.

Glass half full, or glass half empty? I hear a guy resigning himself to the inevitable disembowelment of his bill.

Enough inference. The next stop is the Ways and Means Committee, where opinion is split on the SSBT and there’s widespread opposition to the payroll tax. After that, well, there’s a lot of room for pessimism.

There’s little appetite for raising taxes in Montpelier — or should I say “raising more taxes,” since tax increases will almost certainly be part of a budget-balancing deal. (Front runner: Ways and Means chair Janet Ancel’s plan to cap itemized deductions at 2.5 times the standard deduction.) There’s also the EPA-mandated Lake Champlain cleanup that needs funding. In this climate, it’ll be hard to justify funding the health care package as well.

Regarding the SSBT specifically, Governor Shumlin and House Speaker Shap Smith don’t like it. Really, there aren’t many real fans; some just see it as the least bad option. Most lawmakers seem allergic to the payroll tax, even in reduced form. But let’s say, just for the heck of it, that the Health Care Committee’s bill passes the House. What awaits in the Senate, that notorious den of centrism where liberal House bills go to die?

“I wouldn’t predict what a vote today would be,” says Senate Finance Committee chair Tim Ashe (more D and less P with each passing day). “I’d say they both start in difficult places in terms of a Senate vote. Individual committees may be more or less favorable, but in the whole Senate, both would struggle to pass at this time.”

Gulp. Well, I guess I shouldn’t be surprised. So I guess that leaves us with no money for enhancing our partially-fixed health care system?

“That’s an open question,” says Ashe. “There are the resources to pay for new initiatives or increased support for existing initiatives can come from existing sources or new revenues.”

Oh really? You’ve found a pot of money somewhere?

“I’ll mention just one resource. …This year, Vermonters without insurance are going to ship about six million bucks to the federal government in a penalty. Next year that money goes up to 12 to 14 because the penalty basically doubles.

“So 23,000 Vermonters will be shipping all that money to Washington, and they will get nothing for it. Question is, is there a way to help them NOT send the money to Washington and get nothing for it, but to keep the dollars here and give them something for it? I don’t know what the answer to that is, [but] it makes you scratch your head and say, ‘Well, jeez, wouldn’t it be easier if they just had insurance here?'”

Nice to see the Senator thinking outside the box, BUT… he himself admits he doesn’t know the answer to that. And even if we could somehow funnel the penalty money into health insurance, we’re talking “about six million bucks” this year and 12 mill the year after that. That’s a far cry from the Health Care Committee’s $70 million a year.

Six million, or even 12, isn’t going to buy you a whole lot of improvement. The Medicaid gap would remain painfully wide, and good-quality insurance would remain out of reach for many working Vermonters.

But that’s the kind of year we’ve got. Best to ratchet down expectations.

Of course, we’re now looking at budget gaps in the $50 million range for each of the following two years. Substantial health care reform keeps receding further over the horizon. And universal access? Rapidly approaching pipe dream territory.

The Good Ship Two-Tax leaves the harbor

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“Yes.”

That’s the one-word answer I got from House Health Care Committee chair Bill Lippert (D-’Burbs). The question? Did he consult with Speaker Shap Smith and Governor Shumlin before proposing a two-tax approach to funding health care?

As you may have heard, Lippert’s committee yesterday passed a health care bill including a .3% payroll tax and a two-cents-per-ounce sugar-sweetened beverage tax. Thus confounding the predictions of low-budget Vermont Political Observers (ahem) who thought the introduction of the lower payroll tax might be the death knell for the beverage tax.

Asked to elaborate on his one-word revelation, Lippert unsurprisingly didn’t offer much:

“…there are different points of view on different parts of the bill. That’s all I can say, really. The Governor’s made clear that he’s a fan of the payroll tax and not a fan of the sugar sweetened beverage tax.”

Of course, in this budgetary environment, the governor’s going to wind up accepting some items he’s “not a fan of.”

On the other hand, the Health Care Committee is a relatively safe harbor for the beverage tax; it approved the tax last time around, only to see it run aground in Ways and Means. So, will it be smooth sailing for the committee’s bill this year?

Nah.

“Sail through? No, it will not sail through. There are waves and shoals and whatever metaphor you want to use. I’m looking forward to it not being a shipwreck.”

