Toward Evidence-Based Healthcare Reform
I’ll be chatting with Steve Cormier this Wednesday (2/8/2012) on his show, The Corm Project.
Tune in at 100.7FM, or stream from http://www.nsnradio.net
Following up on a recommendation in the Hsiao report of 2010, the Shumlin Administration has released a study on the pros and cons of a “no fault” medical malpractice 
system. Hsiao had recommended looking to New Zealand for a model, but according to VT Digger’s report on the study, the recommended system, New Zealand, can’t really be imported because it covers more than just medical malpractice.The malpractice report is full of citations of studies about the impact/non-impact of caps on damages and awards, surveys of physicians, analysis of hospital costs.
Sadly, they didn’t evaluate what might happen if a Vermont law passed in 1991 would finally be allowed to be implemented!
Yes, there is ALREADY a law on the books in Vermont that could help reduce defensive medicine, while NOT diminishing the rights of the aggrieved to pursue claims through the malpractice system.
Act 160 of the 1991 session included a “contingent amendment” to Title 12, Ch 215 that states: “(b) Practice guidelines duly established by professional organizations of health care providers, by licensed hospitals, or by quality assurance programs recognized by state law shall be admissible as evidence on the question of whether the respondent met or failed to meet the applicable standard of care.”
I’ll repeat: this is on the books now, but has not been implemented because it was amended on the Senate Floor by single payer advocates to set the implementation date as contingent upon “universal access to health care.” Which was not defined, of course. It was made “contingent” with strong support from the plaintiffs bar, even though this language in no way caps damages or awards, nor does it hinder anyone’s access to the courts. It simply encourages providers to follow practice guidelines and gives them a modicum of protection if they do. If the guideline is wrongly applied, inappropriate or the patient is harmed, the existing malpractice rules still apply.
The champion of this 1991 amendment was Sen. David Wolk of Rutland. It was supported by the Medical Society, the Administration, businesses and others. Basically, the effect of this amendment is that in a malpractice case, if a practitioner demonstrates that s/he was following “duly established” practice guidelines, that would be an affirmative defense against the suit. The plaintiff would have the right to demonstrate why the application of that practice guideline was inappropriate.
But at least practitioners have a reason for following practice guidelines (which for example might indicate an MRI or c-section was not indicated by the facts known at the time). Right now, practice guidelines are ignored because they provide no protection whatsoever to patient or practitioner. I was told by the former chief of surgery at FAHC that he was having trouble compelling employed physicians at FAHC to follow guidelines (thereby reducing the incidence of unnecessary tests and procedures) because they told him guidelines wouldn’t help them if they were sued. He told me “I could get them to follow guidelines if this fear were removed.”
Isn’t it about time we dealt with this? Are we going to let the plaintiff’s bar stop a common sense change like this from happening?
All that is required is to amend the implementation date for this ancient amendment to read “July 1, 2012.” A one line piece of legislation. Maybe it could be part of H. 559, the “Omnibus Reform Bill” for 2012? Or S. 208, the Illuzzi/Miller alternative? Or, as so many things are, attached to the Budget Bill?
Here’s a journalist who takes seriously the advice of rabblerousing scribe I.F. Stone: you can find out astonishing things about what your government is doing if you just read the reports they issue.
Emerson Lynn read a report just issued by the Shumlin Administration called “Act 48 Integration Report: The Exchange,” and found some astonishing fact, facts that made him ask the question “An 18.3% hike in premiums? Are you kidding?” And then he answers his own question: unfortunately, they are not.
Here is Mr. Lynn’s op-ed: http://www.vermonttiger.com/content/2012/02/an-184-percent-hike-in-premiums-are-you-kidding.html
(Click here for the Shumlin Administration’s report. The 18.4% rate increase shows up in two tables on pages 38 and 39.)
Mr. Lynn worries that not enough legislators will read this report for themselves before voting to herd individuals and small businesses into this version of an Exchange.
This isn’t scare tactics, my friends. This is the Shumlin Administration’s own report about what they are doing. But yes, it is scary if you are a small business….
