Tag Archives: single-payer health care

Grüberdämmerung

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.

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The moral imperative for health care reform, revealed in a handful of statistics

At the January 27 meeting of the House Ways and Means Committee, Sara Teachout of the Joint Fiscal Office distributed three fairly simple charts that tell the story of our unfair state income tax system in bold relief. I’ll be examining those charts in an upcoming post, but right now I want to focus on a small slice: the deduction for medical expenses.

The first chart lists the most frequently claimed tax deductions across the top, and income classes down the left side. It tells a fascinating story about who benefits from which deductions, and how much. But today I’m concentrating on the first two columns, shown below:

Medical deduction chart 1

A couple of explanatory points. First, this data is from 2011, predating Vermont Health Connect and the Affordable Care Act. Second, I should explain the rules for deducting medial expenses. You can’t deduct health insurance premiums, just actual medical and dental expenses. You can only deduct medical expenses if they total more than 10% of your gross income, and only the portion above 10% is deductible. It’s a very high standard; you’ve gotta have some serious medical bills and no insurance (or really bad insurance) to qualify.

As you might expect, “Total Medical” is the outlier among deductions; it’s the only one claimed more often by the poor and working poor than by the wealthy. There are two simple reasons for this. The first is that the poorer you are, the less likely you are to have health insurance. The second, obviously, is the lower your income, the fewer bills it takes to qualify.

It’s no giveaway, though; if you’re making $25,000 a year, then medical bills over $2500 are enough to throw you into severe financial difficulties. A tax break on a portion of those bills won’t make you whole.

These columns reveal the hidden cost of our old health care system — the human and social cost, and the actual financial cost. Vermont is foregoing a large amount of potential tax revenue because so many people incur medical bills that eat up a significant portion of their earning power.

I don’t know if these numbers were factored into Gov. Shumlin’s calculations on single-payer. I sure as Hell hope so, because it’s a cost that’s every bit as real as a payroll tax.

As for the human and social costs, the top three lines indicate that more than half the total value of medical deductions was taken by those with incomes under $50,000. These are people who cannot afford a significant unplanned expense, because they’re barely making ends meet in good times.

Here’s the same slice from a second chart that shows the total number of filers in each income class, and the number who took a medical deduction. This shows that more than 50% of those claiming a medical deduction earned less than $50,000, while virtually no wealthy people claimed one.

Medical deduction chart 2

Now look at that top line. More than half the low-income filers qualified for medical expense deductions. That’s nearly 5,000 individual stories of illness and deprivation, of life-changing financial crises, most likely including thousands of bankruptcies. How many people lost their jobs and their homes, and saw their lives go into a tailspin, because of an uncovered illness or injury in 2011 alone?

So far, health care reform has dramatically reduced the ranks of the uninsured in Vermont. These figures show how crucial that progress is, for the stability of our society and the very lives of our most vulnerable.

These figures are also a powerful argument that we need to keep it up. We shouldn’t have thousands of poor and working-class Vermonters qualifying for this deduction. There should be none, or very few at most. That’s the goal of, and the moral imperative for, universal health care.

The Shummy Shimmy

Before the November election, I’d planned to write a post-election piece offering my services to the Shumlin administration for the newly-created position of Shitkicker-In-Chief. The duties would include pointing out the flaws in administration reasoning, deflating egos when necessary, and the occasional loud guffaw.

The idea was based on my belief (hahahaha) that the election wouldn’t be close. When Shumlin won by a shoestring, I thought my idea was irrelevant. The election was a more effective shitkicker than I could ever be.

Seems I was wrong, because the Governor has quickly fallen back into to some bad habits. One of his worst is his almost-complete inability to admit that he was wrong about something — even if it’s something trivial. It makes him appear small-minded, overly defensive, duplicitous, and condescending.

This habit is again on display in the foofaraw over releasing documents related to single-payer health care.

For those just joining us, when the governor announced in December that he was ditching single-payer, WCAX’s Kyle Midura asked a provocative question. Here’s the exchange, as reported by Seven Days’ Paul Heintz:

“Will you waive executive privilege for all backdated documents at this point related to this question so we can see what you knew when?” Midura said.