At that point, we abandoned the metaphor. Point being, Lippert has no illusions about the permanence of the vessel — oops — he’s built.

He makes a good case for it, from a liberal point of view. Since the Governor reduced his payroll tax plan, the combo tax was an alternative way to fund an array of health care reforms aimed at broadening access, reducing the uninsured, encouraging expansion of primary care offerings, and further bending the cost curve.

The bill would improve available subsidies in the health care exchange for those making between 133% and 300% of the federal poverty level. Even with current subsidies, many of the working poor can’t afford health insurance. Or their coverage has such high out-of-pocket costs that they can’t afford to use it. Kind of defeats the purpose of health insurance, no?

The sugar-sweetened beverage tax, Lippertays, makes sense as a funding source for health care because it “raises revenue, but is also a way to invest in longer-term behavioral changes and better health.”

Of course, he acknowledges diverse opinions about the beverage tax, even on his own committee, and expects more of the same going forward:

I have no illusions that what we propose will be a final product at the end of the session, but it was our responsibility, and I was given the direction, to work with the committee to identify and articulate priorities that could make a difference now and could be investments for the future, even in a time of tight budgetary constraints. We may have exceeded that, but we did our best.

A number of us came into this session saying, we’re not going to be able to move forward on the universal access through single payer, but there is still reason for us to move forward in a significant way in health care.

Moving forward “in a significant way” required more revenue than the Governor’s reduced payroll tax would provide. Problem is, there’s pretty broad disagreement on the relative merits of the payroll tax and the beverage tax — across party lines. At this point, there’s no consensus on how to pay for health care reforms, or how much to pay. The likeliest outcome: a lot of the reform provisions will wind up on the cutting-room floor as legislative compromises eat away at the Health Care Committee’s revenue proposals.

The vultures descend

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Here’s a little item that I find amusing. Maybe you will, too.

At yesterday’s meeting of the House Health Care Committee, Rep. Avram Patt (D-Shap’s District) brought up the subject of those long, confusing Explanation Of Benefits forms (EOBs) we get in the mail every time we see a doctor or have a covered service or procedure done. You know, the ones nobody ever reads?

Well, Avram Patt reads ’em. And he had some questions, mainly centered on the lavish “prices” for services beyond the basics. How are those prices arrived at? Do they reflect the cost of the services rendered? Does anyone — covered or not — ever actually pay that?

He had inquired about some of this with his insurer, and been told that if an uninsured person gets a whopping bill and complains, “it’s immediately negotiated down.” And the original fee? That’s an “algorithm” — a calculated starting point for negotiations.

Short answer, in other words: Nobody ever actually pays that price, and it seems to have nothing to do with cost.

The committee wanted more information on these questions and some others, and decided to seek testimony — mainly from Shumlin administration functionaries.

But lo and behold, I look at the revised committee schedule this morning, and at 11:00 a.m. I see a lobbyist clusterf**k. Lobbyists for MVP Healthcare, CIGNA, and Blue Cross Blue Shield will be lined up, one after the other, to explain those EOBs. Presumably in an industry-friendly, “No no, it really makes sense, please don’t ask us to change” sort of way.

That’s all. I just found it amusing that healthcare industry lobbyists were so quickly available on less than 24 hours’ notice, and all at the same time.

Big Beverage’s Hired Guns pt. 2: Mountain Dew wishes and Twinkie dreams

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“When you work in this building long enough, you notice things like thread count.”              — Anonymous Statehouse scribe

The House Ways and Means Committee heard a full morning’s worth of testimony today on the proposed sugar-sweetened beverage tax. The most interesting witness, not in a good way, was one Kevin Dietly of Massachusetts-based Northbridge Environmental Management Consultants, speaking on behalf of the beverage industry. He definitely had the fineest suit in the room, not to mention bright pearly-white teeth. (Oh, and a Google search indicates that he’s a member of the Chautauqua Yacht Club. Must be nice.)

And he acknowledged, in answer to a question from the committee, that he has represented the food and beverage industries since 1986.

That’s a long time serving the same paymasters.

