Stirring the Pot

Shap Smith, the Speaker of the Vermont House of Representatives, must be wondering who needs the Republicans when you have Cynthia Browning.

There has been no bigger thorn in the side of the House leadership than the member of the House from Arlington, Manchester, Sandgate and most of Sunderland. On issue after issue, she has bucked the Democrat-controlled legislature bigwigs and now has taken that independent streak to the next level, by filing a lawsuit against Gov. Peter Shumlin over his administration's failure to comply with a provision of Act 48, the statute passed by the Legislature in 2011 which set in motion the process that called for a total overhaul of Vermont's healthcare system and its financing, often, and misleadingly referred to as a "single payer" system.

The reality is that there will remain multiple payers, like Medicare, and Tricare for military families and other groups.

Providing broader reaching health insurance for those who couldn't afford before it is a laudable goal. Too many families postpone getting timely health care for fear of incurring unaffordable bills. Then, we they do go for treatment, too often, the problems are worse and more expensive to treat. The "fee for service" model that has characterized the U.S. model of health insurance is ripe for an overhaul. But.....

Under Act 48, the Shumlin administration promised to supply a financing plan by January 2013 for Green Mountain Care - the formal name for the new state-driven insurance system that will come into being in 2017, assuming the state obtains the waivers it needs from the federal Affordable Care Act. One year and four months later, there has been no plan produced. The best Team Shumlin has come up with is a vague promise to offer one by next January, conveniently after the state elections.

Given their track record so far, that's an uncertain commitment. In fairness to the Governor and his group of healthcare experts, fashioning a financing package for a "single payer" plan was always going to be a complicated project. And we understand that it's better to get the major components, if not all the details, settled and in place, before going public with it. But this is getting ridiculous. Normally we would be sympathetic to the notion that dribbling a complex package like a single payer financing plan out in bits and pieces, which opens up opportunities for it to be picked to death incrementally, doesn't make good political sense. But after this much time, delay and obfuscation, the governor's team should at least be able to share their views on what the main obstacles are. We'll hazard a guess that even after deducting the cost of insurance premiums from the average Vermonters checkbook, the cost of constructing a viable system in a small state like Vermont will not be a wash, but will be more expensive than what we have going now. And with the tax capacity of the state utterly maxed out, that's creating a problem.

We could be wrong. We're looking forward to finding out. So are a lot of businesses, who now have to operate in a climate of uncertainty around what the future holds for health insurance costs. One of the selling points of a single payer plan in theory is that it purportedly removes the burden of offering health insurance benefits from the backs of businesses. But if that comes at the cost of a whopping double-digit payroll tax, that benefit diminishes rapidly.

Another powerful argument in favor of a single payer approach is that it would standardize all the health insurance forms health providers must currently fill out, understand and monitor. Having to staff offices with employees who are up to that task is an extra financial burden on small medical practices that could be diminished by forcing insurance carriers to agree on standard forms. While different carriers may offer varying plans, even in the era of the health insurance exchanges and platinum through bronze plans, it should be possible to standardize and save costs.

As we've said here before, the health insurance situation prior to the Affordable Care Act was ripe for an overhaul. It was expensive, inefficient and too many people were - and still are - unprotected. With most of the health exchanges now functioning more smoothly than they did last October at the start of their initial roll-out, more people who couldn't afford health insurance now have it, and that will eventually translate into more people getting pre-emptive medical attention, instead of rushing to hospital emergency rooms when things either get critical or there are no other options. And as we all know by now, the ER costs more all around than treatment at a doctor's office or a community clinic.

We're still from Missouri when it comes to single payer, believing that a hybrid of private sector competition and public sector support and mandates is the way to go. The Massachusetts model pushed by then Gov. Mitt Romney in 2005-06 seems to have worked well, despite the former Republican presidential nominee's reluctance to embrace it during his failed bid for the presidency in 2012. Right now, absorbing the changes ushered in by "Obamacare" would seem like a big enough lift for now. Let's see how that goes before we upend everything again in favor of Shumlincare.

Meanwhile, three cheers for our local representative for holding the Governor and the House leadership's feet to the fire on this one and insisting on accountability. The law is the law. For the governor to flout it and then not release records from post-January 2013 should not be acceptable. It's called transparency, something the Governor apparently needs a refresher course in. We'll wish Rep. Browning and her legal team the best on the court appeal.

Finally, we direct your attention to an important op-ed to be found elsewhere in our opinion section today, penned by Joe Choquette, a lobbyist for the Vermont Press Association. Transparency should extend across boundaries, and one of them is the open meeting law. There's really no issue here. Public meetings should be fully open, and skirting awkward questions by going into "executive" session behind closed doors should be limited to the very few occasions that appropriately call for private discussions, such as personnel matters and contracts, where premature disclosure unfairly harms individuals or municipal operations. That's it. For a state that likes to pride itself on open government, this should be a no-brainer. Funny how it isn't.


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