Gov. Peter Shumlin may well be correct that in the long run, health insurance costs may well decline under a state-run exchange and especially if all roads to such insurance run through the Statehouse and the nearby governor's office. But in the short term, there are a cluster of questions about how to produce the estimated $1.6 billion in tax revenue that will be needed, apparently, to get to that happier place. It's important to note that when everything sugars off, that projected tax hike may well be more than offset - at least for some Vermonters - by savings in smaller health insurance premiums. But to float the boat, that $1.6 billion has to come from somewhere, and whose ox was going to be gored sparked some sharp debate over the past two years. But all was to be revealed during this legislative session, and early on too. Under state law, the governor's health care and insurance team was supposed to have pulled together the financing mechanism and lay it out there by Jan. 15, 2013, presumably to spark a new round of debate. But at least we'd have some inkling of what options were Plan A, or Plan B, and so forth.
Leaving aside the fact that this message didn't arrive until nine days after the legally mandated date, the sketchy details shared by the governor and his health care team hardly qualify as a "plan."
Adding insult to injury, the state spent $300,000 on a contract with the University of Massachusetts' medical school, ostensibly to develop this elusive financing plan and an analysis of "the interaction of new provisions with Vermont's current revenue structure."
Lawmakers had been led to expect a "deep dive" into to pros and cons of the financing options.
Well, hang onto your scuba gear a little longer, apparently.
In fairness, it should be pointed out that this was always going to be a very difficult task. Coming up with a plan to revamp how we pay for healthcare - a major chunk of the state's economy - that would meet the tests of fairness and affordability was always going to be a challenge. And it one that probably requires more time to think through. But deadlines are deadlines, and state law, we assume, is meant to be taken seriously.
Given all the other pressing issues confronting lawmakers - from taxes, spending, education improvement and helping move the state's economy forward, having a divisive debate over how to pay for healthcare is probably not a bad briar patch to avoid right now. So why doesn't the administration simply tell it like it is: Let's just follow the guidelines set forth in the federal Affordable Care Act ("Obamacare"), and let's forget about some kind of quixotic push into the perceived nirvana of single-payer.
Getting the federal act right and implemented by 2017 will be a good accomplishment, and hardly a given. Vermont is an unlikely laboratory for such an experiment in ground-breaking health care insurance, and even less after all the groups of people who already have better health insurance through their employer's benefit program have been charitably excluded.
Health insurance is an industry that is ripe for overhaul. The marriage of work and health insurance benefits - which is how a large number of Americans obtain their insurance - was born out of an historical anomaly in the 1940s. That system has morphed into a nightmarish quagmire which costs too much and delivers at best questionable overall results, along with mountains of time-consuming paperwork. There's got to be a better way to finance health care insurance, as well as health care services.
The Shumlin team, however, hasn't figured that out yet, at least the part that goes with paying for it. It's time to simply confront reality, let the federal program take its course, and once everyone is more comfortable with doing business through the new health care exchanges being put in place, assess whether or not more tinkering is really needed.
Hopefully, it won't cost state officials another $300,000 to figure that out.