Dietly managed to actually travel to Montpelier, unlike his fellow soulless industry flack Lisa Katic, discussed previously. I don’t imagine it was a sacrifice for ol’ Kev, since he presumably drew full expenses and a fat hourly rate for his visit to Montpelier. (He stuck around for the full morning, billable to “Stop The Vermont Beverage Tax.”)

(This wasn’t his first trip to the Statehouse; in 2013 he testified for the beverage industry against a proposed expansion of Vermont’s Bottle Bill. Surprise, surprise.)

His testimony was a carefully-crafted web of industry-friendly statistics and studies, plus back-handed dismissals of the academic experts who’d preceded him in the witness chair. You know, the economists, doctors, public health experts and nutritionists who have consistently found that…

— Sugar-sweetened beverages are a scourge of the American diet, leading to high rates of obesity, diabetes, and other severe illnesses.

— Taxing a specific commodity invariably leads to lower consumption.

— Lowering consumption of sugary drinks will have a beneficial impact on public health and public-sector healthcare spending.

— There’s no evidence of a significant “border effect”; in fact, there’s quite a bit of evidence that any “border effect” would be minimal or nonexistent.

— The impact on employment is neutral to mildly positive. Consumption of sugary drinks goes down, but people buy other stuff instead.  The equation balances out. Plus, the tax revenue funds jobs in government or the healthcare sector.

Pish-tosh, said Dietly, slamming “academics” who live in “a different world,” a “theoretical world.” When they retreat to their “ivory towers, things get a little wacky.”

Welp, so much for scientific research. Can’t trust anything they say.

As for Mr. Dietly, when you Google his name you get a massive quantity of testimony before various legislative bodies around the country on behalf of the food and beverage industries. Here’s a sampling of The Expensive Wisdom of Kevin Dietly:

He spoke to a New York Senate committee in 2010 in opposition to a proposed beverage tax. His arguments were essentially the same, then and now: a beverage tax would have disastrous economic consequences (but he entirely leaves out the fact that consumers will substitute other items for taxed beverages, thus mitigating the dreaded financial and employment impact), and it wouldn’t have any effect on public health (carefully selected statistics cited, inconvenient ones waved away).

In 2012, California voters faced a ballot measure to require labeling of foods that contain GMOs. (The measure was defeated after a very costly “No” campaign bankrolled by Big Food.) And oh looky here: Kevin Dietly was a hireling of the “No” campaign, and offered a very high estimate of the cost of GMO labeling — as much as $400 per year for each California household. His estimate was based on the assumption that producers would universally switch to costlier ingredients in order to avoid the GMO label (a dubious assumption at best), although he admitted that “We certainly don’t know what will happen.”

Speaking to Nevada lawmakers in 2011 on the subject of recycling and bottle deposits, Dietly positioned the beverage industry as having been “among the leading packaging innovators of the past 100 years,” and touted the industry as supporting a range of programs “to promote recycling.” And then he makes forceful arguments against deposit laws. If you read through his testimony, there are striking parallels in method, style, and type of argument with today’s testimony against the beverage tax.

In 2014 he addressed Connecticut lawmakers about a proposal to expand the state’s bottle bill. He asserts that it would impose unbearable costs on manufacturers and retailers, and had the audacity to depict the deposit/refund system as “counter to the goals of sustainable recycling and materials management.”

In 2002 he spoke before a U.S. Senate committee (chaired by Jim Jeffords) which was considering a “Beverage Producer Responsibility Act.” The concept of “producer responsiblity” has been a mainstay of advancement in environmental law; in Germany, for instance, producers have cradle-to-grave responsibility for their products — from bottles to automobiles. Its economy seems to be getting along just fine, no?

But according to Dietly, such an act would have been costly to consumers and businesses, and had little or no environmental benefit. Hmm, if he thinks there’s a disconnect between the Ivory Tower and reality, I sense a greater disconnect between industry-funded experts and reality.

I could go on, but you get the idea. Kevin Dietly is a well-traveled, amply-compensated spokesflack for the beverage industry, fighting for its interests in legislative halls around the country. His testimony should be judged accordingly.

Beverage tax pipped at the post?

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This should have been a good day for the sugar-sweetened beverage tax. State lawmakers were unconvinced by Governor Shumlin’s proposed payroll tax, and many had turned to the beverage tax as a way to help close the Medicaid cost gap. Today, the House Ways and Means Committee is considering the beverage tax, and advocates on both sides are pointing to this hearing as a key moment.