From the Associated Press wire service this morning:
Both Jeanne Keller of Burlington, who has represented employers on health care issues, and the National Federation of Independent Business’ state chapter say by including employers with up to 100 workers, the Vermont exchange would cover too broad a range of businesses, and provide too few types of health insurance coverage.
House Health Care Committee Chairman Mike Fisher says those claims are exaggerated.
I’ll set out the evidence and let you, dear reader, be the judge of whether the claims are exaggerated.
1. According to the U.S. Census Bureau, defining “small business” as an employer of <100 people, which is what Rep. Mike Fisher’s bill (H. 559) will do, will include 98% of Vermont businesses in the definition of “small business” for the sale of health insurance in Vermont.
3. Rep. Fisher’s bill proposes to eliminate sale of insurance to small businesses and individuals EXCEPT through the Exchange. In other words, what is on the Exchange is your only route if you among the 143,000, which includes all employees/families of 98% of Vermont employers. And if you don’t like it, there is no option to buy something else outside of the Exchange. That is effectively outlawed by H. 559.
4. Act 48 (last year’s reform bill) contemplates the offer of a single health plan design, with the only variation being two levels of out-of-pocket exposure (the so-called “Silver” and “Gold” plans).
5. Act 48 requires the state only to “make reasonable efforts to have more than one carrier” selling that plan on the Exchange, and in order to have more than one carrier, the state is not required to recruit an “out of state” carrier.
6. The federal law contemplates that the federal government will offer something on each state’s Exchange, but it’s not known yet how their provider networks will be set up, or whether it will be any more affordable, or what benefits it will cover. It is a total unknown at this point, over which the state will have no say.
But it’s not just about cutting off options. It’s also about the risks they are creating by doing this. In one fell swoop, on 1/1/2014, one quarter of the population will change plans from what they had in 2013. Is one carrier, one plan design, one enrollment portal, one help desk, one state really capable of carrying this out smoothly and without a break in coverage, in payment to providers, mailing out all those cards, etc? So, is the claim that “the Exchange will cut off options for too many Vermont businesses and provide too few choices” an exaggeration, as Rep. Fisher claims? H. 598 and Act 48 will cut off options for 143,000 Vermonters, according to the Administration’s own estimates. Almost a quarter of the entire state will have access to one plan, one premium, possibly one carrier, one place to buy health insurance. The Administration had better know what they are doing, because they not allowing any Plan B — someplace else to find the coverage you want and can afford.
If you want to see an alternative way to set up the Exchange, look at S. 208 (Illuzzi and Miller). It lets the size 50-100 employers stay where they are. It allows people to buy plans outside the Exchange, where they may find plans more suitable for them. It doesn’t put 143,000 Vermonters into a single plan, single carrier, and single file, and hope for the best. I’d encourage members of the House to look at S. 208 to understand all of their options as lawmakers.
Maybe Vermont is so exceptional that H. 559 would work. We’ll have to hope so, because this “stepping stone,” single file plan seems to have a whole lot of momentum already. Or am I exaggerating?
The fun just won’t stop. Now the critics are attacking the Green Mountain Health Board for issuing a Request for Proposals so that it can have help with their public communications. (http://vtdigger.org/2012/01/13/margolis-when-any-pr-is-bad-pr/ plus the comments posted below the story).
As one comment pointed out, the attacks don’t mention or decry the fact that Governor Jim Douglas hired more than a half-dozen full-time press secretaries for various agencies during his Administration.
I would add that not only did every major state agency garner its own full-time PR flak, but in doing so the Douglas administration fairly decimated the capital press corps (from whose ranks the flaks were hired). If anything, this action greatly reduced the transparency to the public of what both the Executive and Legislative Branches were doing during those years. I recall many of the Governor’s supporters defending his decision to do this, as an improvement in transparency, however.
If you actually read the entire GMHB RFP (which someone basing their analysis on evidence should do before joining the chorus of criticism, IMHO), the tasks for the contractor appear to be reasonable and straightforward, designed to promote the public’s awareness of GMBC, their tasks, and their independence from other state agencies.
