1 VT Single Payer Plan It ain t over till it s s over! Yogi Berra The latest single payer battle was won, but the single payer war is far from over. Dan McCauliffe, MD Dermatologist - Rutland, VT
2 So far there have been three attempts to move Vermont to a Single Payer health care system. A fourth attempt is currently underway!
3 The third attempt resulted in a Single Payer law, passed in May 2011 but without a financing plan Two previous attempts at passing a single payer law in Vermont failed when the financing was addressed. So this time around a single payer law was passed without a finance plan, and again it failed, once the financing was addressed, after a long delay, and millions of taxpayer dollars were spent needlessly. People who said VT was wrong to pass the single payer law before figuring out if we could afford it, are now saying we told you so!.
4 Leading up to the 2014 election 3½ years after the law was passed we still have no financing details!
8 After the 2014 election, the announcement is made.
9 Single Payer Is Not Dead! Beware of the resurrection of single payer health care in Vermont, under the guise of a health care all-payer global budget.
10 Shumlin s other single payer plan This is what Governor Shumlin said last month during his single payer renunciation speech, We must double down on health care reform by strengthening the Green Mountain Care Board so that we have a better shot at long- term cost containment, pursuing a federal all payer waiver so that we can be the first state in America to pay for quality not quantity,.
11 Shumlin s other single payer plan Move Vermont to a global budget payment system to finance health care. Definition of global budget Set amount of money to pay for health care Typically the budget is based on a hospital s historical revenues, which are adjusted for inflation and changes in the age and size of the population a hospital serves.
12 Definition of global budget Health care providers get a set amount of money to take care of an entire population of patients, rather than being paid for each service. Providers are at risk of going over budget. Global budgets lead to health care rationing, usually by long waiting times.
13 Federal global budget waiver The Shumlin administration is currently seeking an all-payer global budget waiver to include Medicare and other federal health care funds in a global health care budget. The plan is to develop a single payer global budget payment scheme as used in the Canadian single payer health care system, that will be administered through the Green Mountain Care Board.
14 Don t t be mislead by the name All-payer is sometimes used without mentioning global budget. The confusion in terminology arose from Maryland s s move from its all-payer system of payment to a global budget system of payment in It is unfortunately misleading that they kept the all-payer terminology rather than change it to global budget.
15 Maryland s all payer waiver Maryland got an "all payer" Medicare waiver over 36 years ago, that allowed Medicare and private insurance to pay the same amount for each service in the fee-for for-service payment method. Medicare paid over a billion dollars more to Maryland hospitals each year (than to hospitals in other states) to allow Medicare to pay higher fees for services.
16 Maryland s all payer waiver This became too expensive so the federal government is now requiring Maryland to move to a global health care budget,, if it is to keep the extra billion dollars from Medicare each year. So the all payer waiver has really been changed to a global budget waiver. The global budget went into effect last year 5 year test period.
17 Media coverage of Maryland s new all-payer (global budget) plan Calls it like it is: a move towards a single payer system.
18 All payer-global budget waiver cost & demographic hurdles for Vermont Over age 65 population % below poverty level Median income % on Medicaid Extra Medicare funding Privately insured Maryland 13.4% 9.8% $73,538 18% ~$ 1 billion per year more Vermont 16.4% 25% by % $54,267 30% none less
19 What s s in store for Vermont Under a global budget, Vermont will likely receive a set amount of health care dollars each year from the federal programs (Medicare, Medicaid, Tricare,, Federal Employees Health Plan) and combine them with a set amount from private insurers (e.g., BC/BS) based on per capita projections from last year s s health care expenses, linked to a yearly increase based on projected growth of the economy (as was done in Maryland).
20 Future Vision of VT Health Care Financing Under a Global Budget Federal Health Care Funds Medicare Medicaid Tricare Federal Employee Insurance Additional Taxes Private Health Care Funds Blue Cross / Blue Shield MVP, etc. Set amount of $ each year Green Mountain Care Board will collect and administer the funds Set amount of $ each year Population-based payments to regional hospitals, UVM & Dartmouth Medical Center payments to individual providers unrelated to number of services provided? Self Funded ERISA Protected Businesses
21 Problems with global budgets Under a global health care budget, each patient is seen as a potential liability (a potential budget buster), particularly those with expensive medical problems. The risk of cost overruns will be born by hospitals, physicians and other providers. This creates a perverse incentive for providers to limit care to stay within budget as they bear the risk of going over budget.
