Vermont Single-Payer Proposals a 'Major Step in Right Direction': Doctors' Group

Longtime reform advocate and Vermont
family physician Dr. Deborah Richter hailed Wednesday's report of
health system
expert William Hsiao to the Vermont Legislature, particularly
Hsiao's findings
that a single-payer system would be the best remedy for what he
called the
state's "broken" and "unsustainable" way of paying for care.



"Dr. Hsiao's team of researchers found that a streamlined,
single-payer system for financing health care would save money by
reducing
excess paperwork and bureaucracy, cover everyone in Vermont with no
increase in
health spending, reduce or eliminate patient co-pays, promote job
growth and
economic development, and control costs," Richter said.



"Although the devil is in the details, the broad outlines of
his single-payer proposals are very promising," she said. "They
represent a
major step in the right direction.



"This thoughtful, evidence-based approach to solving our
state's health care problems - an approach that involves our new
governor, our
congressional delegation and state lawmakers poised to take swift,
positive
action to translate reform proposals into law - stands in stark
contrast to the
noisy goings-on in Washington this week," Richter said, alluding to
the
Republican party's symbolic vote in the House to repeal the federal
health law.



While her overall attitude toward Hsiao's draft report was
very positive, Richter said that her group, the Vermont chapter of
Physicians for a National
Health Program, would be making recommendations to improve the
single-payer
models to maximize administrative savings and strengthen cost
control even
further. After a period of public comment, a final report from Hsiao
is due
Feb. 17.



"Only a one-payer system can maximize the efficiencies and
cost savings," Richter said. "So it will be important to fully
incorporate
Medicare and Medicaid into the system as soon as possible. We will
also be
recommending the use of single-payer tools like separate operating
and capital
budgets for hospitals."



"Optimally, a single-payer program would also prohibit the
participation of investor-owned, for-profit delivery systems, which
studies
show drive up costs and produce worse medical outcomes," she said.


Hsiao is a professor of economics at the Harvard School of
Public Health and an internationally recognized authority on health
care
systems. Last year he and his team were commissioned by the
Legislature to
analyze three models for state health reform, including a
single-payer model,
where private insurers are excluded from the system and all medical
bills are
paid by a single public or quasi-public authority.



In his presentation to Vermont lawmakers, Hsiao outlined the three
models: a public single-payer plan, a plan that builds on the new
federal
health law but adds a so-called public option, and his team's
recommended plan.



Hsiao's team found that the "public option" plan would yield
the poorest results, having only a very modest impact on reducing
costs and
having almost no impact on reducing the number of the uninsured.



While citing the merits of a publicly administered
single-payer plan, Hsiao's team ended up by recommending a
"public-private
hybrid single-payer" model that would be managed by an independent
board and
that would contract-out the job of claims processing to private and
public
bidders. A private company like Vermont Blue Cross Blue Shield, for
example,
could be hired to process the claims, as is done currently by
Medicare.



Richter likes the idea of the independent board and says
physicians in Vermont
favor single payer because it's the only approach that gives them a
voice and
negotiating power - something they lack with insurers today. Single
payer will
also benefit the state's physicians by simplifying billing and
giving them a
choice of practice options. "It will make primary care very
attractive in Vermont," she said.
"We'll be able to choose where we want to practice and patients will
be able to
freely choose their doctors."



She also would like to see the enactment of a plan that
provides for comprehensive care.


Richter practices family medicine in Montpelier,
and has pushed for single payer in Vermont
for more than two decades. She is a past president of Physicians for
a National
Health Program, a nationwide organization of 18,000 doctors who
favor
single-payer national health insurance, commonly referred to as an
improved
Medicare for all.



"Dr. Hsiao has performed an extraordinary service," Richter
said. "Vermont
has an historic opportunity to lead the nation on fundamental health
reform."