Envisioning a New Vermont Health Care System

June 13, 2013  
Filed under Health & Wellness

By Al Gobeille

At 14, I worked a summer job as a dishwasher for the hefty sum of $1.85 per hour.  I loved the people I worked with, the fast pace, and the check I received each Friday.  When I returned to work the following summer, I was promoted to prep cook and received a raise in pay to $2.50 per hour.

While this seems like a small amount of money today, it meant a lot to me.  I quickly realized that hard work paid off.  I’ve had plenty of jobs since, but the lesson is ingrained in everything I have ever done.  Work hard, learn fast and be committed, and good things will happen. I used these lessons to build a business, raise a family and try to help my community.

Unfortunately, today this connection is not clear for many Vermonters.  Vermonters work very hard, remain some of the most creative people in our country, and possess a level of commitment most companies would cherish.  So what has changed?  The link between hard work and higher wages has been broken for many by the tremendous impact of rising health care costs.  Simply put, almost every penny workers gained in wage growth in recent years was consumed by health care cost increases.  A recent report in the journal Health Affairs found that, while workers’ paychecks steadily increased between 1999 and 2009, the additional pay went almost entirely to cover the rising cost of health care.  By 2009, a worker whose paycheck should have provided an additional $650 per month due to wage inflation instead had only $95 left after paying for increased costs of health care.

Many Vermonters who have the benefit of employer-provided health insurance have been working hard simply to maintain that benefit, and have foregone wage increases as a result.  Others have seen the quality of their health insurance erode, through higher out-of-pocket costs, as their employers struggle to maintain health insurance and increase wages.  Vermont taxpayers have paid more to assure that those without work-based health insurance have coverage through Medicaid and other state programs.

As a member of the Green Mountain Care Board (GMCB), it is my job to help solve this problem.  The GMCB is working to bring health care cost growth in line with growth in our economy so that Vermonters can once again enjoy wage growth without giving up health insurance.  This is essential to the vitality of Vermont’s economy.

I have great faith that we can achieve this goal, but it will not be easy.  This is not a simple problem waiting for an easy fix.  Our current system has evolved over decades, and it will take time and tremendous effort to make the fundamental changes needed to improve the patient experience, focus on quality and outcomes and control costs.  I see great promise in the leadership of our physicians, nurses and other health care providers who are actually reforming the system we have today.  Conversations that would not have happened in the past are now occurring between institutions, government agencies, and among health professionals. More importantly, this dialogue is actually changing the way care is delivered.

It will take the courage and tenacity of our health care leaders to make these efforts have a lasting impact.  We cannot miss this opportunity.

Al Gobeille is a member of the Green Mountain Care Board.

The Green Mountain Care Board was created by the Vermont Legislature in 2011 to:

  • improve the health of Vermonters
  • oversee a new health system designed to improve quality while reducing the rate of growth in costs
  • regulate hospital budgets and major capital expenditures as well as health insurance rates
  • approve plans for health insurance benefits in Vermont’s new “exchange” program as well as plan to recruit and retain health professionals and
  • build and maintain electronic health information systems.

The Green Mountain Care Board (GMCB) is an independent group of Vermonters charged with ensuring that changes in the health system improve quality while stabilizing costs. Nominated by a broad-based committee and recommended by Governor Peter Shumlin, the Board is led by chair Anya Rader Wallack, a long-time leader in Vermont health reform, and includes two doctors, Karen Hein, M.D. and Allan Ramsay, M.D.; a business owner, Alfred Gobeille; and former Vermont Secretary of Human Services Cornelius Hogan. The current members of the Board serve terms ranging from three to six years.

The most unique thing about Vermont’s Board is that the Legislature assigned it unprecedented responsibility for all the major factors influencing the cost of health care. This includes hospital budgets, health insurance rates, benefit decisions and major expenses, rates paid by insurance companies and Medicaid, and plans to ensure Vermont has enough of the right health professionals and uses health technology to decrease costs. While in other states responsibility for oversight of these different parts of the health system is split among different agencies, Vermont’s Legislature created one Board to consider all the variables.

The Board has focused on reviewing insurance rates, approving an insurance benefits package, regulating hospital budgets, and launching “pilot projects” that test different methods for paying for health care to improve quality and minimize costs. This work lays the groundwork for moving in a careful, deliberate way toward the broader goals of Act 48: to provide all Vermonters with health coverage, increase the quality of care, keep costs sustainable, cut the link between employment and health insurance, build a publicly financed health care system, and improve the health of Vermonters.

The Board wants to hear from Vermonters and continues to travel around the state to listen to questions, ideas and concerns.

Source: www.gmcboard.vermont.gov.

For more information, visit www.hcr.vermont.gov.


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