Health Care Reform Ain’t Beanbagby John McClaughryThe bill to put Vermont on the irreversible path toward a single payer health care system is now well on its way to the governor’s desk. The ceremonial signing may well be the governor’s answer to the pageantry of the Royal Wedding.Perhaps the most startling aspect of this four month legislative saga has been the enormous contrast between the daunting requirements of organizing the new $3 billion government program, and the limited competence of its advocates.The 2010 legislature launched the process – for at least the third time – by voting $300,000 to Dr. William Hsiao of the Harvard School of Public Health to explain how to gather all Vermonters into the grand single payer system. The Hsaio team recommended a level of health benefits thought to be suitable for Vermont’s under- 65 population. It specified the payroll tax rates required to bring in enough tax dollars to pay for the program. It claimed an astounding $590 million a year would be saved (starting in 2015) by abolishing health insurance companies.So the House Health Care Reform Committee brought out a bill that gave the Hsaio-recommended Green Mountain Care Board the power to set benefit levels and decide how much to underpay health care providers – but neglected to include any provision for raising the necessary $2 billion of new taxes. Instead, the new Board was told to take another year and another million dollars to grapple with the same questions that Hsaio had already studied.Once the eligible population is identified, the Board’s view of the “appropriate health care at the appropriate time in the appropriate setting ” spelled out, the costs of that care estimated, and the Federal subsidies added in, the Board can tell the legislature how much it will have to raise in new taxes to keep this ship above water.In the Senate, the majority Democrats won the vote of Sen. Kevin Mullin (R-Rutland ) by agreeing to require the Board at some unspecified point to announce to the world that it believes that Green Mountain Care would reduce administrative costs (whose?), contain the growth in health care costs, improve the quality of care, attract providers, and not damage the state’s economy. There is no appeal process or enforcement mechanism for these declarations.Gov. Shumlin has made it clear that he wants the new ObamaCare-mandated Exchange to be the only place anyone can obtain health insurance. In addition, liberals have long ago taken to viewing Health Savings Account plans as a conservative plot to thwart their collectivist ambitions. Sen. Vince Illuzzi (R-Essex-Orleans) offered a carefully crafted amendment that would have prevented the Exchange from exterminating the popular HSA plans. The Democrats voted it down 11-19. The Democrats also voted down an amendment from Sen. Randy Brock (R-Franklin) to advance the date for the Administration’s health care tax request from January 2013 to September 2012 . That would allow the voters to learn what’s in store for them if the governor is reelected. Only eight senators were willing to support that eminently sensible provision.It was patently apparent during the legislative debate that the backers of single payer – now relabeled “universal and unified health system” – have little grasp of the complexities involved in completely disassembling and repackaging Vermont’s $5 billion health care sector to satisfy the red-shirted Sanderistas shouting that “health care is a human right”.The Democratic legislators are marching to orders from the Shumlin health care high command. They are almost mystically convinced that the native genius of Vermonters can somehow make Green Mountain Care work. This is so even though forty years of the almost identical Canadian single payer model have produced rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and of course much higher taxation.Typical of this widely held attitude is the remark of Sen. Anthony Pollina (I-Washington): “We’re from Vermont. We’re one of the smartest states in the country, and we can figure this [single payer thing] out.” This is the same Sanderista activist whose venture to pay farmers premium prices for milk and sell it at competitive prices predictably collapsed into insolvency.As the saying goes, “politics ain’t beanbag.” Neither is health care reform, but the beanbaggers are in the driver’s seat.John McClaughry is vice president of the Ethan Allen Institute (www.ethanallen.org(link is external)). Here are two views on Vermont’s attempt to reform the health care system, one from John McClaughry of the Ethan Allen Insitute and the other from Andrea Cohen of Vermont Businesses for Social Responsibility.Businesses for Health Care Reformby Andrea CohenThe Vermont House took bold and necessary action by passing the Universal Health Care bill, H. 202. There are many businesses in this state that support reform because they believe the current health care system is unsustainable, inefficient, and unfair. Vermont Businesses for Social Responsibility is one statewide business association that believes inaction is not an option and that businesses large and small, all across the state, will benefit from an improved system.When VBSR solicits feedback from our 1,200 members the stories we hear about the current state of our health insurance system are shocking and discouraging. In addition to the burden of annual double-digit cost increases, we hear about how the current system creates a competitive disadvantage to employers who offer decent health insurance benefits when their competitors do not. As one might imagine it is hard to have the low bid on a construction job when you are paying $10,000/year for each of your employees’ health insurance when your competitor is not incurring the same cost. It adds insult to injury when the business realizes they are also paying for their competitor’s uninsured employees due to the cost shift. We frequently hear about lost opportunities; when a person does not dare leave a dead-end job to start their own business for fear of losing health insurance. Another less spoken of, but still common, situation is when an employer retains a mis-matched employee because they don’t want the employee to lose health coverage. While this is admirable it is not smart business. We also frequently hear about the tremendous amount of time and effort many businesses need to devote to exploring options and managing health insurance- this is time and effort that is being diverted from their core business functions. The time has come to decouple health insurance from employment.In addition to the obvious inefficiencies and counter-productive market signals the current system sends, from a dollars and cents perspective it is just not sustainable. Last summer VBSR surveyed our membership and we found that the cost of health insurance was the greatest obstacle to the success of our member businesses’greater than taxes, greater than regulations, greater than access to capital. The cost of health insurance was a greater barrier than any of the nineteen other choices offered. If we truly want to help Vermont businesses succeed we must take steps to move away from our employer based health insurance system and we need to start now.Here is what we know: – Health insurance continues to get more expensive for employers. 61% of our member businesses that offer health insurance pay more than the equivalent of 10% of payroll. 20% of them pay more than 20%. – Employers are responding to the increasing costs by offering lesser quality health insurance coverage to their employees. 36% of survey respondents reported they have reduced benefits in last 5 years. – Employers are asking their employees to contribute more towards their health insurance. 43% of the businesses have introduced or increased employee contributions in the past 5 years.H.202 sets Vermont on a path for reform. It sets up a process for payment reform and for reducing system costs. What H.202 does NOT do is impose a financing system’financing solutions will be tackled as part of future work. It is important that we continue to have an open and honest conversation about what this bill does and does not do so that we may improve the system to the benefit of our businesses. We need to at least be willing to explore an alternative system that the experts tell us will save us $590 million in its first year of implementation, and that will bring equity and quality health care.VBSR believes inaction will cost us way too much. Vermont has a history of using its independent and self-reliant nature to take bold initiatives. By collaboratively designing and instituting a true system of universal health care, Vermont could take a leadership role in business attraction, retention, and success. The benefits associated with doing so include a more stable and productive workforce; greater incentive to create, move, or expand a business in Vermont; improved efficiency and reduced costs throughout the public and private sectors; and a healthier population of Vermonters.Andrea Cohen is Executive Director of Vermont Businesses for Social Responsibility. She lives in Montpelier, VT.