In an hour-plus conversation last week with Stephen Kimbell, commissioner of the Vermont Department of Banking, Insurance, Securities and Health Care Administration, the take-away message was that the upcoming changes to Vermont’s health care system will be a cooperative effort involving providers (hospitals and doctors) as the state’s crafts a new system of health care. Change will not come at the expense of the providers, Kimbell said.
“It is not on this administration’s agenda to close any of the hospitals or force mergers or consolidations of governance,” Kimbell said. “My pleas to the hospital CEOs and CFOS when I came to this office was, ‘Work with us to build an integrated system of delivery, reduce duplication and everyone get on electronic medical records so we aren’t doing multiple tests. We’ve got to have a system where you do it once and you do it right.” Kimbell cited imaging (x-rays) and blood work as two examples of many in which there are needless duplications from one provider to the next.
Money must also be saved in services delivered to people with chronic diseases and those who frequently use emergency rooms, he said; two areas in which the community at large must help play an important role.
Passing a law that allows physicians to help end a patient’s life under very controlled circumstances, known as “death with dignity,” is one such measure that could help (an effort was tried this pass session but postponed until next year).
Another is approving some type of rationing measures, as Oregon has done, that help control health care costs. This has not yet been talked about in Vermont in terms of the current debate, but should we, for example, provide extraordinary end of life measures in surgery, such as heart transfers, for 92-year-old patients? Where do we, as a society, draw the line and how can we work together with our providers to craft an appropriate policy that satisfies both the medical community and extended families of the patient? Citizens of the state need to give the medical community, and family members, permission to focus on a person’s quality of life, not just their longevity, when making decisions of what is appropriate care for terminally ill patients.
Additional savings will come from consolidating the insurance market. “We need to have a consolidated market with common products and share risk across as many lives as possible,” he said, adding that those who are self-insured, about 120,000 Vermonters, will maintain those plans and not double-pay into any state-wide single-payer or universal care system.
Kimbell all but alleviated the fear of some providers and consumers that the state would have to strip the state’s smaller hospitals of some vital services (through consolidation with larger regional hospitals) to achieve the needed savings, even while Gov. Peter Shumlin and House Speaker Shap Smith have refused to be as straight-forward.
But if there is even the hint of a contradiction there, why believe Kimbell?
Because he understands that if the state’s health care reform initiative is to be successful, it has to win over the support of the state’s hospitals and the medical community. This is, after all, a political process; and it’s easy to imagine how quickly a movement would be afoot to vote the present legislature and the governor out of office if their recommendations were to significantly weaken the state’s community hospitals.
It is also comforting to know that Kimbell is no left-wing radical hell-bent on a universal health care system. Rather, he is a businessman, through and through, who believes in changing the status quo because is not sustainable and is, in his words, “going to kill us.”
That Vermont has a voice of pragmatism driving its health care reform initiative, along with a pragmatic governor and leadership in the Legislature, may turn out to be the key to successful legislation.
Angelo S. Lynn