Dean still had NO plan, and this report clearly points that out. THey state that the best way, perhaps the only way to do what is recommeneded is a single payer plan.
D. We do not have a health care system in Vermont.4 That means:
1. No one is in control.
2. No one is responsible for ensuring that high-quality medical care is adequate for the needs of the public.
3. No one ensures that medical charges are appropriate or that they are paid in full.5
4. There is a "disconnect" between the consumer receiving health care and the entity paying the bill. Consumers are shielded from the cost of the service.
5. There is no global budgeting or targeted growth planning for health care in Vermont.
6. There is little in the way of public accountability for the performance of health care institutions, or for their long-term planning.
7. Although administrative costs, including those associated with government paperwork burdens, have reached an unacceptable level, no one has been able to do anything about it.
E. This commission does not recommend the Single Payer option, even though we have been told by The Lewin Group that it could cover all Vermonters, including more than 51,000 currently uninsured, for 5 percent less than what we are collectively paying now.6 Some of our opposition is on philosophical grounds, but in practical terms, we reject that option for a variety of reasons, including:
1. Concern over the negative financial impact on small employers and wage effects on employees in terms of reduced wages or lost jobs (assuming that most program costs would come from a payroll tax).
2. Concern over whether, in the American historical political context, it would be possible for government to control costs and utilization.
3. Doubt that program funding would be maintained at an adequate level so as not to place health care institutions at financial risk and cause providers to leave the state.
4. Belief that the political consensus necessary for implementation does not exist.
F. In the alternative, we have proposed a number of initiatives that would collectively address many of the problems of health care availability and affordability. Among our recommendations are measures
1. To promote personal responsibility for health behaviors.
2. To curb excessive administrative costs.
3. To offer health care availability and affordability to more people by extending Vermont Health Access Plan coverage with minimal damage to the commercial insurance market.
4. To strengthen the insurance market and promote the possibility of more insurers offering health insurance.
5. To enhance education and critical thinking about health and related topics.
6. To curb unnecessary health care utilization.
G. We also recommend that the Legislature take greater responsibility for ensuring the availability and affordability of health care in Vermont.7
H. We recognize that many of the availability and affordability problems in Vermont require federal solutions,8 and we include with this report a letter to our Congressional Delegation with recommendations for federal action.
I. This commission is united in our belief that decisive action must be taken by the Legislature in the immediate future, and that new and unprecedented ways of approaching the challenge, including those presented here, must be given careful consideration.
III. Context of the Problems
This outline is presented as a frame of reference for the problems we identify and the recommendations we present elsewhere in this report. We understand that is not a complete treatment of the subject, but we offer it as a guide to understanding the context of our discussions.
A. By conventional measures, the quality of health care in Vermont is considered to be good.
1. As is the case in any state, quality varies significantly by location, by provider sector, and by availability of competent professionals and paraprofessionals.
2. The methods of measuring health care quality in Vermont are limited. Vermont creates and has amassed significant amounts of health care data, but has not yet learned to use these data to drive decision making. Policy makers have inadequate information about
a. Basic system-level outcomes.
b. The relationship between quality and financial incentives offered by vendors, insurers and others doing business in the health care economy.
B. The health care economic sector in Vermont, now exceeding $2 billion, has grown to a size comparable to the size of state government;9 unlike state government, however, its spending decisions are not legislated or subject to gubernatorial veto or similar consequences, nor are they subject to public stewardship controls such as the state government's Capital Debt Affordability Advisory Committee.
1. One partial exception is the Public Oversight Commission's review of hospital operations.
a. There has never been any overall assessment, however, of the appropriate range of services to be offered by Vermont's 14 community hospitals.
2. Health care spending is rising far faster than personal income or government revenue.10
3. Like others in the United States, Vermonters pay considerably more per capita for health care than do people anywhere else in the industrially developed world.11 As noted above, we now spend more on health care than we do in state revenues to support state government.
4. The current health care financing arrangement employs a combination of public and private funds and direct and third-party payments.
C. Vermont provides government coverage intended to be sufficient to ensure financial access to health care for children, pregnant women, and new mothers.