“There is nothing to hide on what we knew when, so we’d be happy to show you any documents you wish to look at,” the governor responded.

Emphasis: “any documents you wish to look at.” And Midura’s use of “this question” is generally seen as referring to Shumlin’s decision on single-payer.

Naturally, multiple media outlets made public-records requests for any related documents. And that’s when Shumlin backtracked: the administration withheld “hundreds of pages of documents related to single-payer,” reports VPR’s Peter Hirschfeld.

Shumlin never wrongShumlin says he never intended for him comments on Dec. 17 to mean that he’d release all internal communications related to single-payer.

“Now no governor ever divulges inter-staff conversations, but what we did divulge was all the data that led us to the conclusions that we came to,” Shumlin said.

Okay, I can see that point of view. But why did he promise, on Dec. 17, to release everything?

Evasive maneuvers, Mr. Sulu!

So far, we’ve heard two different explanations.

In an email to Heintz, the Governor’s legal counsel Sarah London asserted that Midura’s question referred narrowly to “the specific question of Medicaid reimbursement rates.”

On the other hand, Shumlin told Hirschfeld that he thought the question referred only to documents involved in a lawsuit by Rep. Cynthia Browning.

“Well as you know we had a fairly well-publicized court case … where we were asked to divulge all the data, studies and information about every detail that led us to the disappointing conclusions that we came to about public financing,” Shumlin said. “I assumed that his question was simply, are you going to continue to withhold that data? Or are you going to share it?”

It got even worse when Shumlin tried to clarify his position at a news conference yesterday:

“If you listen to the entire question, I answered it very clearly. And what I said was, the question I understood — I had it played back to me, so I think I got it — was, ‘Are you going to release the documents that, frankly, hadn’t been released before?’ You may recall Cynthia Browning requested them and we went to court and the court ruled in our favor. ‘Are you now going to release those documents? The documents that give us the data, all the dates, what you’ve done, all the studies?’ And I said, ‘Of course, we are. We want Vermonters to have that information.’ If you took the question as something else, you should’ve asked it that way. You didn’t.”

The Shummy Shimmy.

It’s one of his worst features: ducking and diving in a transparent effort to avoid admitting he was wrong.

I guess they could still use a Shitkicker-In-Chief.

Here’s a little free advice. Or consider it part of my S-I-C job application. Here’s what he should have said — and it’s not much different from what he did say.

“I apologize for misspeaking on Dec. 17. I should not have promised to release ‘all documents,’ because every administration needs some measure of privacy in its internal policy discussions. Any chief executive would agree with that.

“We have provided as much documentation as we can. The information we have released should be more than adequate to understanding how we arrived at our decision. I hope you, and the people of Vermont, can appreciate our position.”

There. Was that so hard?

The occasional apology would go a long way toward changing Shumlin’s image for the better. The long-term benefit would far outweigh the immediate discomfort.

 

Here’s something Governor Shumlin should stop saying

Ever since last Thursday’s inaugural ceremonies, Gov. Shumlin has been telling anyone who will listen that he was “saddened” by the presence of protesters. Like other Democrats, he singles out the one protester who crossed the line by singing during the benediction.

He has to highlight that one moron because otherwise, the demonstrators were not disruptive or offensive. They followed the rules of civil protest. The inauguration proceeded as scheduled until the very end.

Of course, what really offends the governor is that they dared to crash his coronation. The Vermont Press Bureau:

“The inauguration is an opportunity where we all say, ‘Let’s roll up our sleeves, cut out all this party stuff and get to work,’” the governor said. “And I just don’t think that they did their cause… much good by the kind of tactics they employed…”

Or in Brill Building terms: “It’s My Party and I’ll Cry if I Want To.”

The whingeing is excessive and self-centered. But I’d like to focus on one thing the Governor is saying, over and over again, that hurts his credibility. It goes something like this:

“I was really saddened by what happened yesterday, because I’m as frustrated as anyone with our health care system, and there’s no one that wants to see the goal of universal access as much as I do,” he said.

That’s from Saturday’s Burlington Free Press, but he’s been spouting variations on that theme in other outlets.

And he needs to stop. Now.

