Vermont Tiger

Medicare – The Promise That Can’t Be Kept

a mistake is becommng a betrayal

by Tom Evlsin

The promise was simple: once you reach 65, Medicare will assure that your medical costs don't become a catastrophic burden to you or children who might feel obliged to care for you. Since President Lyndon Johnson signed the Medicare bill in 1965 and gave ex-President Harry Truman the first enrollment card, the definition of "catastrophic burden" has been lowered many times by both Republicans and Democrats, the cost of medical care has skyrocketed as has the number of possible (usually expensive) medical interventions, and life expectancy has increased. The promise cannot be kept!

Geezers like me who recently reached 65 on the average had put in only on dollar for each three dollars of benefits we'll receive. That's a huge UNEARNED benefit. We didn't know that we'd be ripping off those still working but we are. The cap has been taken off earnings subject to Medicare tax; rich people pay a higher tax on their earnings than poor people. Premiums for recipients have been raised for those who are still classified as high earners. Payments to providers have been cut back forcing other users of health services to subsidize Medicare. But the funding gap keep growing inexorably as the number of workers supporting each retiree shrinks, we live longer and longer, and ever more ingenious (and expensive) medical procedures are invented. Raising taxes on the rich wouldn't solve the current problem let alone the future one; there's no one to pay for our care but us and our kids. Charging the kids more now means there's an even bigger gap when they retire. The promise cannot be kept!

Kimbell vs. Lynn

Vermont's great health care debate

(ed. note: this lengthy post begins with an editorial by Emerson Lynn which generated considerable comment here and elsewhere when first published last week.  Steve Kimbell, Commissioner of the Vermont Department of Banking, Insurance, Securities and Health Care Administration responded in an op-ed made generally available to Vermont media (we were left off the list and our feelings are hurt).  Mr. Lynn has now responded with a rebuttal to Mr. Kimbell's critique.  This back and forth should be essential reading for anyone attempting to understand the terms and terrain of the great health care debate now in progress.  The debate will, no doubt, go on ... and on.  One can only hope that it will increasingly generate more light and less heat and that, in the end, Montpelier will do the right thing.)

An 18.4 Percent Hike in Premiums? Are You kidding?

by Emerson Lynn

If the Vermont Legislature intends to shoot itself in the foot with its health reform efforts, the gun is loaded and the trigger about to be pulled.

In testimony this week, lawmakers began the task of outlining the details of how a health benefits exchange system would work, what sort of plans would be offered, who would run them, who would be covered, and what the costs would be. As one can imagine, it’s complicated and the details are overwhelming to most observers – legislators included.

What the legislators are working from is called Act 48 Integration Report: The Exchange. It is a 67-page document that has been left to the administration to explain.
 
For the moment, this exchange [basically a place for small groups and individuals to purchase health care] only includes businesses with fewer than 100 employees. The plans being considered don’t include what many businesses currently offer, which is the so-called “bronze” plan that carries a high deductible.

This concerns many of the businesses that testified before the committee. High-deductible plans have been the only means by which they could offer employees insurance and do so affordably.

Still, generally speaking most businesses are willing to consider any option that provides coverage to their employees, if the out-of-pocket expenses are the same or less.

For those who read the report, the news was nothing but pure rate shock.

An Easy Fix

... for medical malpractice.  Jeanne Keller explains.

Kidding Around?

Jeanne Keller writing about Emerson Lynn's warning of steep increases in health care premiums:

This isn’t scare tactics, my friends. This is the Shumlin Administration’s own report about what they are doing. But yes, it is scary if you are a small business….

On health care in Vermont, Ms. Keller is the gold standard.

Nobody is kidding, here.  Or crying "Wolf."

Like They Do In Quebec

by John McClaughry
 
Last Monday (Jan. 30) Gov. Peter Shumlin appeared before a chamber of commerce legislative breakfast in St. Johnsbury. During the question period he reported how his good friend Quebec premier Jean Charest had told him that many companies had asked him about locating a plant in Vermont, New Hampshire, Maine or Quebec, and Charest had gotten all of them to choose Quebec because of Quebec’s single payer health care system. There are some who will be skeptical of this report.

