Vermont has experimented with healthcare reform for a long time, and now for the first time vast amounts of federal money are being sunk into the effort, write Darcie Johnston and Robert S. Emmons, M.D., in the winter 2013 issue of the Journal of American Physicians and Surgeons.
“Although Vermont has a population of only 630,000 residents, our small state has to date received more than $400 million in federal funds, and the spigot is still flowing.”
In 2011, Gov. Peter Shumlin signed into law the first state-wide single-payer system in the U.S. The goals included the elimination of health insurance and a guarantee that all Vermont residents will get “affordable and appropriate care at the appropriate time in the appropriate setting” (as determined by a five-member government board), write Johnston and Emmons.
The system is to be supported by a combination of a 14% to 18% payroll tax and other taxes—“the largest tax increase in Vermont’s history,” they write. All the promised savings will come from cuts in provider payments. All providers, including private physicians, will be subjected to a global budget.
An amendment to allow Vermonters to enter into private financial arrangements with medical professionals was defeated on a vote of 94 to 44.
Johnston and Emmons predict that both businesses and physicians will flee Vermont. “Patients will find fewer doctors available, with long waits and likely denial of access to care.”
To support the Provider Incentive Program, all health information will be entered into a central data repository. Authors note that patients will not be able to opt out and keep their data confidential, nor will they be allowed to decline the help of case managers to supervise care of their chronic illnesses.
“Vermont’s plan for payment reform relies heavily on the use of capitation payment and bonus schemes to influence physician behavior, a carryover of techniques from managed care.” This means that “physicians will be incentivized to withhold beneficial treatment from patients, and the only recourse for injured patients will be to take legal or administrative action against their personal physicians, rather than the architects of the flawed incentive plan.”
Other states need to monitor the outcome in Vermont very carefully before enacting similar schemes, they conclude.
he Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
PDF of full article: http://www.jpands.org/vol18no4/johnston.pdf
Visit Vermonters for Health Care Freedom at: http://vthealthcarefreedom.org/