22 Problems with global budgets Non emergent medical care like joint replacement and cataract surgery will delayed to avoid breaking the budget, as experienced in Canada, Great Britain and other countries that utilize global budgets. The next decade may prove a bad time to need timely access to health care services, as proved by Canada's experience with global budget caps. This will be worsened by Vermont s s aging population that will require more health care.
23 Waiting Times in Countries With Single-Payer Global Budgets Canadians seeking non-urgent surgical or other therapeutic treatment faced a median wait time of 4.5 months in 2013 ( NHS waiting times soar as doctors blame cuts in hospital budgets - Waiting lists grew 61% in the past year, (The Guardian, August 2011)
25 British Newspaper-2008
26 02 May 2012 Same British Newspaper - four years latter (2012)
27 Rationing Health Care A survey of Canadian doctors has revealed that 25% have had a patient die while on a waiting list.
28 Why global budgets are the wrong cure Canadian economist Yanick Labrie provides an excellent explanation why Vermont is wrong to use global budgets in financing its health care system. Montreal Economic Institute
29 Why global budgets are the wrong cure to reining in health care costs Decision makers have always regarded the global budget model as easy to administer and useful for reining in rising costs. However, this cost control which has not in fact prevented expenditures from rising has historically come at the price of service rationing: : given continually increasing demand, hospitals have had no choice but to limit admissions in order to stay within budget.
30 Why global budgets are the wrong cure The chronic problem of waiting lists in Quebec and in the rest of Canada is therefore rooted in part in hospitals funding models. Furthermore, global funding offers no incentives for hospital managers to innovate in order to reduce expenses and improve access and wait times.
31 Why global budgets are the wrong cure On the contrary, an innovation that led to spending reductions would translate into an equivalent decrease in the hospital s s next budget. Similarly, an innovation that led to wait times being reduced and more patients being treated would produce increased pressure on the hospital s s fixed budget. In either case, since patients are a source of additional expenses for the hospital, there would be no benefit to gain from greater efficiency.
32 Beware of Global Budgets This is another way to get to a single payer health care system. The state government will take over the administration of health care to Medicare and other insured beneficiaries.
33 If Gov. Shumlin is successful in getting the all-payer-global budget waiver that allows Vermont to administer Medicare, etc Will seniors and others be better or worse off than under traditional Medicare and insurance coverage? Will Vermonters be called upon to pay higher taxes to help pay for global budget shortfalls? How will health care waiting times be affected?
34 If Gov. Shumlin is successful in getting the all-payer-global budget waiver that allows Vermont to administer Medicare, etc Will Vermonters have free choice in choosing doctors and hospitals in other states under the state administered health care plan, like under traditional insurance and Medicare, or will they need to seek out special permission to do so? Will Vermont be able to retain an adequate health provider work force
35 So what should our short and long term What needs to be done about health care reform in Vermont. goals be to insure sensible health Short term and long term goals. care reform in Vermont?
36 What we need to push for this legislative session Repeal ACT 48 that established the single payer plan and the Green Mountain Care Board Bureaucracy (Not likely to happen) Pass legislation that preserves a patient s ability to pay for health care with private funds. (As possible in every other country other than Canada, Cuba and North Korea).
37 What we need to push for this legislative session Make participation in the Health Connect Exchange optional, like in the other 49 states. Move VT Health Connect to the federal exchange, as done in most other states.
38 Longer Term Educate voters and engage them in the health care reform process in hopes that they vote for legislators with common sense who are not blinded by their own ideology. Seek a system that provides easy access to high quality care for all Vermonters, while containing costs through means that do not negatively impact Vermonters health care, or the economy of the state. Empower patients and providers, not health care bureaucrats.