D. Vermont ranks among the highest in the nation in the percentage of residents who have health care coverage.12
E. Most patients in Vermont aren't directly responsible for the actual costs of their health care.
F. The financial access to health care varies enormously. For some people, there are minimal financial barriers to obtaining necessary care. For others, necessary care is financially inaccessible.
G. With significant exceptions, Vermonters have enough health care facilities and personnel to serve their needs. The chief exceptions are related to shortages of primary care practioners in some rural parts of the state, dentists in some areas, physicians in pediatric subspecialties, nurses and nursing assistants.
H. Generally speaking, Vermont's utilization rate for medical care is below the national average and the national utilization rate is the lowest in the industrial world.
1. Vermont inpatient hospitalization rates are below the national average. Data on outpatient utilization are incomplete.13
2. U.S. hospital utilization rates are the lowest in the industrialized world.14
3. Vermonters on Medicare visit the doctor less frequently than do Medicare recipients in any other state. Data on doctor visits by non-Medicare patients are incomplete.15
4. U.S. citizens in general visit the doctor less often than do people in any other industrialized nation except Britain.16
5. The relationship between higher utilization rates and higher health care and coverage costs is complex. In certain areas of preventive care, for example, curbing utilization does not necessarily curb costs.
6. Of those who seek health care, a very small proportion uses a very high percentage of our health care resources.17
7. Even greatly decreasing utilization rates among the larger portion of the population that is healthy would have limited effect on care and coverage costs, since these are not the people using most of the health care resources.
8. The intensity of care, another aspect of utilization, clearly affects costs. "Intensity" refers to the substitution of a more expensive procedure or treatment for one that is less expensive. MRIs, for example, are more intensive (and more costly) than X-rays, and brand-name drugs tend to be more expensive than generics.
9. While increased costs attributed to utilization can be caused by the increasing use of high technology equipment and procedures, this increasing use can also result in higher quality of care.
10. In general, neither lower nor higher utilization rates are reliable indicators of appropriate care.
I. Vermont adopted community rating in the early 1990s to assure that all small businesses and individual Vermonters have access to health insurance at rates generally available in the marketplace without discrimination based on health status or, within certain parameters, age.
1. Some insurers withdrew from the Vermont market because they did not wish to compete in a community-rated marketplace where they were required to insure all types of risks at similar rates.
2. Community rating has the effect of lowering costs for older people and those with medical conditions while raising them for younger, healthier people. It does not provide incentives to avoid freely chosen risky behaviors.
3. Higher prices for younger people and for businesses with a young, healthy workforce may result in their foregoing insurance entirely, or, in the case of small businesses, in their choosing to self-insure.18
J. Government regulation limits market forces in both health care and health care coverage for certain policy purposes. Limitations are imposed, for example, to make private coverage available for people with medical problems and to spread the cost over the insured population.
1. Vermont ranks about average in the nation with respect to the number and scope of its insurance mandates.
2. Government regulation has not achieved the goal of satisfactorily controlling costs.
http://216.239.37.100/search?q=cache:aC9QzqwOEmkJ:www.state.vt.us/health/commission/docs/report/mainreport.doc+%22Howard+Dean%22+%22Incentive+Plan+for+Medicaid%22&hl=en&ie=UTF-8Since this is a GOVERNMENT document, it is permissable to publish large sections of it.
Regardless, This plan points out that Dean nas NEVER had a plan for Vermont he killed the original planfor universal health care by threateneing a veto to the single payer plan. His own ideas for a multipayer plan had even LESS support than the single payer planned and got killed before it even left the Vermont House of Representatives. So Dean killed his own baby, because he wanted a plan that force all small employers to provide health insurance to all employees, even if these were small mom and pop businesses hiring a kid to do deliveries and could not even afford Heal INsurance for themselves, much less an employee.
Virtually all the coverage provided to people without insurance, which before Dean became governor 90.6 percent of the state had coverage, and by the date of the report above. 91.4 percent were covered. At this incremental rate of .8 percent increase in ten years, Deans incremental methods would take 0ver 100 years to provide 100 percent coverage in Vermont alone.
