Lawmakers begin health reform task

BRIDPORT — State Sen. Claire Ayer filed legislation on Tuesday that lays the groundwork for a single-payer health system for Vermont.
The Weybridge Democrat, chairwoman of the Senate Health and Welfare Committee, filed bill S.57, which proposes that the state create a “single-payer and unified health system.”
The bill — which Ayer hopes will be adopted by her committee — calls for the state to:
•  Establish a board to ensure cost-containment in health care, create system-wide budgets and pursue insurance payment reform.
•  Establish a “health benefit exchange” for Vermont as required under federal health-care reform laws.
•  Create a public–private, single-payer health-care system to provide coverage for all Vermonters after receipt of federal waivers.
•  Create a “consumer and health-care professional advisory board.”
•  Examine reforms to Vermont’s medical malpractice system.
•  Modify the insurance rate review process.
•  Create a statewide drug formulary.
A complementary bill has been filed in the House, according to Ayer.
“It will set the stage for single-payer (health care),” Ayer said following Monday’s first legislative breakfast in Bridport, which was dominated by debate on health-care reform.
Ayer said much of the new health-care bill is based on Harvard University economist William Hsiao’s recent study of Vermont’s health-care system and recommendations on how to improve it. Hsiao recommended, among other things, that Vermont shift to a single-payer health-care system with a limited role for a private insurer — a move Hsiao believes could save the state $500 million in the first year of operation through reduced bureaucracy.
Ayer told breakfast participants that lawmakers were particularly struck by the statistics Hsiao and his team compiled about Vermont’s health-care system.
“In the United State and in Vermont, we spend 18 percent of our (gross) state product on health care,” Ayer said. “That’s higher than any other country in the world.”
She added that statistics show that Americans aren’t getting the best health-care system in the world — even though they are paying the most for services that aren’t accessible to all citizens.
“This bill (S.57) will start up for where we want to be, starting with an insurance exchange in 2014 that’ll set the stage for single-payer health care,” Ayer said.
Rep. Michael Fisher, D-Lincoln, is vice chairman of the House Health Care Committee. He will try to move health-care reform through the House and to a governor anxious to sign a bill.
Fisher pointed to flaws in the current health-care insurance system as providing evidence of why changes are in order.
“What we have right now isn’t working for a lot of us, and is not working well for all of us,” Fisher said.
Vermont’s 620,000 citizens are each spending around $8,000 per year for health insurance, according to Fisher. That figure is expected to rise to around $9,200 per year by 2013, Fisher said.
“Inflation is going through the roof,” Fisher said. “As health care becomes more and more expensive, fewer and fewer of us are going to be able to pay for it.”
The Legislature’s challenge, Fisher said, will be to “bend” the inflationary curve for health-care costs in a manner that makes the system work better for all Vermonters.
“It is going to be a big challenge,” Fisher said. “The goal is to bring all of us into a single pool, where a lot of efficiencies can be made.”
Still, some Vermonters remain concerned about the Legislature’s attempts to unilaterally change the state’s health-care system. Shoreham resident Meg Barnes noted on Monday that the state’s efforts could run counter to the federal health-care reform law that is to be phased in during the coming years (barring a repeal by Congress).
“If we don’t get a waiver, all this work and energy is wasted,” Barnes said.
She argued the Legislature would be better served letting the free market introduce new insurance options for Vermonters to drive down costs.
Ayer acknowledged the state will need four to six federal waivers to implement a single-payer system. She said she is optimistic the state will secure those waivers from federal authorities she said are anxious to make Vermont a test case for a single-payer system.
“There have been a number of conversations between our Congressional delegation and the (Obama) administration — they want to see health care more affordable than it is now,” Ayer said. “They want to see a state that is good to go.”
Rep. Greg Clark, R-Vergennes, said he hopes the state doesn’t move too quickly in endorsing a single-payer plan. He added the jury is out on whether insurance companies are making too much money, as some have charged. And he disputed advocates’ claims of potential savings through a single-payer system.
“I am very skeptical of the health plans that have heard discussed; I am not skeptical a bit discussing health-care reform,” Clark said. “I think everyone in an open market ought to have the opportunity to compete and let the folks decide who’s making too much money and who isn’t.”
Rep. Willem Jewett, D-Ripton, said that health-care expenses are increasing at an average of 10 percent per year — a factor he said should motivate the Legislature to enact reforms.
“This cannot continue,” Jewett said. “We are spending far more than any other country in the world, and quite frankly, we don’t get the health results that other countries do.”
Jewett encouraged citizens to read the full, 130-page Hsiao report and form their own conclusions.
“What I want to do is challenge people, whether you are on the left or the right, to have an informed discussion about health care and health-care reform, and challenge ourselves to not fall back into the old arguments,” Jewett said. “We can kill this thing if we fall back into the old arguments, but if we kill it, we will have lost an opportunity.”
Killing the opportunity, Jewett said, will “mean spending more and more and putting ourselves in an economic disadvantage to the rest of the world, and that would be a shame.”
Other discussion at Monday’s breakfast keyed on:
•  The new Champlain Bridge. Rep. Diane Lanpher, D-Vergennes, reported work has been completed on the sub-surface portions of the new span, with pier work beginning. She noted Flatiron Construction has until Oct. 9 (500 days in total) in which to complete the project.
•  Vermont Yankee. Residents pressed lawmakers on whether the state’s lone nuclear power plant will be shut down next year, or whether a new contract would be negotiated. A majority of lawmakers said on Monday they would like to see the plant shut down and the state replace its power production with renewable energy and purchases from the New England electricity grid. In the meantime, lawmakers said big decisions loom on how the plant’s owners (Entergy) will raise the necessary funds to decommission the plant and where contaminated materials will be taken. Rep. Betty Nuovo, D-Middlebury, said the decommissioning fund contains around $420 million — around half of what she said is needed to do the job.
The next legislative breakfast will be held on Monday, Feb. 14, at the Bristol American Legion hall on Airport Road. The program begins at 7:30 a.m.
Reporter John Flowers is at [email protected].

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