(Last year, the beverage tax passed the House Health Care Committee but died on a close vote in Ways and Means. Things were looking better for the tax this year.)

But wait, what’s this? Shumlin’s posse has come riding over the hill with a revised payroll tax plan that, according to VPR’s Peter Hirschfeld, “looks to have new life” in the Health Care Committee. Fortuitous timing, neh?

The new plan is friendlier to business, cutting the payroll tax rate in half and eliminating an employer assessment on businesses that don’t offer health insurance to their workers.

Chief of Health Care Reform Lawrence Miller says the smaller tax would generate enough money to pay for Shumlin’s plan to close the Medicaid gap. Which makes me wonder how he can now accomplish this with less than half the revenue of his original plan. What got cut?

We’ll find out soon enough, as the Governor’s new plan gets an airing in legislative committees. But its very introduction may well be enough to throw the beverage tax, once again, into the dumpster.

Big Beverage can afford the very best hired guns

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Almost two weeks ago (Feb. 26, to be precise), the House Health Care Committee held a hearing on the health impacts of sugar-sweetened beverages. There was an interesting name on the guest list: Lisa Katic, registered dietician.

Registered dietician speaking on behalf of the American Beverage Association, the trade group that includes Coke, Pepsi, and other mass-market sugar peddlers.

Seems like an odd juxtaposition: a professional dietician talking up sugary beverages.

Sold my soul for a Beltway consultancy.

Sold my soul for a Beltway consultancy.

Which led me to take a closer look at Lisa Katic. Basically, she’s the #1 dietician-for-pay for the food industry. She has her own DC-based consultancy firm, and her clients include the American Beverage Association, the Snack Food Association, and the Grocery Manufacturers Association.

Before she hung out her own shingle, she was on staff at some of the largest Big Food interest groups in the country. In short, she’s made a very lucrative career out of selling her professional credential to the highest bidders.

Further down the page, I’ll tell you about a fascinating talk she gave in 2009 before an industry group. But first, her testimony to our humble legislative committee, delivered by speakerphone.

Her carefully curated pitch: Obesity and diabetes need to be addressed, but taxing a single class of food will do nothing to prevent the twin scourges of the American way of eating. Which ignores a growing body of evidence that beverage taxes do, indeed, have a pronounced and immediate impact on consumption. See, for example, the first year’s returns from a beverage tax imposed in early 2014 by the Mexican government. (Katic brushed off a question about Mexico’s experience, claiming not to have “seen specific data.”)

Not to mention the obvious effects of tobacco taxes: price goes up, consumption goes down. It’s a pretty clear and direct link.

Her next pitch: Sugar-sweetened beverages are one small part of the problem, accounting for “only six percent of the calories in our diet.” Which may be true, but I’ll bet you dollars to (ahem) donuts that sugary drinks would figure much more prominently in the diets of our overweight population.

Katic also parroted the party line in saying that the real problem is the “severe imbalance between calories consumed and physical activity.” This is straight out of Big Beverage’s PR strategy. See its “Mixify” campaign, which touts a balanced approach to life including the occasional shot of sugary drinks. And which is full of buzzwords aimed at millennials: “the deets,” “#Realtalk,” “emoji,” “that bod of yours,” Mixify is your “balance wingman.”

Her point is true, but she undercuts her own argument by saying that a modest reduction in calorie intake, plus more activity, can make for a healthy lifestyle. For sure. But the flip side is that cutting out the soft drinks would have a modest effect per day and a massive impact over time.

Immediately following Katic’s testimony, the committee heard from Kelly Brownell, one of the nation’s leading experts on the subject, a former Yale prof who’s now a dean at Duke University. He hadn’t heard Katic, but he pretty much knocked her “facts” into the nearest trash bin. He pointed to “very strong scientific evidence tying added sugars to obesity and diabetes.” He said a beverage tax “makes all the sense in the world,” because “the largest percentage of added sugar comes from sugar-sweetened beverages.”

In other words, it might be only six percent, but that’s a huge part of the problem and a very simple fix.

Brownell also testified about research indicating that sugar may have the same effect on the brain as “traditional substances of abuse,” triggering increased tolerance and need for sugar, plus withdrawal symptoms.

