Principles
- No person should be denied basic health care in America. An appropriate role for government is ensuring that healthcare is available and provided to those that need it, but can't afford it.
- Promoting health and wellness, and providing incentives to individuals and providers for achieving the same will reduce the total cost of healthcare.
- Individuals should have the freedom to decide whether to accept insurance as a method of personal risk management and/or healthcare financing.
So, what is Green Mountain Care?
Here, in its own words:
“Green Mountain Care is the official State of Vermont website for health insurance. It includes plans such as Catamount Health, Vermont Health Access Plan (VHAP), Dr. Dynasaur, Medicaid, and a number of pharmacy assistance and premium assistance programs.” (greenmountaincare.org)
The consolidation of these multiple programs into an umbrellam plan could be implemented to demonstrate whether there is true economy of scale in a single plan, and whether the State can administer such a program with its own staff. The State currently administers none of these programs entirely. Mostly, the administration is contracted to private insurers who compete for multi-year contracts when they are up for renewal, and there is redundant administration within State government. Let's do this in steps
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Consolidate the multiple government programs that exist today into into a single plan.
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Transfer the administration of the plan from the private sector to the State.
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Demonstrate that the success (or failure) of this model and offer umbrella coverage insurance to others. If it is successful at containing costs, it will be sustainable and attractive to Vermonters as a source of health insurance in a (relatively) free market environment.
Speaking of free markets....
Until very recently, there was practically no federal regulation of the health insurance industry, and until 20 or 30 years ago there was little State regulation. Vermont has gradually imposed more and more stringent requirements on insurers, and predictably, the small market of Vermont has seen a reduction in the number of insurers from a number well into double digits to approximately a handful. The resulting reduction in competition, rapid technological advance and use of mass media to promote specific elements of the medical industry are all contributing to higher and higher health insurance costs. Many Vermont businesses form out-of-state corporations to access lower cost insurance.
But there is a counter solution...
There is little dispute that a lifestyle including proper nutrition and exercise promotes wellness and good health. Natural remedies and treatment for many illnesses and conditions abound, and are effective for many. The cost of health care for those who take care of themselves is astoundingly less than than for those who do not. Yet in Vermont under current State law it is illegal for insurers to provide lower cost coverage to those who adopt healthy lifestyles – this is considered “cherry-picking”. It will soon be illegal and subject to fine for an individual to opt out of insurance and pay cash for health care. Perhaps, the penalty will be small enough that it will be cheaper to opt out than to buy in. Individual choice and freedom with respect to health is a principle to be restored and protected.
Moral hazard created by health insurance...
So, your health care is provided for you; you can grow and eat fresh wholesome food, or you can call for takeout; you can join a gym and workout or you can watch hours of TV. The health implications of these choices are clear. The physical costs are great. The personal financial costs to those with insurance are minimal. Health insurance creates a moral hazard in that the individual with insurance has protection regardless of their behavior and lifestyle. A system that contains incentives for wellness would reduce the total cost of the system.
We get a lot of smoke and mirrors from our leaders in this mattter....
“We might not all like all of their systems but they're spending two to three hundred percent less on health care than we are and they have better outcomes, it means that they are healthier than we are," said Shumlin. (VPR)
Sorry, but nothing can be reduced more than one hundred percent. We have the greatest health care available anywhere in the world. We have a corrupted big business system that adds unnecessary costs by allowing abuses and ignoring wellness.
Governor Peter Shumlin: “I think that every businessperson in Vermont has concerns about change. I think that frankly, every hospital and every healthcare provider has concerns about change, because government has gotten this wrong every single time.” (True North Reports)