For one thing, it’s false. For another, it’s a two-sided statement: Shumlin is trying to emphasize his own political pain and loss — but at the same time, he’s downgrading everyone else’s.

Is there really no one who is more frustrated by Shumlin’s abandonment of single-payer? Is there really no one who more ardently wants to see universal access?

Of course there is.

Start within the administration itself. Are Robin Lunge or Mark Larson less disappointed than Shumlin? How about Anya Rader Wallack? Or Jonathan Gruber, who’s become a national laughingstock and has now lost his best chance to enact single-payer? There must be, at minimum, dozens of staffers and contractors who’ve put their heart and soul into Vermont’s single-payer initiative. That’s not to mention the single-payer advocates like Deb Richter and Peter Sterling, who served on the Governor’s Consumer Advisory Council and had the rug pulled out from under them.

Widening our scope, how about the entire Progressive Party, which put its own gubernatorial ambitions on hold for three straight election cycles in order to give Shumlin a free hand on single-payer? Might they be more frustrated than the Governor?

Which is not to overlook Democrats who’ve fought for single-payer. Maybe ex-Rep. Mike Fisher feels a bit of disappointment after losing his bid for re-election and then the cause he’d worked so hard for.

Finally, let’s not forget the tens of thousands of Vermonters who still don’t have health insurance, and the additional tens of thousands who still struggle to pay their premiums, in spite of the Affordable Care Act’s advancements. They are directly impacted by Shumlin’s decision in ways that he will never, ever be. He’s a millionaire who can afford any kind of health coverage he wants, up to and including concierge medicine from the Mayo Clinic.

That’s a partial list, but a substantial one. I think it’s safe to say that there is at least one person more frustrated and more disappointed than Governor Shumlin.

Whether he intends it or not, the Governor slights the feelings and experiences of all those people  when he claims special status as the number-one victim of single-payer’s demise.

As for what he should say instead, here’s a suggestion:

“My decision not to pursue single-payer health care has caused a lot of anger and frustration, and disappointed a lot of people, including many who have supported me politically. Our inability to move forward on single-payer has brought pain to thousands of Vermonters who are still without health insurance. 

“I apologize to each and every one of them. My commitment to universal access is as strong as ever, and as long as I am Governor, I will strive to advance the cause of universal access to the best of my ability.” 

There. That’s not too hard, is it?

A passel o’ peevishness on Inauguration Day (Part One)

Many a knicker was tightly knotted yesterday, judging by some of the statements made and actions taken at the inaugural ceremony.

Most of the collywobbles arose from the protest by advocates of single-payer health care. Many politicians were vocally incensed at such goings-on. And some of the protesters were shocked — shocked — that they might be handled roughly by police.

The rest of the peevishness came from Republicans reacting, even more childishly than usual, to Gov. Shumlin’s inaugural address. I’ll cover that in a separate post.  Back to the demonstration.

The folks from the Vermont Workers Center went a bit too far when they disrupted the closing benediction. Otherwise their protest was peaceful if occasionally intrusive.

The assembled dignitaries, however, just couldn’t stomach this disturbance of their sacred space. Sen Dick McCormack wins the honor for Biggest Overreaction; he called the protest “fascist.” Protip for public figures: never ever ever ever ever use the word “fascist” unless you’re talking about a violent, oppressive, murderous regime.

Sen. Bobby Starr, D-Hicktown, resorted to the “You Kids Get Off My Lawn” meme: “I think they should get a job.” Dirty hippies!

Senate Penitent Pro Tem John Campbell was among several lawmakers who told protesters they were hurting their own cause.

Snort. As if.

Two points. First, single payer is dead for the foreseeable future. Second, any lawmaker who casts a future vote because of yesterday’s demonstration is failing his/her duty.

And the Governor, speaking today on WDEV’s Mark Johnson Show, said the protesters had “hurt the cause” by showing a “lack of respect for the process.”

Awww. Would that be the same process (and the same governor) who built up their hopes and expectations for years, only to dash them all in a single moment? Shumlin reaped the benefits of single-payer advocates’ support through three election cycles, and then abruptly trashed it all.

