Single Payer in Vermont

Thursday, May 26, 2011

Welcome to Politics Bites, where every afternoon at It's A Free Country, we bring you the unmissable quotes from the morning's political conversations on WNYC. Today on the Brian Lehrer Show, Kevin Outterson, associate professor of Law and associate professor of Health Law, Bioethics and Human Rights at Boston University School of Law, discusses Vermont's efforts to introduce a single payer healthcare system.

The Green Mountain state is experimenting with a new single-payer health care system.

The new system will provide every Vermont resident with health care. Governor Peter Shumlin said the publicly-funded plan would address three major themes: health care as a human right; removing the burden of insurance from employers; and spending less on insurance companies and more on care.

Things won’t change overnight. Outterson said what Vermont has done by passing the plan is to lay out a framework, the details of which will be designed over the coming two years. Next year a financing plan will be submitted to the legislature, and implementation will not start until 2014. Still, Outterson said today was a big step.

Financing the plan is likely to be through payroll taxes, and the key to success will be the ability to control costs.

If Vermont is able to control costs better than neighboring states, then they will be a magnet for employment. People won’t mind exactly how they pay for it as long as the total cost is lower.

Currently about 75% of Vermonters get their health care through BlueCross, and BlueCross Vermont will likely be the contractor the state hires to handle implementation. A state board will determine what procedures will be covered, and Outterson said that board will be extremely accountable to Vermont’s residents.

Vermont’s a small state, and if the board of Green Mountain Healthcare doesn’t remain responsive to the needs of Vermont citizens, they really know how to raise a ruckus. So I don’t fear that somehow there is going to be a faceless board in Vermont. It’s a state where a lot of people know everyone.

Ultimately, while the board could rule against a doctor’s recommendation for a procedure, Outterson thinks that might be a good thing for patients currently being sold unnecessary treatments. He points to studies finding that doctors who offer a certain procedure in their office are far more likely to recommend that particular procedure.

There are a lot of conflicts of interest in medicine today. There was a study last year in Health Affairs that doctors who own MRI machines are much more likely to send you to the MRI… The radiation levels from an MRI are much greater than what you would get from living in Tokyo throughout this [current nuclear] disaster. [Addendum -- Outterson corrected this statement in a later comment on the story, see below.]

One potential hitch to the new plan may be in its ability to comply with the unfolding federal legislation. The federal Affordable Health Care Act requires all states to set up private health care exchanges for the uninsured with no public option. Outterson said Vermont is moving forward on setting up those private exchanges. 

They would prefer to get permission from the federal government to skip that step and go directly to Green Mountain Health Care, and several other states have asked for that as well. Scott Brown, the Republican Senator in Massachusetts, has put a bill in to allow states to do just that, to implement a waiver before 2014.

Outterson said another for Vermont will be Medicare. Vermont would like Medicaid and Medicare to be a part of the Green Mountain Health Care system, but that will also require some flexibility on the part of the federal government.

I think it’s in the best interest of the administration to try. If Vermont is able to make it work, other states will like it. If Vermont doesn’t make it work then we can avoid trying this in the other forty-nine.

The doctor who spearheaded this effort, Dr. Deb Richter, originally tried to bring this legislation in New York. When she was unable to get traction in Albany, she moved to try instead in Vermont.

Outterson said the key to the plan catching on elsewhere will be its success or failure to control costs. Massachusetts is another possible model, with near-universal coverage there on a private model, much closer to the current federal plan. In the next five years, other states will be watching closely both Vermont and Massachusetts to see how these plans do.

If at the end of five years we can say Vermont care is cheaper, they have the lowest health insurance premiums in the country and their people are quite healthy and everyone is happy with it, that’s going to be a powerful argument for the state.


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Comments [15]

gary from queens

We live under the tyranny of a medical monopoly and patriarchal system that would worsen under single GOVERNMENT payer plans.

Last year I ruptured a ligament in my inguinal region. I walked into an MRI facility on Hillside Ave and Francis Lewis. I was going to pay for an MRI in cash or credit card. The employee there told me I cannot obtain an MRI without a doctor's prescription.

So I joined Family Health Plus and called different managed care groups and asked if they covered the MRI I wanted. They all said I would have to join the group, go to their MDs, and wait for the MDs application to go through to know whether anything is covered.

