Vermont leads the way

Posted Tuesday, March 22, 2011 8:51 am

LENOX

Writing about the Massachusetts health care reform program in a 2009 issue of the Wall Street Journal, Governor Deval Patrick stated, "Because of our reform, families are less likely to be forced into bankruptcy by medical costs." Both Governor Patrick and President Obama have used the benchmark of medical bankruptcy as a key measure to prove the success of their health insurance reforms.

Unfortunately, according to a study this month from Harvard University by Dr. David Himmelstein and associates, the absolute number of medical bankruptcies in Massachusetts increased between 2007 and 2009, the years after health care reform had been enacted. Dr. Himmelstein commented, "Massachusetts health reform, like the national law modeled after it, takes many of the uninsured and makes them under-insured, typically giving them a skimpy defective policy that's like an umbrella that melts in the rain. The protection's not there when you need it."

For example, in Boston, the least expensive individual coverage available to a 56-year-old carries an annual premium of $5,616 and a deductible of $2,000, and even then only covers 80 percent of the next $15,000 cost for covered services. Therefore, someone with a chronic condition like diabetes could have to pay $10,000 annually out of pocket, in addition to the premium.

Article Continues After Advertisement

The current Massachusetts heath care reform, on which President Obama has based his national reform legislation, is not adequate. Massachusetts reform has not ended medical bankruptcies in our state, a finding that strongly suggests that national reform won't reduce medical bankruptcies nationwide.

Article Continues After These Ads

While individuals, small businesses and towns struggle to pay for inadequate health care insurance, CEOs of non-profit health insurance companies continue to walk away with obscene amounts of our hard-earned dollars. Blue Cross /Blue Shield's former chief executive, Cleve L. Killingsworth recently received an $11 million payout, while Blue Cross board members individually received up to $89,000 to rubber stamp Killingsworth's compensation.

As many states and congressional Republicans look for ways to roll back President Obama's signature health care law, Vermont is moving in a different direction. During his inaugural address, Governor Peter Shumlin proposed guaranteeing health insurance to all Vermonters, noting that current health care costs "[represent] an enormous hidden tax on families and small businesses across our state. If left untethered, the rising cost of health insurance will cripple us." Shumlin has proposed the creation of a single-payer system for Vermont in which private delivery of healthcare would continue, but the government would act as everyone's health insurer.

This "Expanded and Improved Medicare-for-all" option was barred from the national health reform debate by special interest groups. By choosing a single-payer program, Vermonters would divorce health insurance coverage from employment, and eliminate the administrative waste of private insurance companies, including outrageous CEO salaries.

Article Continues After Advertisement

Dr. William Hsiao, an international expert on health care reform at the Harvard School of Public Health, was commissioned by the Vermont Legislature to conduct a study about the best way to provide universal coverage, reduce the rate of cost increases, and create a primary care-focused, integrated delivery system. Hsiao stated, "The system capable of producing the greatest potential savings and achieving universal coverage was a single-payer system -- one insurance fund that covers everyone with a standard benefit package, paying uniform rates to all providers through a single payment mechanism and claims-processing system. Our analysis showed that Vermont could quickly save almost 8 percent in health care expenditures through administrative simplification and consolidation, plus another 5 percent by reducing fraud and abuse. . . All told, we estimated that Vermont could save 25 percent in health care expenditures over 10 years."

In the national health reform debate, Vermont, not Massachusetts, now leads the way.

Susanne L. King, M.D., is a Lenox-based practitioner.