Advocates are understandably upset about that, and the inauguration of Peter Shumlin was an appropriate time to express their outrage. It was, in fact, the perfect time. The Governor shouldn’t play with people’s beliefs, and expect to be shielded from the consequences by his sense of decorum. As a Mark Johnson Show caller pointed out, disruption is the only way for people who feel disenfranchised to make their voices heard.

So, no sympathy for the hurt fee-fees of our distinguished leaders.

Not that the protesters are without blame. The single moment where things went too far was during the closing prayer. Protesters were outside, singing. One of them, Ki Walker, entered the balcony and continued to sing. A protest organizer later claimed that Walker thought the ceremony was over. But Walker was right there at center stage. He could see that the ceremony was continuing. And he kept on singing.

Afterward, he explained himself to Seven Days’ Paul Heintz:

 “Our tone was, like, nice or whatever,” Walker said.

Duuuuuuude. 

But the Whiniest Protester Award goes to Sheila Linton, who was part of the group occupying the House floor after the ceremony. When police began trying to remove the group, very politely, she refused to move or speak. When they tried to lift her arms, she began screaming as though they were using a chainsaw. (You can see the video on Seven Days’ website.)

Okay, here’s a lesson for Vermont’s Junior Gandhis. Your commitment to passive resistance  includes the possibility of what one trooper called “pain compliance” — the application of discomfort to those who resist police action. And this wasn’t Bull Connor with firehoses and Dobermans; these were state troopers acting with restraint and deliberation. Sorry, Ms. Linton, no sympathy here.

The demonstration itself was relatively mild, Mr. Walker being a notable exception. So was the police response. People on both sides got way more upset than they should have been.

The best reaction came from House Speaker Shap Smith, quoted by the Vermont Press Bureau’s Neal Goswami:

“I think this was an incredible example of the openness of our democracy,” he said. “In the people’s house, people are allowed to petition, and I would expect that over the coming weeks, we’ll talk with people about setting up hearings.”

Measured, reasonable, respectful. Just about perfect.

(Still to come: VTGOPeevishness.)

 

Big ol’ lead airliner

There’s an absolutely devastating piece on VTDigger this morning. If you haven’t read it, go. Now.

For those who didn’t immediately take my advice, the story outlines the role Governor Shumlin played in holding a pillow over single payer health care’s face until it stopped breathing. Or, as the headline says, “Shumlin built ‘lead airplane’ for single payer.”

If the story is true, here’s basically what happened. At some point, the governor decided that he couldn’t win on single payer. Then, rather than face the music directly, he larded his single payer proposal with assumptions that added to its cost and suppressed its revenues. As the story says, “he cast the program in the most negative light possible.”

And then he walked away.

How did he do it?

Well, first of all, he presented only one plan, when he’d promised a menu of options.

Aside from that, his plan offered top-shelf coverage, paying for 94% of clients’ health care costs — a 94 Actuarial Value. He could have gone with a lower figure; “Act 48, Vermont’s single payer law, directed the administration to shoot for a plan that covered 87 percent of costs.”

So he ignored the law. Not much new there.

The 94 AV added $300 million a year to single payer’s cost.

He also chose to add out-of-state residents who work in Vermont, which added another $200 million. And he called for the elimination of Vermont’s provider tax, which cut $160 million in revenue.

He also chose to assume the new system would yield no administrative savings — which had been one of his big selling points for single payer.

You can see where this is going. Shumlin projected a first-year cost of $2.6 billion, but he could have brought in a perfectly acceptable plan for well under $2 billion.

And he knew it. And he chose not to tell us.

The massive report released by the administration at year’s end included not one, but 15 plans. But Shumlin chose to present only one.

Among the 15 different models in the document dump is Financing Concept 12, which uses an 87 percent actuarial value and would require $1.6 billion in state revenue for the first year.

It excludes out-of-state workers and does not offer supplemental coverage to federal employees or people with employer sponsored coverage, all of which is contained in the plan Shumlin chose.

It’s hard to read that and feel anything other than betrayal.

Maybe there were perfectly sound reasons for Shumlin’s choices, but he didn’t give them and he didn’t provide any options. Instead, he “buried” them in his pre-holiday document dump.