39 The European Experience European countries have been reforming their health care systems and have been moving away from the single payer model. Even in socialist Sweden they are now relying more on private health insurance to overcome the long waiting times in their socialized single payer system.
40 The European Experience The annual report rating 33 health care systems in Europe had to say about why the Dutch system has been #1 for three years in a row. The Dutch have established a European model to copy not least by abolishing single-payer systems. The Netherlands is characterized by a multitude of health insurance providers acting in competition,, and being separate from caregivers/hospitals."
41 The European Experience One important net effect of the Netherlands healthcare system structure would be that healthcare operative decisions are taken, to an unusually high degree, by medical professionals with patient co-participation participation. Financing agencies and healthcare amateurs such as politicians and bureaucrats seem farther removed from operative healthcare decisions in the Netherlands than in almost any other European country.
42 Get involved in the reform process and make your voices heard after after all healthcare is all about you THE PATIENT!
MYTHS ABOUT SINGLE PAYER COMING TO VERMONT For information on myths about single payer in general, please click here. MYTH 1: Physicians will leave the state if we enact single payer. This is the claim
Health Reform: New Opportunities For Maryland To Invest in Home- and Community-Based Services Health reform gives Maryland new opportunities to provide homeand community-based services (HCBS) through Medicaid,
December 12, 2008, 6:30 AM Why Does U.S. Health Care Cost So Much? (Part IV: A Primer on Medicare) By UWE E. REINHARDT Uwe E. Reinhardt is an economist at Princeton. Medicare, the federal health-insurance
Health Reform: New Opportunities For Kentucky To Invest in Home- and Community-Based Services Health reform gives Kentucky new opportunities to provide homeand community-based services (HCBS) through Medicaid,
Health Reform: New Opportunities For Colorado To Invest in Home- and Community-Based Services Colorado has been one of the nation s leaders in ensuring that seniors and people with disabilities are able
Health Reform: New Opportunities For Idaho To Invest in Home- and Community-Based Services Health reform gives Idaho new opportunities to provide homeand community-based services (HCBS) through Medicaid,
Health Reform: New Opportunities For New Hampshire To Invest in Home- and Community-Based Services Health reform gives New Hampshire new opportunities to provide home- and community-based services (HCBS)
Health Reform: New Opportunities For Nebraska To Invest in Home- and Community-Based Services Health reform gives Nebraska new opportunities to provide homeand community-based services (HCBS) through Medicaid,
Health Reform: New Opportunities For Massachusetts To Invest in Home- and Community-Based Services Health reform gives Massachusetts new opportunities to provide home- and community-based services (HCBS)
Embargoed until August 20, 2003 5PM EDT, Administrative Waste in the U.S. Health Care System in 2003: The Cost to the Nation, the States and the District of Columbia, with State-Specific Estimates of Potential
When Public Payment Declines, Does Cost-Shifting Occur? Hospital and Physician Responses November 13, 2002 Washington, DC These materials were commissioned by the Robert Wood Johnson Foundation for use
by Dimitri Drekonja, MD, MS, FACP After what seemed like a short hiatus, health-care stories are creeping back into the news, with numerous (and often contradictory) claims: The Affordable Care Act (aka
The health care reforms proposed by President Obama and some Members of Congress would nationalize nearly 20 percent of the U.S. economy, and would eliminate individual health care choices and delay or
Candidate Position on the Private Healthcare System (as of November 2015) Clinton Defends the ACA Sept. 23, 2015 Plan outlines Clinton s proposals: Lower Deductibles, Coinsurance, and Co Pays Up to three
For more information, contact Christie Herrera, director of ALEC s Health and Human Services Task Force, at (202) 742-8505 or firstname.lastname@example.org. Why does my state need the Freedom of Choice in Health Care
From: Katie Mason, MPP, Research Analyst II, NCSL Health Program Date: August 4, 2010 Health Provider and Industry State Fees and Taxes A Colorado Story Colorado Medicaid Background Colorado s Medicaid
