A section little noticed at the time conferred upon the new Green Mountain Care Board the power to "set rates for health care professionals to be implemented over time, and make adjustments to the rules on reimbursement methodologies as needed."
At the time most believed that this power of the Board was necessary for the Board to determine how much to pay doctors providing services within the "public-private universal health care system" created by the act - always, of course, in light of available appropriations.
Rep. Cynthia Browning (D-Arlington) has a PhD in economics, and a penchant for asking important and sometimes troublesome questions. She read Act 48 and noticed that the Board's power to regulate prices charged by medical providers extended to any service provided by any doctor in Vermont - even a service offered privately to a patient paying directly out of pocket.
On March 19 Rep. Browning offered an amendment to this year's health care bill (H.107) to repeal the Board's power to price-control - and thus exterminate - private medical agreements completely outside the coming single payer system. The liberal Democratic House voted it down 44-94. Only four Democrats voted for it.
The argument against the Browning amendment came down to this: if Vermonters with money could escape from Green Mountain Care, Vermont would end up with a two tier system - Green Mountain Care for ordinary people, and prompt, premium care for those who can pay for it. That would fly in the face of the sacred "principles of universal health care," where everybody pays and everybody gets whatever care the system can afford to deliver.
Of course, one of those sacred principles is "(5) Every Vermonter should be able to choose his or her health care providers." Apparently that principle has already gone down the drain.
It's worth doing what the Green Mountain Care advocates resolutely refuse to do: look at 39 years of single payer in Quebec, just 60 miles north of Montpelier.
After years of health problems, including a hip replacement, George Zeliotis of Montreal got fed up waiting in declining health while the hard-pressed Quebec Medicare system delayed offering him treatment. So he went to his doctor, Jacques Chaloulli, and offered to pay him for health care. The government forbade it, and the two of them went to court.
In 2005 the Supreme Court of Canada struck down Quebec's prohibition on private contracting between patient and doctor. The court held that prolonged waiting is a denial of the access to health care promised by the Quebec Charter of Human Rights and Freedoms.
The lead opinion in the decision identified the issue as being whether the prohibition is "justified by the need to preserve the integrity of the public system." Justice Deschamps concluded that it was not, that long waits for medical care were Quebec's form of rationing scarce health care dollars, that the practice resulted in needless deaths, and that the prohibited private health care would likely have saved those lives.
The province's defense of its prohibition is precisely the rationale for totalitarianism: "to preserve the integrity of the (constipated, bureaucratic, unworkable) public system." That thought would be familiar to the late fascist dictator of Italy Benito Mussolini, with his motto "everything for the state, nothing against the state, nothing outside the state."
Gov. Shumlin's grand scheme of "universal" single payer health care can "work," on paper, only where the government completely controls the medical "universe." By preserving the Board's power to drive out any doctor-patient private-pay alternative to Green Mountain Care, the 94 defenders of Act 48's power to destroy any and all private options have cast their lot with the forces of totalitarianism. The voters should emphatically remind them that the first word of our state's motto is "Freedom."
John McClaughry is vice president of the Ethan Allen Institute (www.ethanallen.org).