Vermonters, getting sick of Deanfailing to keep this pact for universal health were fairly sick of him by 2000, betweeen the Republican attacks on Civil Unions, and the losses to the Progressive PArty due to Deans conservatism, Dean himself feared that he would not get the 50 percent vote required, and the decision would be made by secret ballot in the legislature...the REPUBLICAN legislature.
So Dean again PROMISES health care by 2002:
Dean promises health coverage for all by 2002
October 4, 2000
By FREDERICK BEVER Vermont Press Bureau
BURLINGTON - Gov. Howard Dean on Tuesday unveiled an ambitious goal for Vermont's health care system - enactment by 2002 of a plan that would lead to health insurance coverage for every state resident.
Appearing at a press conference at the Burlington Community Health Center, Dean said he would build on proposals expected from a $1.3 million, yearlong study of Vermont's health care system aimed at finding ways to get insurance to Vermonters who currently lack it.
"It will allow us to look at the infrastructure essentially for going to universal health care for all Vermonters," Dean said. "It's a complicated subject; $1.3 million is a lot of money, and I think we ought to be able to figure out how to solve the problem. ... We're going to look at some innovative things."
Those innovations might include a state subsidy to help small employers buy health insurance for their workers, or the expansion of federal or state health insurance programs. Although the study will emphasize building on existing programs, it may also include consideration of more radical changes, such as the "high risk pool" and "single-payer system" advocated, respectively, by Dean's Republican and Progressive opponents.
http://www.geocities.com/dmmead/2002/sc0110.htmlhttp://rutlandherald.nybor.com/News/State/Story/13593.htmlTHis time he adds a vague statement about helping small businesses with grants to assist them. But as soon as the election is over, the promise is forgotten:
But by 2002, what is Dean doing:
Slicing the state budget
By Tom Zolper
Free Press Staff Writer
MONTPELIER -- When the state's economy drooped this fall, Gov. Howard Dean huddled with his cabinet members to deliver a sober message: Prepare to diet.
In weight watchers' language, all state agencies were instructed to plan to lose up to 10 percent of their body weight. The good times were over.
When legislators return to Montpelier on Tuesday for the opening of the session, they will find the state's finances in worse condition than when they left in June. Money from tax collections flattened this fall just as costs for schools, road projects and government health-care programs were climbing.
Lawmakers will make difficult decisions on spending and taxation, some for the first time in their careers. Dean will ask them to go along with his austerity program. But crowds of Vermonters and special interest lobbyists also will warn about the consequences of budget cuts.
http://www.geocities.com/dmmead/2002/sc0110.htmlAnd these are among Denas recommended cuts:
Governor’s Budget Cuts Medicaid Programs
Governor Howard Dean, in his eleventh and last budget address, cut several Medicaid programs including prescription drugs, dental care and vision services. Dean told lawmakers times a tough and sacrifices had to be made.
The Dean budget for FY 2003 is $891 million in state spending, one percent more than the state expects to spend this fiscal year but nearly 3% less than the budget passed last year ($916 million). Revenues this year are expected to be $50 million below budget. Dean wants to use the "Rainy Day" fund to cover some of the $50 million shortfall but does not want to tap that fund for FY 2003. Next year’s budget is based on revenue estimates of $893 million.
If passed as presented, Dean’s budget would:
Eliminate the VScript Expanded Program.
Reduce the Vermont Health Access Plan pharmacy benefit.
Increase the co-pay up to $750/year for medicines under both the VScript and VHAP pharmacy programs. (Those eligible now pay only a few dollars for each filled prescription).
Eliminate the Medicaid dentures, chiropractic and podiatry programs.
Reduce the adult dental programs (cover pain and suffering only, not preventative care).
Add a 50% co-pay to adult vision programs.
Add a $250 co-pay per admission to VHAP inpatient hospital benefit.
Reduce the hospital outpatient payment by 10%.
Establish a hospital outpatient co-pay of $25.
These cuts would save about $27 million, $11 million in state money. Few advocates for the elderly are happy with the budget and have vowed to restore the money lost to these programs. A coalition of over a dozen advocacy groups held a rally and press conference at the Capitol building to denounce the budget cuts.