U.S. Healthcare Reform: What s the Problem? What s Being Done About It? Topics @ Ten October 21, 2012 http://www.whitehouse.gov/assets/documents/cea_health_care_report.pdf http://www.whitehouse.gov/assets/documents/cea_health_care_report.pdf
HEALTH CARE It goes without saying that health care reform remains the focus of a great deal of debate and attention even after all the years since the Patient Protection and Affordable Care Act, or Obamacare,
Health & Government Module 5 i2p Expedition India National Emblem of India : Emblem i2p Expedition India India 2011 1 Take Home Points The United Nations has declared access to basic health care a human
Pension Sustainability Making public sector pensions more secure and affordable gov.pe.ca/pensionplans Minister s message Prince Edward Island s two large public sector pension plans, the Civil Service
The American Healthcare System By David M. Cutler Otto Eckstein Professor of Applied Economics at Harvard University and Member of the Institute of Medicine America is the largest, most diverse society
Spencer Berthelsen, M.D. Texas Club of Internists April 4, 2014 Cost The US spends twice as much per capita as the average of other industrialized nations Institute of Medicine 30% of healthcare dollars
Maryland Medicaid Program Maryland s Pharmacy Discount Waiver Tuesday, November 19, 2002 Debbie I. Chang Deputy Secretary for Health Care Financing Maryland Department of Health and Mental Hygiene Overview
CANADIANS ON HEALTHCARE Public Release Date: - January XX, 2006 XX:00 a.m. (EST) Ipsos Reid is Canada's market intelligence leader and the country s leading provider of public opinion research. With operations
Universal Healthcare: Affordable Care Act Versus Improved Medicare-For-All Nick Anton, MD Goals Briefly review the current state of American healthcare Review the Affordable Care Act (ACA) Review Improved
Health Reform and the AAP: What the New Law Means for Children and Pediatricians Throughout the health reform process, the American Academy of Pediatrics has focused on three fundamental priorities for
1 Good to Know ColoradoCare Colorado Health Care Cooperative Name Change: The proposal has been renamed ColoradoCare because it is shorter. It s also less likely to be confused with CoHealthOp, the Colorado
STATEMENT OF PATRICK CONWAY, MD, MSc ACTING PRINCIPAL DEPUTY ADMINISTRATOR, DEPUTY ADMINISTRATOR FOR INNOVATION AND QUALITY, AND CHIEF MEDICAL OFFICER, CENTERS FOR MEDICARE & MEDICAID SERVICES ON EXAMINING
Understanding the Affordable Care Act Game Instructions Overview Health care is in a state of rapid change. Both at the state and national level, legislation is changing the way Coloradans access and pay
Improved Medicare for All Quality, Guaranteed National Health Insurance by HEALTHCARE-NOW! Single-Payer Healthcare or Improved Medicare for All! The United States is the only country in the developed world
Medicare Payments And Its Relationship To The U.S. Healthcare System Stuart H. Altman, Ph.D. Sol C. Chaikin Professor of National Health Policy Brandeis University Should Medicare Focus Only on The Functioning
Health Reform: New Opportunities For Maine To Invest in Home- and Community-Based Services Maine is among the states that have made the most progress in ensuring that seniors and people with disabilities
Healthcare Guide Healthcare Billing Guide: Strategies to Master Insurance and Billing Published by www.dorlandhealth.com Tips on Understanding Your Medical Bill 1 Healthcare Billing Guide: Strategies to
Louisiana Budget Project Analysis Medicaid Amendments Would Compromise Future Budgets By Steve Spires, May 24, 2013 447 Third St., Suite 200 Baton Rouge, La. 70802 www.labudget.org Two bills with the potential
Remarks to the Tompkins County Legislature, January 21, 2014 NYS Tax Relief Report Overview and an Alternative Strategy On December 10, 2013 a New York State Tax Relief Commission created by the Governor
BASIC TRAINING FOR FUTURES TRADERS: 14 Recommendations from a Top Futures Broker Stuart A. Vosk Center for Futures Education, Inc. P.O. Box 309 Grove City, PA 16127 Tel.: (724) 458-5860 FAX: (724) 458-5962
PUBLIC VS. PRIVATE HEALTH CARE IN CANADA Norma Kozhaya, Ph.D Economist, Montreal economic Institute CPBI, Winnipeg June 15, 2007 Possible private contribution Possible private contribution in the health
The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier
WEEK 10 SUPPLY SIDE REFORM AND REIMBURSEMENT Activity- based funding versus block grants The cost containment thesis was outlined in the previous lecture. In this lecture we examine proffered solutions.