“Specifically, the GMCB is looking for a vendor to perform the following tasks:
I’d suggest that if the GMHB had not issued an RPF to find someone to organize and help them with their communications, they would be left only three alternatives:
(1) They could have proposed in their budget to add another staff position to do this, and taken huge criticism from the same people attacking them now. Or:
(2) They could have assigned existing technical staff to create templates for press releases and announcements, and design their stationery; to organize and send out the notices for their public meetings, write press releases and post notices about the issuance of draft documents for public review; to develop plans to distribution Q and A’s to the public and press about why GMB is doing what they are doing. Had they done that, they would have taken criticism from people like me who would ask why they are using the time and talents of a health care technical expert who should instead be concentrating on containing health care costs. Or,
(3) They could do nothing, and show up for their public hearings in dark and uninviting rooms, where there aren’t any people to give them input and ask them questions, and no reporters to tell the story to the rest of us who couldn’t be there. And then they would be criticized for lack of transparency, hostility toward public engagement and input, yadda yadda yadda.
In other words, given the venomous environment developing around the GMHB’s tasks (and the lack of civility is evidenced on both sides, I’m sorry to say), the GMHB can’t win. Maybe they could have been more careful in the word choice in their RFP — instead of every using the term “public relations,” they could have used “public engagement” — well, except that “public relations” is a term of art describing this kind of consulting service.
Yeah, I guess they can’t win. But good luck to them, and once I’m on that email blast list that’s created, I plan to take advantage of every bit of transparency that’s broadcast, and even force some they don’t offer. I’d invite the chorus of critics to constructively join me in getting the most out of this public communication contract.
The 2012 legislative session will finalize the shape of the Health Insurance Exchange to be launched on 1/1/2014 in all states, including Vermont. The Shumlin Administration has announced that their Exchange proposal will be released the week of January 16th. Unfortunately, they also announced they won’t have time to circulate it to stakeholders in advance, so to some extent we all have to speculate now as to the approaches they have planned.
But one of the key issues the 2011 legislature postponed to 2012 will certainly be in the package next week: How to define “small business” for the Exchange. Under the federal reform law (the Affordable Care Act, or ACA), only “small businesses” are eligible to purchase in the Exchange. ACA allows states to choose whether to define small business as <50 employees, or up to 100 employees. In 2016, by federal law all Exchanges will be open to the <100, so a limitation to <50 would be only for the first two years.
This became a flashpoint last year when the Shumlin Administration and Democratic leaders in the House and Senate drafted and supported legislation to set the threshold at <100. Many employers objected, and asked instead for the definition to be <50, the current statutory definition of a “small business” eligible for “small group” health insurance coverage. Given the push-back, the Administration and legislative leadership punted, and sent the issue to BISHCA for study and a recommendation in 2012. That report is what we’ll read for the first time next week.
Meanwhile, a bi-partisan counter-proposal to continue to define small business as <50, has been introduced in S. 208, sponsored by Senators Vince Illuzzi and Hinda Miller. S. 208 has already gathered support from the Lake Champlain Chamber of Commerce and many other businesses.
Here’s why many of us (including the sponsors and supporters of S. 208) want to continue to define small business as <50, instead of <100, at the inception of the Exchange, and then gradually increase the size to >100, following the requirements in ACA.
1. Bringing larger employers into the small group community rated pool will drive up the costs for 50-100 employers, requiring them to cross-subsidize small businesses, whose costs tend to be higher.
Studies show that larger groups will have to pay more to subsidize the smaller groups (the community rating means that everyone would pay the same premiums, and larger groups tend to have lower claim costs right now). Ask an employer in the 50-100 range (like Rhino Foods, for example) what they pay for an individual premium now, compared to what they could buy from MVP, BRS or the Chamber in the small group market now, and they’d tell you they get better coverage for less. Should they be forced to pay more to subsidize small businesses? Yes, we all would like smaller businesses to be able to pay less, but is this the time to set up this cost shift? Or do we try to contain costs for another two years before forcing the Rhinos of the world into the Exchange? The Administration has not shown yet that the Exchange plans will cost less than what anyone could get outside the Exchange.