Later I had the chance to ask a question: “Governor, since you mentioned Quebec, can you tell us how your Green Mountain Care will differ in any material respect from the Quebec single payer system?”

His reply was this: “In Quebec health care providers work for the government. They will stay private in Vermont. Vermonters will have universal access.”

In the first place, Canadian Medicare is more universal than Green Mountain Care will be. It covers all Canadians except those in the armed forces or in prison. To distinguish Green Mountain Care as being more universal is, frankly, ridiculous.

The other part of Shumlin’s answer is more troubling. He actually believes that Canadian health care providers are employed by the government. That’s true in the United Kingdom’s National Health Service, but it is unarguably false with respect to Quebec. Shumlin’s Green Mountain Care will operate exactly like Quebec Medicare, right down to the controlling board, government definition of essential benefits, setting compensation rates for providers, writing all the checks to pay private providers, and setting a global budget in the name of cost containment.

I am shocked that Gov. Shumlin is so totally ignorant about the system just fifty miles north of Montpelier, while he is trying to impose exactly that system on Vermonters.
 
 

An 18.4 Percent Hike in Premiums? Are You kidding?

unfortunately, no

Politics by Emerson Lynn

If the Vermont Legislature intends to shoot itself in the foot with its health reform efforts, the gun is loaded and the trigger about to be pulled.

In testimony this week, lawmakers began the task of outlining the details of how a health benefits exchange system would work, what sort of plans would be offered, who would run them, who would be covered, and what the costs would be. As one can imagine, it’s complicated and the details are overwhelming to most observers – legislators included.

What the legislators are working from is called Act 48 Integration Report: The Exchange. It is a 67-page document that has been left to the administration to explain.

Duck

the health exchange haymaker is coming right at you

by John McClaughry

Just two years from now –if you are among the 143,000 Vermonters covered by private health insurance - you are highly likely to find your health insurance in complete limbo. That is, if Gov. Shumlin has his way with the legislature, which given its composition, is also highly likely.

To understand why this will probably happen, let’s go back to the 2009 passage of ObamaCare. The centerpiece of that legislation is the requirement that by 2014 each state must establish a health insurance “Exchange”.

This Exchange will operate on a state-managed web site where small businesses and individuals will compare available health insurance policies, and choose the one that best meets their needs. Individuals will then qualify for Federal income-based subsidies to purchase their chosen coverage.

This doesn’t sound too threatening on its face – but there’s more.

Flak Over Flack

the governor shoots down the board's proposal for hiring a pr person and it's a lose/lose deal.

Politics by Emerson Lynn

The Green Mountain Care Board has met the first public relations conflagration of its youthful existence and capitulated.

The board, in charge of determining the size, shape, and form of the state’s health care reform law, voted 4-1 to rescind its decision to hire a communications consultant to help it gather and disperse information. The decision to hire was made because the board doesn’t have the expertise, or the time, to do the job itself.

The eruption came about because opponents were able to label the proposed expenditure as nothing but political spin. The board was hiring a public relations flak to put a positive spin on the board’s efforts.

Shooting fish in a barrel is harder work.

Under Exaggerating

... is the claim that “the Exchange will cut off options for too many Vermont businesses and provide too few choices” an exaggeration, as Rep. Fisher claims? H. 598 and Act 48 will cut off options for 143,000 Vermonters, according to the Administration’s own estimates. Almost a quarter of the entire state will have access to one plan, one premium, possibly one carrier, one place to buy health insurance. The Administration had better know what they are doing, because they not allowing any Plan B — someplace else to find the coverage you want and can afford.
    Jeanne Keller

A Non-Choice of Health Care Plans

When Henry Ford first started selling his Model-T automobile, he told his customers that could have it any color, "As long as it is black."  The movement to reform health care in Vermont is launched on the same trajectory.  There will be an "exchange" but it won't offer the buyer much choice.  He can opt for Plan A or Plan B ... which will be identical to Plan A.  Just about the only "choice" available will be in the amount of a policy's deductible. This is to be the first stage on the route to single-payer. 

The disadvantages are obvious.  The perils are less so.  Jeanne Keller in a post that appears on the Campaign for Vermont website.  Read and be very concerned.