Tag Archives: Department of Financial Regulation

Trying to Remove One Hand from Our Health Care Pocket

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If you’re unfamiliar with the term, you might think “pharmacy benefit manager” is a job title for some anonymous mid-level health insurance executive. Like, say, the guy pictured above. But no, a pharmacy benefit manager is a corporation that sticks its big fat nose into the middle of America’s misbegotten prescription drug system and snorts up all the loose cash it can.

That’s my definition anyway. If you’re a high-priced lobbyist for the national PBM trade association, things look a little different. “Pharmacy benefit managers exist for one purpose: to drive down cost of prescription drugs,” said Sam Hallemeier of the Pharmaceutical Care Management Association (PCMA). PBMs, he continued, “reduce costs for insurers and consumers, reduce waste, and improve patient care.”

Wow, I hadn’t realized that PBMs are charitable enterprises that simply want to make the world a better place.

Oh wait, they’re not. The PBM marketplace is dominated by three large firms that are owned by three of America’s largest for-profit health care firms: Caremark, operated by drugstore chain CVS; Express Scripts, operated by insurance giant Cigna; and OptumRx, brought to you by insurance giant (and sworn foe of spaces between words) UnitedHealth. These mega-corporations are in business to make profits. If their PBMs are holding down costs, you can bet your life they’re doing it for their own benefit, not yours or mine.

You may wonder when I’m going to get to the Vermont political point of this. Well, the Legislature is considering a bill, H.233, that would impose substantial new restrictions on PBMs. And while our state has a track record of disappointment when it comes to health care, this thing might actually stick.

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A Deal We’re Likely to Regret Someday

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Blue Cross and Blue Shield of Vermont is about to be swallowed whole by one of its much larger cousins. The deal seems benign and, since it holds out the promise of lower costs for health insurance, it’s virtually certain to go through.

The unintended consequences will come later. As will the intended consequences.

The proposed deal, first announced in May, is on a fast track to approval. The state Department of Financial Regulation set aside a two-week window for public comment, which closes the day after tomorrow. Next week, the DFR will hold a public hearing. After that, approval seems a certainty. The two partners have said they want to finalize the arrangement by October 1.

The deal involves BCBSVT, which I will call “Vermont Blue” for clarity’s sake, becoming “affiliated” with Blue Cross Blue Shield of Michigan, or “Michigan Blue.” And despite the seemingly collegial tone of “affiliation,” it’s a takeover. Like a shark devouring a tasty fish.

Or, to change midstream to a different animal analogy, Michigan Blue is the dog and Vermont Blue will be the tail. Michigan Blue insures more than five million people; Vermont Blue, at 200,000, will effectively be a rounding error on Michigan Blue’s bottom line.

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What Is This “Health Care System” Of Which You Speak?

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If there was an organizational chart outlining America’s process for supplying and paying for health care, it would look something like this. It’s not a “system” as much as a mare’s nest that grows more and more complicated — and less efficient and increasingly unjust — over time.

I’m guessing here, not a health care management expert or anything, but this mess has got to be costing us untold billions that might otherwise go to, I don’t know, making people healthier? There are inefficiencies, redundancies, and a massive amount of profit-skimming at every turn. That’s why other developed countries can provide much broader and more equitable coverage at a much lower cost. I have often thought that health care in America would be cheaper if we simply left big bags of cash everywhere.

Aside from the inadequacies and inequities of our “system,” there’s also the fact that it’s completely out of our control. Decisions made at high corporate levels trickle down like warm piss upon our heads, and damn but we’d better be grateful for the golden showers.

This line of thought was triggered by VTDigger’s story about likely reform efforts in the state Legislature. A story that could have been published, with alterations in the details, just about any time in the past. Yep, our health care “system” needs reform, and by God, our elected officials are gettin’ to work.

But the scope of that work will be limited indeed.

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This Map Is A Lie

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I’ve been following the state of Vermont’s travel maps for months now, and watching the grim progression of the “red zone” closer and closer to our borders. Through it all, I’ve gotten a bit of visual comfort from Vermont’s apparent exemption from the great red tide.