And he cited economic projections showing that an increase in beverage prices would, indeed, reduce consumption.

And now, let’s close the Katic/Brownell circle.

In 2009, Lisa Katic gave a talk to the National Institute of Animal Agriculture, a subset of Big Agriculture. She was there to provide an overview — a sort of “know your enemy” briefing — of the top activists opposing the interests of Big Food. (Audio of her talk can be found on Swinecast, an appropriately named podcast service of the pork industry.)

One of her targets was Kelly Brownell. She said he’d been “instrumental… in drawing parallels between the food industry and the tobacco industry” in their response to rising health concerns. Deny, delay, and deflect, basically.

In discussing Brownell, Katic told her Big Ag audience that “there are people who want nothing more than to line up CEOs of food companies or commodity groups and haul them in front of Congress and be able to grill them like they did with the tobacco companies.” And, she concluded, “Kelly Brownell is one of those people.”

Which, in her mind, is a bad thing. You can draw your own conclusions.

Katic’s other targets included Marion Nestle, Michael Pollan, Alice Waters, and Eric Schlosser. She lamented the fact that Schlosser’s book “Fast Food Nation” is required reading in some college courses, “which is a problem.” In discussing Waters, she mispronounced the name of Waters’ groundbreaking restaurant — “Chez Panay.” And she even slammed the American Dietetic Association; of one of its subgroups, she said, “They’re not always talking about sound science.”

Katic’s definition of “sound science” is analogous to that of climate-change deniers. Nothing that threatens her clients’ interests is absolutely proven, the real problem lies elsewhere. She’s smart enough to acknowledge problems with the American diet, but she’s bought and paid for enough to try to deflect attention elsewhere.

When Katic testified before the Health Care Committee, she was billed as a representative of the American Beverage Association. But committee members seemed unaware of the depth of her ties to Big Food, or her career-long track record of defending the interests of her paymasters. She is a very well compensated mouthpiece for Big Food, Big Beverage, Big Snack, and Big Agriculture, and her testimony should be evaluated in that light.

Single-payer price tag: the dollars matter less than what they bought

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Another fine “Fair Game” column by Seven Days politimeister Paul Heintz, most of which is an attempt to put a price tag on Gov. Shumlin’s failed pursuit of single-payer health care.

The takeaway number: $2 million. But that comes with some major cutouts; if you changed the ground rules, you could come up with a much higher number.

Heintz sought that number for ten weeks before the administration finally came up with it. And after all that time, all they did was add up two numbers: $597,000 to ten consultants, and $1.33 million spent on the governor’s Office of Health Care Reform.

However… the consultants and the OHCR weren’t the only people who put in time on single-payer. Work was also done by staffers in “10 offices, departments and agencies.” There was lobbying and flackery on behalf of single-payer. And many millions were spent on the Green Mountain Care Board and other entities that might not have existed, or been nearly so expensive, if not for their work on single-payer.

So, $2 million. Or a lot more, your choice.

The big question, though: was that too much? And the answer is, it depends.

If it was spent well and wisely, then $2 million or even $20 million would be a perfectly reasonable investment in research on a huge policy initiative. If it was spent poorly, then $2 million or $2,000 would be a waste.

So it depends. If you oppose single-payer, it’s an outrage. If you favor single-payer and believe the governor did his best, it’s reasonable.

And if, like me and many other single-payer supporters, you have your doubts regarding the administration’s performance, then that $2 million figure will make you a bit more queasy about the whole enterprise.

Urp.

Not all businesses think alike. Or, Mr. Barlow, your table is ready.

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We have a winner in theVPO’s first-ever giveaway.

In some secluded rendezvous…

In some secluded rendezvous…

As you may recall, earlier this week the Lake Champlain Regional Chamber of Commerce made an ass of itself: one day, its president issued a clarion call for action on Lake Champlain, and the next, its lobbyist strenuously insisted that the LCRCC would fight tax increases to fund cleanup efforts.

Hypocrisy, thine initials are LCRCC. Anyway, in light of that, I offered a free dinner to the first lobbyist who accepted a measure of financial responsibility for his/her group, industry, or membership.

Well, we have a winner, and it’s just who you might expect: Dan Barlow of Vermont Businesses for Social Responsibility.