We are the consumers. Yet we cannot even know what we are paying for, let alone get what we are paying for. Personal healthcare accounts would change all that, because it would enable each of us to ration our own healthcare.

There are some people who want to be cared for like they were infants. They do not want to make any decisions about their health and medical care. They can have single payer. Just don't make me pay for it. Because i'm an adult who wishes to be treated like an adult, and have the right to make decisions about my body.

May. 26 2011 11:49 AM
gary from queens

Before liberals swarm to the people's paradise of Vermont, they should know that only Alaska, Arizona, Wyoming and Vermont recognize the right to bear arms and require no permits to carry guns. (Montana also has this policy in all but a few urban areas.)

The Second Amendment didn't invent the right to own guns. It merely recognizes it: "(T)he right of the people to keep and bear arms shall not be infringed." It doesn't say, "The people shall have the right to keep and bear arms."

Unfortunately, the Supreme Court, while striking down outright bans on handguns, left room for permits. But it's hard to see how that is consistent with the natural right of self-defense.

May. 26 2011 11:01 AM
Nathaniel Reichek from Northport, NY

Mr Outterson's "correction" is no better than his initial error in that "imaging procedures generally' also do not match his assertion. Further it should be pointed out that the risk from diagnostic procedures that do use radiation is not the same for all people. The risk is a "lifetime attributable risk" of cancer, which can occur many decades after exposure. So for the same radiation exposure, the risk for a young person might be significant, but the risk in the sick elderly who generally undergo such procedures may effectively be nil because of their limited life expectancies.

May. 26 2011 10:43 AM

Thanks for all the corrections - we just cleared up the MRI/radiation question on air. You're very attentive!

May. 26 2011 10:38 AM
John A.

The sad fact is that Hospitals Require routine overcharges -- Added line items and hideously inflated service charges -- to survive, and insurance companies provide this. I'm not saying this is right, its that the people who will be found to originating charge fraud won't be the insurance companies - the bureaucrats we are accustomed to hate - but the caregivers themselves. Reversing this fraud will indeed require a gentle hand.
Based on three Hospitalizations reviewed in detail.

May. 26 2011 10:32 AM
E. Kaplan from Manhattan

I was going to leave a comment about MRI not using ionizing radiation, but I see several other people already have. It would be good if you'd correct Prof. Outterson's statement lest listeners be frightened to undergo this noninvasive procedure.

May. 26 2011 10:27 AM
Kevin Outterson from Boston

I should have said "imaging procedures" generally, not MRIs - thanks for the correction

May. 26 2011 10:23 AM
Venkat from Manhattan

The guest talked about the radiation from MRI being greater than that in Japan which is absurd since MRI doesn't use ionizing radiation.

May. 26 2011 10:23 AM
Emily from Boston, MA

I am a physician. Mr. Outterson said the radiation from an MRI was very high. I believe he intended to say CT scans, because MRIs do not use radiation at all. Otherwise, I support his comments.

Emily Lowry, MD

May. 26 2011 10:22 AM
Antoine Rabinowitz from Mammaroneck

Your guest mentioned that MRI gives off more radiation than the current reactor meltdown in Japan. MRI does not use radiation. CT does.

May. 26 2011 10:21 AM
Anthony from Newark

Although the point Mr. Outterson is making re doctors using MRI too often when they own an MRI is well taken, he is 100% incorrect about radiation concerns with MRI. He must be thinking of positron-emission-tomography (PET) or X-rays -- MRI in fact does not emit radiation.

May. 26 2011 10:19 AM
Chris from Brooklyn

MRI's do not use radiation!! Magnetic Resonance Imaging. X-ray scans, PET scans, and CAT scans use radiation, but MRI's are just big magnets.

May. 26 2011 10:19 AM

An interstate compact is an agreement between two or more states of the United States of America. Article I, Section 10 of the United States Constitution provides that "no state shall enter into an agreement or compact with another state" without the consent of Congress.

May. 26 2011 10:18 AM

How does it affect state taxes? One of the big arguments against a single-payer system would be the large increase in taxes it would require. My counter-argument is that my family would be saving $10,000 per year on health insurance premiums! So at worst, it would come out even for us. Probably cheaper.

May. 26 2011 10:16 AM
David from Staten Island, NY

If Vermont does create a single payer system and another state does so, too, would it be legally possible for those two states to combine their two systems into one system?

May. 26 2011 05:43 AM

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