The most powerful word in the English language is the word no. That is particularly true to people and organizations who consistently depend on the word yes to get things done. When they are told no, they have to change what they do, or stop doing it.
When Fletcher Allen CEO John Brumsted last week was quoted as saying he didn’t see how a publicly financed healthcare system in Vermont could bring in enough money to meet its needs, he was assigning more power to the word no, than has been customary. Fletcher Allen is the 800-pound gorilla in Vermont’s healthcare system; it normally gets what it wants and it always wants/needs more.
Fletcher Allen is not the only 800-pound gorilla in the healthcare process. Blue Cross Blue Shield is the state’s dominant health insurance company; for those in the health care exchange, the company is the insurer for 96 percent. The company has asked for an average rate increase of 9.8 percent and it, too, banks its business on the ability to get regulators to go along with its requests.
But our health care law and our five-member Green Mountain Care Board (GMCB) are fixated on the word no. Health care costs approximate 19 percent of the state’s gross domestic product and it’s the expressed objective of the GMCB to lower costs.
That means saying no.
A lot.
To the 800-pound gorillas.
Mr. Brumsted understands that. But health care is like the proverbial three-legged stool. It’s built on access, affordability and quality. You can have any two, but you can’t have all three without one suffering. Mr. Brumsted is looking at a politically based system that will be inclined to say no to the money necessary to provide access to a high-quality healthcare system. He worries about that.
Most hospital CEOs share the same concern. With good reason. All they need to do is to point out the poor reimbursement patterns of years past. It will be difficult enough for the Legislature to devise a plan to generate the $2 billion necessary to replace what we pay now for commercial insurance. But our costs continue to rise and the worry is that the Legislature will not respond with the money to keep pace with inflationary needs. Again, the state has a poor record of meeting these responsibilities. We need to look no further than state appropriation levels for higher education.
But hospitals, like our university and state colleges, are generally viewed as big enough and strong enough to survive whatever the Legislature can toss their way. Some way or another, they always manage.
Except they don’t. The cost is just transferred to others in the form of higher tuitions for higher education, and higher insurance costs for those with private insurance.
In these examples, saying no isn’t something that signified the power of new thinking. Rather, it was the “power” that comes from denying the need to think things through. It’s the power of inertia.
If the mistakes of the past are to be avoided, we will need a level of transparency and trust that we’ve yet to see.
What hospitals are asking is this: If they rebuild their systems to accommodate a new set of expectations, what assurance do they have that they will be supported in that effort?
What hospitals fear most is the word no, but with no strategic plan behind it, leaving providers, including insurance companies, to battle it out amongst themselves, leaving Vermont a tattered health care landscape.
It’s June. In six months the makings of a plan need to be in place. Little wonder people are beginning to feel anxious.
By Emerson Lynn, St Albans Messenger