Help Me Understand

[Chris Santee]

from Vermont State Auditor Tom Salmon to the Fairfax News:

H.202: Please hit the Pause Button
The Latin root of the word auditor is auditus: “a listening, a hearing.”
I have aggressively listened and sought understanding of Vermont’s healthcare bill H.202:
1.   I attended Dr Hsiao’s first public hearing in 2010, in Room 11 of the Statehouse when he declared the difficulty.

2.   I attended his January 19, 2011, presentation in the House chamber and reviewed his materials.

3.   I have reviewed H.202, which is now in the Vermont Senate’s hands.

4.   I have listened to medical professionals and reviewed the Joint Fiscal Office projections (scary in the coming years).

5.   I have discussed the matter with insiders who call the process a “train wreck” because “providers are mobile” and “subsidized clients will have to accept basic care with lower service levels --- or will the state have to fund a silver and gold plan too?”

6.   I have listened to lawyers who ask about the Constitution and the “privileges and immunities” clause that could draw, logically, unhealthy people here. “Let’s go to Vermont for that surgery I’ve put off.” Please note the bill already confirms we have a shortage of doctors.

7.   I have read op-eds and listened to radio interviews of thoughtful, informed professionals who have deep concerns that we are moving too fast. Representative Browning articulated her concerns very well, and voted “nay.”

8.   This bill misleads the public by presenting a stated purpose that includes “setting forth a strategic plan”, when in reality it demands great energy and resources (millions of dollars) across state government far exceeding scope and possibility.

9.  One week ago I participated on a health care panel in Rutland. I said very little except to voice my concerns as an auditor; the impact to the financial statements, bond rating and future liability of the state are unknowns. It was a civil and thoughtful discourse among the audience, legislators, healthcare professionals, insurance salespeople, etc. The unanswered questions were too numerous to document. Cross-border, ERISA and residency concerns just to name a few.

New information on all fronts would lead responsible leaders to push the pause button and gather more information before proceeding.  The financial incentives and promises of administrative savings are no longer realistic, given all the amendments arising. Furthermore, past audits by our office have indicated that Vermont lacks a proven track record of strategic planning, performance measurement and implementing reform.

Much has changed since Dr.. Hsiao has visited Room 11:  A well intended idea has met its unfeasibility. Why not work within the operational reality to construct a feasible plan without all the hype and history making?  In the auditor’s office we live by the creed: “A quality process leads to a quality product.”  In a March 2010 letter to Congressman Welch last year, I sought to convey the same message. President Obama had a chance to really fix Medicaid and Medicare but he punted. Now Vermont is on track to repeat the same type of mistake.

This bill is a political solution attempting to solve a complex financial problem. Medicaid keeps Joint Fiscal’s Steve Klein up at night because leaders have lacked the courage to address the real problems.

Vermont has some other large problems, too. With unfunded pension and OPEB (other post-employment benefits) responsibilities, increased income sensitivity payments, declining income tax revenues, federal ARRA money going away, and infrastructure and demographic challenges, it is time for leaders to lead and financial people to be heard. I hope people will hear what I am saying. I have testified on sensitive matters from the Bennington “sick” building, to pre-kindergarten, to the unemployment fund. The fiscal impact of this commitment of resources is unknown without a better formulated strategy in advance.  Vermonters can handle the truth.

Thomas M. Salmon CPA is the Vermont State Auditor. He lives in Saint Johnsbury.

[Loctavious]

Chris,
     Would you mind commenting on strictly the rhetoric side of this 'discussion'?  You're a known republican who offers mild to no rhetoric and if you do, provides factual evidence to support your view.  You refrain from 'offering' energized and grossly inflated terms, name-calling, and the typical and offensive partisan rhetoric (possibly due to the fact it polarizes even further the differing opinions and actually serves to prevent either side from seeking any middle ground or possibility of seeing the others point of view). 
      I feel that perhaps your presentation of how such charged rhetoric, name-calling, and poorly thought out adjectives ( or perhaps it's a lack emotional intelligence) to describe issues, is counter productive to what some folks hope to achieve when they themselves opine about these issues - which is to offer their view on how said issue will affect them adversely.
      ALSO - I'm pretty sure Henry wouldn't condone language which is meant to offend, name-call, or otherwise belittle another's point of view  - especially profanity - as he states on the top of the page of the forums.

Thanks bud. 

Loct

[rod anode]

loc.you must have been in mensa

[mkr]

Loct, I believe Chris is just passing on the info from Tom Salmon up above and not his words.

[cedarman]

Health INSURANCE reform is NOT HealthCare reform.  It seems to me that politicians focus on the "administrative costs".  Yes, there can be some savings in that area, but we won't see significant savings in healthcare cost until we start looking at WHY cost of care is climbing so much faster than inflation.

Is the overall increase due to more people seeking healthcare due to an aging population, or is cost climbing so fast due to rapid increases in the cost of procedures and medications? 

Are the costs of materials required for diagnosis/treatment climbing rapidly due to a lack of supply or due to suffocating government regulations?

[Chris Santee]

Thanks, Coach, always a pleasure to hear from you, you say the sweetest things.

Yes, mkr, some of my posts are from me and some were submitted to the Fairfax News, I try to identify all.
(I don't want to be like the Republican legislator who read someone else's speech on the floor, I'll refrain from blasting him).
Or did I just do that ?