Dan didn’t nominate himself; a friend in the media, who’d just love to see me spend my money, pointed out to me that at a Statehouse press conference yesterday, Barlow (speaking for VBSR) endorsed Gov. Shumlin’s proposal to close the Medicaid cost gap through a payroll tax. I wasn’t at the presser, but Barlow’s statement has been reported by VTDigger, which is good enough for me.

So Dan, if you want to strap on the ol’ feed bag, let me know.

This brings to mind something that’s been bugging me for a few days. On Monday, the usually impeccable Anne Galloway of VTDigger posted a story entitled “LEGISLATIVE MANDATES HAMPERING RECOVERY, BUSINESS GROUPS SAY.” The story recapped the usual litany of complaints about taxes and costs and regulations — and that hoary old chestnut, “uncertainty.”

Which is just bullshit. Life, by its very nature, is uncertain. Potential legislative changes are one of the smaller aspects of it. To cite just one obvious example: the price of oil. Who predicted its nearly 50% drop in recent months? That alone plunged a fatal dagger into Vermont Gas’ pipeline to Ticonderoga. Fuel costs are a much bigger factor in running a business than anything the legislature might reasonably do.

Galloway’s piece could have been written by a functionary in Jim Harrison’s back office, so one-sided was it. The only note of dissent was a brief comment by House Speaker Shap Smith in the very last paragraph.

Now, you could make an argument for this article as part of VTDigger’s ongoing coverage of the legislature: let’s take a look at how business groups are feeling about the course of the session. Other views will get a hearing elsewhere.

But even on that narrow pretext, the article falls short. By focusing on The Usual Suspects, it fails to reflect the range of views within the unmonolithic “business community.”

It doesn’t, for example, quote VBSR. Not even a little bit. It doesn’t quote business types like Small Dog’s Don Mayer or Fresh Tracks Capital’s Cairn Cross, who have much more nuanced views of the potentially positive role of government in economic development. It doesn’t mention former State Rep. Paul Ralston of Vermont Coffee Company, who’s chairing Shap Smith’s working group on improving the economy. It sure as hell doesn’t quote Ben Cohen or Jerry Greenfield.

EVen if you accept the premise that an overview of the business community is a worthwhile use of VTDigger’s media platform, this article was woefully incomplete. A rare FAIL for a diligent and trustworthy news source.

Grüberdämmerung

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Ah, Jonathan Gruber, the gift that keeps on taking.

The latest twist in this uncomic opera: Auditor Doug Hoffer has examined Gruber’s invoices for consulting work on behalf of the Shumlin adminstration, and found them seriously wanting.

In Hoffer’s words, his review of documents “raised questions about Dr. Gruber’s billing practices and the State’s monitoring and enforcement of particular contract provisions.” More:

Dr. Gruber’s invoices referred only to “consulting and modeling” and offered no details about specific tasks. In the broadest sense, those three words describe the work performed, but such generalities do not appear to satisfy the intent of the contract.

It’s like taking a math test where you’re asked to show your work, and you turn in a sheet with “WORK” in big letters on an otherwise blank page.

Hoffer further states that top Shumlin officials Robin Lunge and Michael Costa “were aware of the need for more details in the invoices, but approved them nonetheless. … [they] had an obligation to request additional detail from Dr. Gruber, and they failed to do so.”

Gruber’s first and second invoices raise suspicion because each showed the same round number of hours worked (100 for Gruber and 500 for research assistants). Hoffer judges the round figures, and the fact that two invoices totaled exactly the same, “implausible.” He concludes that the administration “ignored the obvious signs that something was amiss.”

To me, this is the real Gruber scandal. The conservative shitfit over a handful of intemperate remarks — made during a period of years in which Gruber must have spoken on the record hundreds of times — was nothing more than political opportunism by the opponents of health care reform. But this?

Even if Gruber was invoicing to the best of his ability, it certainly reveals shoddy management by the Shumlin administration. Which is, unfortunately, of a piece with the administration’s general performance on health care reform. Did they take a relaxed approach to spending money because so much of it came from the federal coffers? Perhaps.