But, as others have noted this week, that comfort was entirely without foundation. The blue lagoon shouldn’t be blue at all; it should be a mix of red, yellow and green. You don’t get that if you just glance at the map. But if you check the fine print, you see that the three shades of blue correspond to red, yellow and green. By the standards of this map, my county (Washington) is in the red zone, the no-travel zone.

The shades of blue for Vermont are a deliberate choice by the creator of the map — the Department of Financial Regulation. And it’s deeply misleading. It feeds into our innate sense that Vermont is different, better, and at least somewhat immune from the problems that beset all the other states. Like we have an invisible, ineffable moat around our borders.

In truth, if the same color scheme was used throughout, Vermont’s counties would be roughly equally red, yellow and green. And in fact, the situation has already worsened; we learned at the Scott administration’s Friday Covid briefing that roughly one-half of Vermont counties would be colored red if the out-of-state standards were applied.

If I were to ask why Vermont’s counties were colored in blue, the response would probably be, “Well, this is a travel map, and we want to showcase the areas where it’s safe to travel from. Vermont isn’t part of that equation.”

Okay, well, maybe. But at the very least, they should use a different set of much flashier colors instead of three subtly differing shades of the same hue. Maybe orange, purple and blue?

This is the state’s travel map. But it’s also the state’s primary (perhaps only) visual representation of the spread of the coronavirus. The map should be recrafted to accurately impart that message as well.

The hottest potato in Vermont

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Our political elites are still involved in the unedifying spectacle of desperately trying to create distance between themselves and a former best buddy. Unedifying, and beggaring belief.

The best bud, of course, is alleged EB-5 scamster Bill Stenger, who still denies  — also beggaring belief — that he knew nothing about the misuse of $200 million in investor funds, and that it was all the dark-skinned flatlander’s fault. Pretty much everyone in Vermont politics has cozied up to Stenger in the past, and anyone in a position to bestow favors did so on a regular basis. Democrats, Republicans, even Bernie. (Who has thoroughly ducked the issue, his endless narrative about the evils of corporate influence notwithstanding.)

At the head of the “run away from Bill” parade is none other than our esteemed Governor, Peter Shumlin. One of his worst attributes as a leader is his extreme reluctance to admit he screwed up, even in the face of overwhelming evidence. And that makes his frantic positioning in this case all the more incredible; you can almost hear him claiming that Vermont’s handling of Stenger was a “nothing-burger.”

Yeah, that phrase will be on his political headstone, and it’s largely his own fault. He’d be better off just acknowledging unpleasant realities and accepting responsibility. Because as the state’s chief executive, he is uniquely responsible.

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Let the rewriting of history commence

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Slightly off topic: Good thing the Burlington Free Press published its advertorial piece about Q Burke (written by a Q Burke PR person) before the shit hit the fan at Stengerville. I hope the Freeploid got paid in advance, because Stenger’s not cutting any checks anytime soon. The article, identified as “NEWS,” can still be viewed on the Freeper’s website. At least for now. I’m surprised they haven’t consigned it to the dark web already.

Anyway, on with the shitshow. Unsurprisingly, Governor Shumlin has launched full-steam-ahead into a thorough rewrite of history. He’s claiming that he saw the Stenger/Quiros scandal coming before everyone else, and his administration took proactive steps to uncover the scandal and limit the damage.

Bwahahahahahahahahahaha.

If true, his response to the scandal was astoundingly muted. It looks as though he began slowly edging away from his previous boosterism for the project, which included many an international junket which saw him doing his level best to steer investors into the Stenger/Quiros web of fraud and deceit. Slowly edging away, but otherwise holding his tongue. How unlike a watchdog.

I wonder what he’d say to all those investors if he was somehow confronted by them all. Do I hear a “nothingburger”?

Perhaps I’m being overly harsh on the Guv, since he didn’t have direct oversight on EB-5 projects, he inherited the oversight process from the administratively flawless Douglas administration, and the Stenger/Quiros plan seemed like such a boon for a long-depressed part of the state. But his words today just made my blood boil.

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