Henry, sorry I didn't keep it to a sentence or two, that's tough.
In my humble opinion, I believe it's going to cost you more in cash, co-pays and you may have to find a new doctor, maybe in a new town. You'll have to wait longer for an appointment and more and more of your coverage will be denied as the program gets more and more expensive.

J_Gluck, thanks for explaining who the doctor is and providing the links, but you can say Harvard, Harvard, Harvard all you like.
There are others at Harvard who disagree.
You mention "He is an economist who studies the economics and health proficiency of healthcare systems in the US and around the world." 100% Correct, but this is a first time experiment in the US and I'm not really interested in being one of his guinea pigs in his study, I'm a human being, and I happen to need healthcare (My primary has already informed me that we won't be together much longer).

Gary, thanks for (I'm having some problems posting here)

[Stand Alone Defense]

Thanks for your input Chris, and also well said I agree with you 100% on this issue!! I got your back buddy!!

[Chris Santee]

The problem may have been posting at the same time as cedarman.
Or maybe your site is just tired of hearing from me.


Gary, thanks for commenting, I believe communication is very important and I appreciate both you and Carolyn posting here.
But, (you knew that was coming) I don't think it's a cautious step that sends 28% of our doctors packing.

Or does it ??
The D from Jericho, who I admired for honesty admitted to Anson Tebbets, that some people taking the poll may not have been docs afterall. Darn, lost the link from WCAX.

Mike, I agree about Dealer.com and IBM, what they have to say worries me and we should listen to them. How's Tampa liking Manny ? I hope your storms are over for a nicer spring.

Thor, yes I saw through the smoke and mirrors and don't agree with Till, but I was surprised he admitted 28% would leave the state before he admitted they might not be doctors (I'll get that link now).

Then, I'm going to enjoy some of this sunshine, I hope you all do too.

[Chris Santee]

Here's the link from WCAX:
http://www.wcax.com/Global/story.asp?S=14390288

It's chiily out today, but very sunny, enjoy !

I've got some selectboard stuff to follow up on. I was interested in a speed bump by Gaming Weasel's house to slow down the kids at the covered bridge, but if they get in an accident, it would be my fault for putting the speed bump in.
Not the kid's fault for driving 60MPH through the covered bridge, no, it would be my fault.
So a bump is out (sorry for any confusion here Lena6) but a deputy might be in.

Don't Speed on Maple Street !!!

[Loctavious]

No seriosuly - chris - i wasn't being facetious or sarcastic - I legitmately meant what i said about your approach NOT being as charged and partisanly-riling ( that is not a word but perhaps it may become one) as others - no joke.  Or maybe it's because i know and respect you  that i don't take it to heart - regardless, i'm sure you'll agree the rhetoric gets us no closer to the middle - which is where real progress is made.

[mirjo]

i'm sure you'll agree the rhetoric gets us no closer to the middle - which is where real progress is made.

Agreed. It's where the answer lies. I think most people agree something needs to be done. I think the concept of a single payer system run by the government makes people's hair stand on end, with the exception of yours Henry , because the government time and again has proven itself to be a bogged down, inefficient behemoth, fraught with partisan infighting and grandstanding. (especially Washington) Our local folks at the state level really want to do the right thing, but knowing what the right thing is, is not an easy question to answer and not an easy task to undertake.

We hear a lot about administrative costs. A LOT. What we  don't hear about (and I think it was mentioned here somewhere...) is  why health care costs so much in the first place. Why do MRI's cost $3000? How are those costs calculated? Cost of machine/energy use/personnel to run, what other factors figure in to that number? Are the older models less energy efficient? Do the newer models which take less time and therefore "see more patients/day" make more money for the hospital overall? Does the radiologist need to charge $400-500 to read it? And then does the specialist who ordered it need to charge that much again? These questions I've never had answered, but have always wondered. Whenever I've had an MRI, two docs have charged for reading it. If the Radiologist is the expert, why is the other guy charging for his concurring?

I'm not a numbers cruncher, nor a member of Mensa,  but it seems logical to me that if Health Care Reform is the issue at hand, then maybe the entire scope of the issue should be dissected. It seems like maybe Health Care reform and Insurance reform are getting confused (also mentioned, I believe). I think there is a problem with both, but I also think they are kind of two separate, but related things.

For years, hospitals (pushed by ins co) have been moving away from inpatient stays to more procedures that are "day surgeries." Clinical Pathways were implemented years ago as a means of tracking patients on expected outcomes for specific surgeries and only those who deviate from the anticipated path stay longer (they ultimately cost more and generate more paperwork  and make the numbers look bad) Bypass patients are only expected to stay about 3-5 days. The plan of care is very routine and the outcomes and deviations are very predictable in most cases. This is just one example.

It seems like this trend toward saving money for the  insurance company and getting people out of the hospital faster (which is better in many cases, though not all) didn't lead to any real reform in health care or in saving money any money, since insurance and costs have continued to increase phenomenally. There is so much more to this than  single payer vs what already exists.

Everyone who has great insurance coverage that they don't want to mess with I say  you're lucky. I will also say that not everyone is sitting in that boat with you. I think there is a happy medium somewhere, but those in charge need to look and  listen carefully. As any good carpenter will tell you: Measure twice, cut once.