Tag Archives: Hamilton Davis

The Dangerous Drift of Vermont’s Health Care System

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When he was governor, Peter Shumlin made a big push on health care reform. It didn’t end well for reform or for Shumlin. Since then, the system has become less functional and more expensive but there’s been no appetite for another push.

With one major exception, and that’s OneCare Vermont. It has soldiered on in its effort to rein in health care costs by paying providers for outcomes rather than treatment. It has spent a tremendous amount of money, but so far there’s not much evidence of impact.

That’s troubling, and it’s more so when you read VTDigger’s piece about the latest Green Mountain Care Board meeting. Beyond that, there’s a broader critique of our health care system in a recent series of essays by journalist and health care policy analyst Hamilton Davis. Taken together, it looks like a huge sector of our economy (upon which our physical and financial well-being depends) is drifting along with a bunch of people who call themselves “Captain” staying as far away from the helm as they can.

The Digger article makes the leaders of OneCare look like The Gang That Couldn’t Shoot Straight. The GMCB, especially its new members, were asking questions that shouldn’t have been tough to answer. For instance, do you have any evidence that your system is working? Can you point to measurable results in terms of cost savings or improved outcomes?

OneCare leaders seemed to be taken aback by this line of questioning.

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Court Locks Black Box

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Do high courts do Friday newsdumps? It would seem so. The Vermont Supreme Court issued a ruling on Friday, July 1 — heading into a three-day holiday weekend — with massive implications for independent oversight of OneCare Vermont, our favorite too-big-to-fail institution, and for the state auditor’s office.

The newsdump worked like a charm. VTDigger cranked out a quickie same-day story that hit the Internet at a time when lots of people had stopped paying attention to the news. By Tuesday, July 5, the decision had pretty much vanished from public attention. A strong statement from Auditor Doug Hoffer blasting the decision went largely unnoticed. But I sure hope responsible parties in the Legislature have taken note, because something needs to be done to fix this.

The unanimous decision denied Hoffer access to OneCare’s payroll information. He had sought access after OneCare’s payroll and benefits expenses jumped from $8.7 million in fiscal year 2019 to $11.8 million the following year. He understandably wanted to find out why. It’s an issue that should concern us all because OneCare is (a) kind of a rolling experiment that’s (b) playing with massive amounts of public money for which it is (c) not very accountable at all.

I’ll get back to OneCare, our most mysterious of public sector black boxes, but first I want to discuss the Auditor’s part of this. The court ruled that the Auditor has no authority in statute or in contract to access OneCare’s financial records. It asserted that financial oversight belongs solely to the Green Mountain Care Board, which is essentially OneCare’s captive partner in this grand experiment.

Well then, I ask, what in hell do we have an auditor for?

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Shumlin doubles down on bashing fellow Democrats

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If you thought there was a chance that Governor Shumlin would tone down his insistence on last-minute spending cuts, well, think again. Earlier, he’d called two key Senate committee chairs on the ceremonial carpet to argue for tax reductions and spending cuts — in a spending bill that had already passed the Senate Appropriations Committee. This didn’t go over well with Democxratic lawmakers, per Paul Heintz:

Gov. Peter Shumlin’s erstwhile allies in the Democratic legislature lashed out at him Thursday for pushing new cuts after the Senate Appropriations Committee signed off on the budget.

“It’s insulting to the process,” complained one top Dem.

… “It’s been pretty lonely in there all winter,” Sen. Bobby Starr (D-Essex/Orleans) said, referring to the Appropriations Committee, on which he serves. “I woulda thought they would’ve been in at least a month ago, if not five, six weeks ago, offering some suggestions.”

House Majority Leader Sarah Copeland Hanzas noted that the House-passed tax and spending bills actually called for less spending than the Governor’s original budget plan. She called the gubernatorial disconnect “perplexing.”

Welp, the Governor is unbowed by all the pushback.

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So, maybe health care reform is working?

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For those of us who practice compassionate liberalism (which is actually a thing, unlike compassionate conservatism), the primary reason for health care reform is to ensure that everyone can access the services they need. But reform isn’t going to work unless it meets another goal: containing the costs of health care, which were out of control under the old system.

And here’s some good news on the green-eyeshade front, courtesy of VPR:

Vermont’s 14 hospitals have submitted budgets for the fiscal year starting Oct. 1 that increase by just 2.6 percent over the current year’s budgets, the smallest annual increase for the Vermont health care delivery system in four decades.

… The 2.6 percent inflation figure follows on the heels of a 2.7 percent jump in the current year. Taken together, the performance of the hospital system should be considered a positive augury in the coming debate over Gov. Peter Shumlin’s single-payer reform initiative.

Kudos to VPR’s Hamilton Davis for slipping “positive augury” into his script. Few radio reporters would dare so much.

Anyway, yeah, two consecutive years of low cost increases for Vermont hospitals. In fact, as Davis reports, those increases are roughly one-third the rate of increase since the year 2000. And this year’s figures came in under the Green Mountain Care Board’s target of 3 percent. GMCB chair Al Gobeille pronounced himself “very pleased” with the submissions.

It’s still early days in health care reform, but something is obviously working. And this is a “positive augury” because state law requires the government to demonstrate an ability to control costs in order for Governor Shumlin’s single-payer health plan to go forward. So far, so good.