So, Vermont misses a chance at single payer. Even worse, the entire idea of single payer has been significantly set back, perhaps by decades. Because now we have a liberal governor, a strong advocate of single payer, concluding that it’s not practical.

This hurts.

Another conveniently incomplete explanation from Art Woolf

Just in time for Christmas, Vermont’s Loudest Economist has left a flaming bag of conventional-wisdom poo on our doorsteps. (At least he didn’t try to come down the chimney.)

He’s scribbled out a column entitled “Explaining Demise of Single-Payer.” Which, of course, does virtually nothing to explain the demise of single-payer. I mean, this is Art Woolf we’re talking about here.

The good professor spends most of his time on a shallow meander down Memory Lane, explaining that despite the efforts of the last three Vermont Governors, our percentage of uninsured Vermonters has remained basically the same.

Of course, Woolf’s entire argument falls apart right there, because his beloved statistics end at 2013 — before the Affordable Care Act had gotten off the launchpad. So he’s telling us that Shumlin has failed to reduce the uninsured population, even though Shumlin’s reforms hadn’t begun to work.

Sheesh.

Woolf goes on to the only useful part of his “analysis.” In recent years there have been efforts to expand Medicaid eligibility, and they have worked. However, there’s been a corresponding decline in coverage through employers, so it all washes out.

Us liberals would blame this on a worldwide, concerted effort to drive down wages and benefits — the race to the bottom, as revealed in the stagnation of buying power for all but the very top earners, the persistent crappening of benefits such as employer-provided health insurance (and the steady cost-shifting to employees by way of worker contributions, high deductibles and copays) and the virtual disappearance of defined-benefit pension plans.

Woolf, good capitalist lackey that he is, blames the loss of employer health insurance on the expansion of Medicaid.

What apparently has happened during the past 15 to 20 years is that some employers who formerly provide insurance to their workers no longer provide that benefit. Most likely, it’s because their employees can get a better coverage plan at no or low cost from the state.

“What apparently has happened,” my ass. Woolf might be justified in making that evidence-free assumption, if not for all the other evidence that employers are squeezing their workers and transferring responsibility for their well-being to the government. (See: all the Walmart employees on some form of public assistance. I guess Woolf would blame that on welfare, not on a greedy corporation.)

The toxicity of Woolf’s presentation becomes clearer in th;e ensuing paragraph:

Their employers can therefore afford to pay their workers higher wages instead of providing health insurance benefits. This is one of the unintended consequences of government policies that are all-too-often overlooked by policymakers.

Well, sure, they CAN afford to pay higher wages. But they DON’T. And Woolf knows damn well that they don’t. He must be aware that working Americans’ wages have been stagnant for decades.

And he must be deliberately excluding that fact from his presentation so he can preserve his dubious conclusion: government largesse is to blame for private-sector miserliness. If not for Medicaid expansion, he is effectively saying, working Americans would still be getting health insurance from their employers.

Working Americans can only respond with a bitter laugh.

He also blames Medicaid for the rising cost of health care: because Medicaid offers low reimbursement rates to providers, they have to charge more to private insurance carriers. Which is true, but again, it leaves employers out of the equation.

Finally, in the last paragraph of Woolf’s column, we get to “Explaining the Demise of Single-Payer.” Sort of:

The state’s Medicaid expansion now provides a backstop for lower- and middle-income Vermonters who might lose their private health insurance. This means the third goal, the fear of becoming uninsured, might have lessened over time for many Vermonters.

Perhaps that’s one reason why there wasn’t greater support for single-payer in Vermont, and why there wasn’t more opposition to the governor’s recent announcement.

Oh, so we should blame the demise of single-payer on the patchwork success of Medicaid? Nothing else at play here, Art?

To be fair, Woolf doesn’t necessarily write the headlines, so maybe he’s not responsible for the vast overpromise of this one. But he is responsible for the incomplete, one-sided “logic” that resides beneath.

Art Woolf’s weekly words of wisdom usually come to us on Thursdays. This one was published on Wednesday. Perhaps tomorrow, on Christmas Day, Woolf will favor us with his reasoned defense of Ebenezer Scrooge, and how the government’s generous provision of prisons and workhouses helped drive down wages in Victorian England.