health care debate

[Carolyn Branagan]

We were almost 18 hours into the debate when the Vermont House of Representatives voted Friday night to approve the latest addition of Health Care reform. The bill sets up the 'exchange', a structure mandated by the Obama health care plan. The exchange offers various insurance plan options for sale. Vermont along with all other states has to set up a system of exchanges to be in compliance with the federal law.  If we don't the feds will come in and do it for us. The debate was over how the exchange would be operated. Not surprisingly there were no answers to how much the exchange would cost or what health care services it would cover. I voted no.

It was pretty frustrating to sit there. Every pro-business, pro- taxpayer amendment we proposed was swamped by their 'no' votes. Federal law allows insurance plan options to be offered outside the exchange, but there have to be some inside the exchange. The majority voted to allow none of these 'outside exchange' plans in Vermont even though it will almost certainly cost more to omit them. That means 95% of the businesses in our state will have no options other than to purchase a plan inside the exchange. That's almost all of our small businesses, those who have fewer than 50 employees.

The message going out was clear: small businesses don't matter as much as larger ones and they certainly can't be trusted to make decisions on health insurance for their employees. This bill will certainly be the death of the remaining private insurance market in our state and then all businesses regardless of size will have no other choice but to purchase plans inside the exchange. There were simply not enough fiscal conservatives to stop this. I voted no. 

Especially troubling to me was the argument that federal money would come in and help lower premiums. I'm sorry, but in this economic environment I can't trust that the Feds will be able to do that. Again, I voted no. 

There was no estimate on how much this system would cost. And there was no idea from what source the funding would come. The whole plan was irresponsible. I voted no.
I want to hear from my constituents. Feel free to contact me at cbranagan@leg.state.vt.us   

Rep. Carolyn Branagan
Franklin-1, Fairfax/Georgia
Vermont House of Representatives

[rod anode]

im voting for obama this time

[mirjo]

Carolyn,

It's been clear from the beginning of the whole health care issue that it is good AND flawed in a number of ways. I can't say that I understand it enough to speak intelligently about it; however, I will say I don't totally disagree with health care reform, but it needs to be done responsibly and thoughtfully. I'm not sure it's being addressed in that manner at the national level, which is disturbing. I don't like or agree with all of the partisan garbage that goes on in DC that seems more self-serving to an ideology than what is good for the American People. Overall, people fear change and fear the government can't and won't get anything right--with good reason to feel that way.

I appreciate that you are being thoughtful about this matter--I think Vermont has a decent handle on health care reform, which unbeknownst to most people has been an on-going process for many years, which began (I think) with Gov. Dean and Dr. Dynasaur covering kids and continued with other things during the Douglas Adm. It goes far beyond the face of Green Mountain Care that people most often hear about. I don't know if any of Gov. Shumlin's initiatives will benefit what we currently have going on or create a bigger problem along with what the feds are trying to do. Naysayers naturally subvert to the negative. I think the Blueprint for Health and what's been going on (here in Vermont)  as far as streamlining services and whatnot  is a good thing. There is more to reform than simply the ins cost.

I think the feds rushed this thing since trying to get it passed and instead of looking at it realistically as in, "This is something that needs work." We have one side pushing it through and the other screaming to get rid of it!   Totally ineffective--as your recent 18 hours can attest to.

I fully agree that there needs to be concrete answers on how this will be paid for: the federal government is well known for un-funded mandates, like No Child Left Behind, to name one in recent memory.  However, I believe there is a need to do something regarding health care. What I have seen in recent years is health ins policies become nothing more than major medical coverage, with yearly deductibles so high that everything is out-of-pocket unless  there is a catastrophic need for surgery or other invasive procedure. I often think people would be better off to bank  the premium they're paying  and make payments to the hospital if they have to have something done. Unfortunately, that sets up a whole different set of problems with the hospital/docs not getting paid in a timely manner--they clearly can't wait years to get the full reimbursement for a surgery etc. But...

I've felt that states working on health care reform should be left to their own matters. I understand the (supposed) logic behind everyone being insured, although I don't understand why the system is allowed to operate this way.

Medicaid/Medicare only reimburses those in the health care industry a fraction of what insurance companies do. Medicaid far less than Medicare does. It's often not adequate to cover the cost of whatever the procedure. This is what is anticipated/feared from a single payer government run insurance system. Everyone opposed to it (I'll bet) feels as though they  will be welfare recipients and will receive sub par medical care. For that reason (I think) they would rather pay high premiums in addition to high deductibles for sub-par  private health ins. I don't see how anyone is winning here as it is, not those paying the high ins., not the providers getting miniscule reimbursement from the state/federal programs.