ONE NATION UNDER INSURED A Crying Shame Many Americans don t realize that in comparison to the health care systems of other countries, ours is not even close to the most efficient or most humane. Every
STATUS OF NEW MARYLAND MEDICARE WAIVER APPLICATION TO CMS Clinical Services Directors Christopher J. Parker, Sr. Vice President/CNO April 4, 2013 Source: UMMS Financial Affairs Committee TODAY'S DISCUSSION
APPENDIX D COMPARISON WITH OVERSEAS ECONOMIES HEALTHCARE FINANCING ARRANGEMENTS Table D.1 Comparison of Healthcare Systems in Selected Economies Part I Predominant funding source Hong Kong Australia Canada
PUBLIC & PRIVATE HEALTH CARE IN CANADA by Norma Kozhaya, Ph.D. Economist, Montreal Economic Institute before the Canadian Pension & Benefits Institute Winnipeg - June 15, 2007 Possible private contribution
Impact of Healthcare Reform on Small Business January 12, 2011 Ronald Riner, MD The Riner Group, Inc. 5811 Pelican Bay Blvd., Suite 210 Naples, FL 34108 800.965.8485 www.rinergroup.com Healthcare Reform
QUESTION NO. 3 Amendment to Titles 1 and 3 of the Nevada Revised Statutes CONDENSATION (ballot question) Shall Title 1 of the Nevada Revised Statutes governing attorneys, and Title 3 of the Nevada Revised
Accountable Care Organizations: An old idea with new potential Stephen E. Whitney, MD, MBA Testimony to Senate State Affairs September 22, 2010 Impetus for ACO Formation Increased health care cost From
The Alliance Roundtable with U.S. Rep. Tammy Baldwin An Insider s View of Congressional Efforts to Reform Health Care The Alliance hosted a roundtable discussion on November 13 with U.S. Rep. Tammy Baldwin,
HEALTHCARE CHANGES AFFECTING YOUR PRACTICE Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas HEALTH CARE CHANGES 1 st Major overhaul of health care system since WWII introduction of 3 rd party
Health Care Administration and Libertarianism Bryan Neufeld Prepared For Public Administration, Section 001 Professor Sampert University of Winnipeg November 17, 2005 Health Care Administration and Libertarianism
Response to the New Brunswick Government Consultation on a Prescription Drug Plan for Uninsured New Brunswickers Brief submitted by The New Brunswick Nurses Union April 2012 Background The New Brunswick
Health Care Reform Jim Smith American Continental Group 900 19 th Street, NW, #800 Washington, DC 20006 202-327-8100 *Tobacco-related disease *Poor diet *Lack of exercise *Excessive use of alcohol *American
UHI Explained Frequently asked questions on the proposed new model of Universal Health Insurance Overview of Universal Health Insurance What kind of health system does Ireland currently have? At the moment
Article from: The Actuary Magazine October/November 2013 Volume 10, Issue 5 the increase in drug costs for private plans is about 5.2 percent per year, while the annual growth for governmentsponsored drug
Accountable Care Organizations: Forging Stakeholder Partnerships for Health Care Performance and Efficiency Julie Lewis Director of Health Policy Dartmouth Institute for Health Policy and Clinical Practice
Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont Prepared for: The Vermont HRSA State Planning Grant, Office of Vermont Health Access
Strategic Plan for Vermont Health Reform 2012 2014 Released January, 2012; Revised July 2012 by Robin J. Lunge, J.D., Director of Health Care Reform, Agency of Administration, State of Vermont Developed
R E F O R M Changing Economics in an Era of Healthcare Reform Nathan S. Kaufman, Managing Director, Kaufman Strategic Advisors, LLC As health systems prepare for healthcare reform, they are focusing significant
HOSPITAL SUBSECTOR ANALYSIS Fourth Health Sector Development Project (RRP MON 41243) A. Introduction 1. The health status of the people of Mongolia has generally improved over the years, and significant