Dean also reminded lawmakers that they failed to pass a cigarette tax increase last year and suggested the 67 cent tax increase should be passed this year. Currently the Vermont cigarette tax is 44 cent/pack. Opponents of increasing the tax argue that this is, at best, a short term solution, especially since the number of smokers is declining. Opponents also complain that a higher tax would put the businesses along the Connecticut River at a huge disadvantage with New Hampshire because this increase would put the Vermont tax considerably higher than the New Hampshire tax. Proponents of a higher tax argue that a higher cigarette tax not only would provide badly needed money but also would discourage teenagers from smoking. Most studies show that high price is the most important factor in reducing teenage smoking.
http://vnavt.com/vahhavoicewinter2002.htmDean IS offerd ALTERNATIVES. INcome tax increases. Thje exact same program that was passed by Governor Snelling before he dies, and which got rid of the budget deficits Dean inherited. He laso inherited the actions that reduced them, but Dean is careful not to give the credit to Snelling, to whom it is due:
Progressives call for higher taxes for rich
January 25, 2002
By JACK HOFFMAN
Vermont Press Bureau
MONTPELIER — Vermont Progressives renewed their call Thursday for higher taxes on the wealthy in order to avoid some of the budget cuts that Gov. Howard Dean outlined earlier this week.
The Progressives said their proposal was designed to mirror the surcharges adopted during that last budget crisis, but they have not proposed an expiration date for the new surcharges.
Dean reiterated his opposition to raising the income tax shortly after the Progressives unveiled their tax plan. Dean contends Vermont’s marginal income tax rate — that is, the top rate paid by those in the highest income brackets — already is too high.
http://timesargus.nybor.com/Legislature/Story/41293.htmlFar from being a man of vision, Dean is so conservative, and wrapped so tighly into that conservativism to return to the VERY methods that worked a decade earlier and which he takes credit for.
Finally, the Senate, decides trhat Dean is so conservative and so in league with republican ideas, that they just override him and pass a budget that adds money and gets rid of some of Deans cuts:
Senate adds money to budget, angers Dean
May 9, 2002
By ROSS SNEYD The Associated Press
MONTPELIER — Senators passed a 2003 state budget Wednesday that the governor made clear he would veto if it ever reached his desk.
Just hours after an angry Gov. Howard Dean leveled a series of charges about how irresponsible he believed the Senate, controlled by his fellow Democrats, was being, senators did precisely what he warned them not to do.
Even the governor’s closest allies in the Senate ignored him. Sen. Nancy Chard, D-Windham, recommended restoring $440,000 to one of the pharmaceutical assistance programs and the Senate voted 22-7 to go along with her.
“I’ve become convinced that we have a philosophical difference between the governor, the Republican House and this Senate,” said Senate President Pro Tempore Peter Shumlin, D-Windham.
“The governor and the Republican House want to balance this budget on the backs of our most vulnerable Vermonters. The Senate wants to balance this budget on the backs of the pharmaceutical companies who are charging too much for drugs.”
http://timesargus.nybor.com/Legislature/Story/46513.htmlSorry, Deans economic conservatism, and his entire nature is one of a man who is TOO fixed in his opinions to change when change is needed.
Nothing has ever come out of anything conservative. It takes a liberal and progressive nature, and a liberal and progressive politician to be bold and courageous enough to let go of ones own opinions quickly and respond rapidly in a crisis. Dena just does not have than nature, He is a one trick pony. He knows only one anwer an applies it to every problem. That is Cut taxes, Cut spending.
Thats the same answer that George W. Bush has for everything.
Months ago I posted that Dean will eventually start backing away from Universal Health care, and strt the same old incremental crapola. Sorry with now more thna FIFTY million people witout health insurance, ands prices raising so fast for others that they frequently do not get treated, even with insurance, because they cannot afford their share of the payments, an incremental answer is not the right one. It is TOO late for incrementalism.
The most interesting point in the study is that it states that Vermont is only at the national average for providing health care. Affter Deans supposed ten year effort, that is pathetic.
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