As I have re-read your post, it seems like no one is paying any attention and is trying on a "one size fits all," which is never the case that works in Vermont. We are a state built on small business, not large industry. If reform of any sort can't be affordable for what's here, then it simply won't work here. It seems there must be a happy medium somewhere, logic dictates that the answer lies in the middle. Who among the players knows the answer? What is the correct/best compromise? Is anyone using the C-word? It seems not to appear in the American political lexicon anymore.


I want to add that while I have a reputation for "leaning left" and have been called a "liberal" and "socialist" more than once, I really don't ascribe to any political party or ideology, just what makes sense to me  and playing devil's advocate to my overt Republican friends here on the forum. I have been a supporter for a number of years and appreciate the service you've put in for Franklin 1.

[cedarman]

I feel like I hear a lot of debate about how to pay for healthcare being called "healthcare reform".  It is NOT.  That is healthcare INSURANCE/PAYMENT reform.  Healthcare reform I think needs to focus more on how to reduce the overall COST of healthcare without significantly reducing the quality.

I have heard of one insurance company paying dr's a premium for every patient signed up for care under that dr/office, even if the dr never sees the patient during the year.  The Dr's are not paid per procedure.  It significantly reduces paperwork for the Dr. office and the Dr. can focus on what (s)he need to treat the patient and not adding on a bunch of extras.

Here is a simple example:  I went to a clinic for strep throat (I knew exactly what it was from repeat experiences). It's in my files with that clinic.  I go through redundant questioning (check in clerk, check in nurse, and the Dr.).  The check in nurse looks at my throat and states it certainly looks like strep, then does a rapid strep test (either out of routine practice, or a need to cover their assets against future liability).  The Dr. comes in (ask the same questions already answered previously), takes on quick look at my throat and states "i would definitely diagnose strep, even without the result (of the rapid strep test)".

I wonder,
IF the clinic was paid by the patient instead of by the procedure, would the $40 rapid strep test have been used when all symptoms indicated strep?
Could electronic software that automatically pulls up relevant patient history when symptoms are presented aid in the diagnosis instead of needing the Rapid strep test?
Could a slightly lower paid Physician Assistant have done the diagnosis and written the Rx for antibiotic?

Then there is the FDA – Did you know they have authority over everything from diagnostic equipment (MRI’s and x-ray machines) and pharmaceutical compounds, to tongue depressors and bed pans?   Maybe if they spent less tax payer money on bed pans and wooden sticks, they could decrease the time (COST) of getting beneficial drug compounds and medical devices to market, thereby, lowering healthcare cost through more efficient use of our tax dollars.

I’ll end my rant for now, but it just seems we need more focus on reducing the cost of the service/product, and not just how to make everyone pay for it.

[mirjo]

I'm with you cederman. I have wondered for ages why it is that things cost so much and no one addresses that particular issue--although we always hear about reduced paperwork and admin costs. I wonder every time I answer questions on a paper before an appointment and then am asked the very same questions again and again what the point of the questionaire is if no one actually reads it or why is person #1 asking if #s 2 & 3 are going to do the same?

AND what about the ridiculous cost of medical supplies, just because they're medical supplies? Price gouging at its finest. Another pet peeve of mine: How many doctors need to be paid to read an MRI? I've had this diagnostic test done (for good reason) and discovered not only does the radiologist charge several hundred to read the scan, but the specialist I was seeing also charged several hundred to read the scan and it was allowed by the ins. co. (at their pre-determined rate, of course, but still several hundred dollars). I certainly feel doctors should be paid a fair wage for their services and expertise, I just don't know if paying twice to have an x-ray read is necessary under normal circumstances and seems like a bit of overkill to me.

As for treating strep w/o confirming it: I don't know if that is good policy or not. Practitioners aren't always right and treating with antibiotics unnecessarily isn't good for anybody. The over-prescribing of antibiotics has led to the proliferation of superbugs that are resistant to treatment. Recently, I suspected my daughter had strep and her pediatrician disagreed, but the rapid strep test was positive--to his surprise. Point of story is that w/o that test we would have been back a few days later paying for another visit and my daughter would have been in that much more pain/discomfort.

I guess I would be asking why the test costs so much--like all other medical procedures etc. I don't know what the answer is, I just know the whole problem isn't being addressed, just a part of it and then inadequately.

[Chris Santee]

watch for physician assisted suicide to be in the news next week, big time.

[mirjo]

That, I am mostly in favor. I have listened in depth to all sides and then some and still believe it's right for people to be able to choose what's best for them personally. That said, the most compelling, thought provoking argument against this bill have been presented by Ed Paquin--a former Vt. House Rep. and not for the reasons some might expect.