INSIGHT on the Issues AARP Public Policy Institute Medicare Beneficiaries Out-of-Pocket for Health Care Claire Noel-Miller, PhD AARP Public Policy Institute Medicare beneficiaries spent a median of $3,138
HOW FEDERAL GRANTS INCREASE ARKANSAS TAXES By Marc Kilmer 11/19/15 Federal grants to state and local governments may seem like free money, in that they pay for projects that the recipients would not otherwise
Waste and inefficiency in the Bush Medicare prescription drug plan: Allowing Medicare to negotiate lower prices could save $30 billion a year By Roger Hickey & Jeff Cruz In cooperation with Dean Baker,
Denial of Life-Saving Medical Treatment under the Obama Health Care Law Jennifer Popik, J.D., and Burke J. Balch, J.D. Robert Powell Center for Medical Ethics June 30, 2012 RATIONING AND THE OBAMA HEALTH
Health Care Policy AN EQUITABLE WAY TO PAY FOR UNIVERSAL COVERAGE Edith Rasell This article describes a way to finance universal health care coverage that preserves much of the current financing system
2016 Evidence of Coverage For more recent information or other questions, please contact Provider Partners Health Plan at 1-800-405-9681 or, for TTY users, 711, from 8 a.m. to 8 p.m. Monday through Friday,
Strengthening the Canada Pension Plan: Take it to the public by Ken Battle, Sherri Torjman and Michael Mendelson November 2013 Strengthening the Canada Pension Plan: Take it to the public by Ken Battle,
Discussion Document of Selected Terms of New Maryland All-Payer Model Educational Materials October 7, 2013 Maryland Health Services Cost Review Commission 1 Agenda I. Answer questions on draft application
The Impact of Prescription Drug Prices on Seniors Over the years medicine has changed, particularly with respect to prescription drugs: more drugs are available, they are more frequently prescribed, and
finding the balance between public and private health the example of australia By Zoe McKenzie, Senior Researcher This note provides an overview of the principal elements of Australia s public health system,
Maine Businesses Role in Health Care Kevin Gildart Vice President, HR General Dynamics: Bath Iron Works General State of Affairs United States United States v. World Health Care Spending & Quality World
III. HOW NURSING FACILITIES KEY POINTS Today, nursing and rehabilitation facilities are funded through four sources: Medicare, Medicaid, Quality Assurance Assessment Program and patient pay. Medicare Part
EXECUTIVE OFFICE OF THE PRESIDENT The Burden of Health Insurance Premium Increases on American Families SEPTEMBER 22, 2009 Health insurance premiums for American families continue to skyrocket. A report
Policy Focus The Need for Social Security Reform Recipes for Rational Government from the Independent Women s Forum Carrie Lukas, Managing Director, Independent Women s Forum August 2011 Volume 1, Number
PUBLISHER OF CONSUMER REPORTS The Affordable Care Act: The First Year DISCOVER WHAT THE NEW LAW MEANS FOR YOU AND YOUR FAMILY A Note About Using This Guide: What s a Grandfathered Plan? You ll see references
CBS NEWS/NEW YORK TIMES POLL For release: Thursday, September 24, 2009 6:30 PM EDT THE HEALTH CARE DEBATE CONTINUES September 19-23, 2009 President Barack Obama's recent speeches and public appearances
Financial and Regulatory Parameters for MSSP Risk Tracks in ACO Learning Network Comments and the blue box indicates LN different from ; red text indicates change from and/or LN on Transition to Two-Sided
Committee Secretary Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600 Email: email@example.com Dear Dr Holland Re: Inquiry into the Private Health
Healthcare IT Angel Investor Intro Presenter: Saul Richter sponsored by August 2015 Agenda What is the problem in healthcare? Why is it so hard to solve? Overview of healthcare change Healthcare spending