Here’s another fact that reinforces my interpretation. Late last year, Gruber submitted two more invoices. In an email to Hoffer earlier this month, according to VTDigger’s Morgan True, Lunge wrote that the administration was “no longer satisfied with the level of detail provided” in those later invoices.

Why “no longer”? Because Hoffer was examining the invoices and they knew they’d be embarrassed? If there’s another explanation, I’d like to hear it.

There are other problems, as reported by True: Tax documents appear to show that Gruber actually paid his research assistant far less than the amount received from Vermont for the RA’s work. DId he pocket the rest? Did the state’s lax oversight let him get away with it?

I’m a liberal, and I’m strongly in favor of universal access to health care. Our current system is an expensive stinkin’ mess, and no amount of wrongdoing by Gruber or others will convince me that reform is a mistake. But in my book, my fandom only feeds my desire for sound management by those we’ve empowered to enact reform on our behalf, and with our dollars.

The Gruber fiasco makes me wonder about the administration’s oversight of all the other consultancies associated with the reform effort. And, for that matter, its handling of the entire process.

Hoffer has referred his findings to Attorney General Bill Sorrell, who says Gruber’s invoicing raises “major questions.” He says he will meet with administration officials to see “what evidence and records are available to justify the billing amount.”

On behalf of health care reform supporters, and those who backed Peter Shumlin because of his promises to institute unversal coverage, all I can say is I hope there are no more shoes to drop. I fear that we’re only just getting our first peek inside the closet.

Revenge of the Slummin’ Solon

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Aww, just when I thought we were rid of the guy, his tainted legacy comes back to haunt us.

GalbraithI speak of the person formerly known as The Most Hated Man in the Senate, Peter Galbraith. In a building full of people convinced that their shit don’t stink, he stood out for his towering self-regard. He saw himself as a master lawmaker and deal-broker, when in fact he was an egotistical meddler always willing to block the process if he thought things could be done better.

By which I mean, of course, that things should be done the way he wanted them done.

One of his more notorious episodes is now making life more difficult for his former Senate colleagues, who now have to relitigate the aid-in-dying law because of a classic Galbraithian power play.

Back in the spring of 2013, after an exhaustive debate across multiple sessions, the state legislature was poised to enact a bill that would have allowed terminally ill patients to seek lethal medication under strictly controlled conditions. The version that passed the House was modeled on Oregon’s successful law.

The Senate vote was expected to be very close. And at a crucial moment, Galbraith and another guy I’m pleased to call “former Senator,” Bob Hartwell, forced a radical rewrite of the bill that basically stripped away all the controls and protections. Galbraith was the driving force behind the idea; he wanted aid-in-dying without any state controls. The idea appealed to no one else, but he refused to budge. In the end, a House-Senate conference committed settled on a Frankenstein monster of a bill that imposed Oregon-style protections at first, but is set to remove them in the year 2016.

It was a ridiculous bill, but it did get aid-in-dying onto the books. And by all accounts, it’s been a success so far: very few people have used it, and even fewer have actually taken a fatal dose, but it does provide a safety valve for those truly in extremis without posing any visible danger to anyone else.

It works. But because of the Galbraith-Hartwell maneuver, the bill has to be reopened this year. Otherwise, we’d enter a Wild West situation, as the Vermont Press Bureau’s Neal Goswami outlines:

If the law is not changed, physicians will no longer be required to tell patients in person and in writing of their diagnosis, prognosis, range of treatment options, risks of taking medication and probable result of taking medication.

Nobody wants that. But thanks to Galbraith and Hartwell, the issue has to be reopened. This week, the Senate Health & Welfare Committee held a hearing on a bill that would continue the current protections beyond 2016. This has given opponents of aid-in-dying a second crack at killing the legislation. According to Goswami:

… opponents of Act 39 will look to repeal it and have allies in the Legislature who will sponsor amendments with that purpose when the legislation to keep the safeguards hits the Senate floor.

Great. We spent endless hours debating aid-in-dying and arrived at a substantial consensus. The resulting bill has worked as intended. But now, in a session already overloaded with contentious issues like the budget, taxes, Lake Champlain cleanup, education reform, and health care, we may have to live through a repeat of the 2013 debate.

And we have Peter Galbraith and his running buddy Bob Hartwell to thank for that. I really, really hope we’ve seen the last of those two assclowns.