2. Defining small business as <100 removes current choice and flexibility, and the return on investment for wellness and other cost control initiatives, for the size 50-100 employers,
Because the Administration would like to put all employers under 100 in the Exchange, while at the same time prohibiting sales of insurance outside of the exchange, they basically are mandating that the 50-100 employers would also have no choices except for the Exchange. In other words, putting them into the exchange cuts off all of their other options, in their scheme.
Currently, they are in the “large group” market and have much more flexibility to design policies that match their workforce. They are experience rated now so their investments in wellness and health prevention programs give them an actual ROI based on their own claims experience. If they are thrown into the Exchange, which is community rated, and cannot buy any plans outside, they lose any opportunity to have flexibility in their plan design, and lose their incentive to invest in worksite wellness programs. (These employers are where the many of the better examples of worksite wellness are right now). So, if the state weren’t mandating the Exchange to be the ONLY place to buy coverage, whether the 50-100 are “allowed” inside may not be such an important issue — it’s the mandate that once in the Exchange, there are no other options, that changes their current flexibility and ROI.
3. Forcing 30,000 additional people and almost 500 more companies into the brief Oct-Dec 2013 Exchange enrollment window, and the 1/1/2014 launch of the Exchange, creates unnecessary additional risks to the success of the Exchange
By redefining “small employer” to <100, you actually compel 98% of employers and 2/3rds of employees in the state into the Exchange. Enrolling this many employers and employees will be a monstrous administrative task. What if the enrollments and roll-out don’t work as predicted? It’s an “all in” proposition to provide plan selection and coverage to all of these people and entities starting 1/1/2014, especially because the scheme includes prohibiting continuation of your current plan, or the purchase of coverage except through the Exchange.
You can see in the chart below that even handling employers <50 is making a significant number of people dependent all working out as planned….and this chart just reflects the small business side. The Exchange is also going to serve individuals: all of the Catamount people, most of the VHAP people and all of the uninsured trying to sign up, get their subsidies straightened out, etc. Why add 442 more businesses and 30,051 more people that you can wait two years to add when the bugs are worked out, and costs are contained?
|
Size of establishment |
Number of Vermont Employers and Employees by Size of Entity[1] |
||||||||
|
<4 |
5 – 9 |
10 – 19 |
20 – 49 |
50 – 99 |
100 to |
500 to 999 |
>1,000 |
Total | |
| Entities |
13,701 |
4,066 |
2,531 |
1,519 |
442 |
255 |
21 |
11 |
22,546 |
| Employees (Mar 2011) |
21,085 |
26,892 |
33,900 |
45,004 |
30,051 |
45,566 |
14,208 |
21,190 |
237,896 |
| % of Entities (cumulative) |
60.8 |
78.8 |
90 |
96.7 |
98.7 |
99.8 |
99.9 |
99.9 |
100.0 |
| % of employees (cumul.) |
8.9 |
20.2 |
34.4 |
53.3 |
65.9 |
85 |
91 |
99.9 |
100.0 |
[1] Source: NAICS: 2009 County Business Patterns Study: County Business Patterns by Employment Size Class. Viewed 11/29/2011 at http://www.census.gov/econ/cbp/
So, the three key issues are:
So much of the inherent risks and problems go away if the Exchange is an option, which was the intent of ACA. It’s the Shumlin Administration’s intent to make the Exchange the only venue for buying health insurance that creates these problems. Of course that issue is paramount if your plan is to use the Exchange as the “stepping stone to single payer,” which explains why the Administration’s plan is to collapse the private market into just an Exchange. But that plan is precisely what is causing the risks and problems noted above. Make the Exchange an option (in other words, still allow employers to continue their current plans, or to buy one outside the Exchange) and if if the Exchange plan is better, of course they’ll choose it. But make it a choice to buy the Exchange plans, not a mandate.
So, that’s the nexus, the core issue of the debate this year about the Exchange. It’s the issue that will be defended the most staunchly, but it is precisely the issue creating these other problems.
In Vermont’s never-ending quest to reform health care, we’ve become pretty good at a couple of things:
Examples abound of how these tactics have already backfired on us. Remember how “savings” from implementation of electronic medical records were used to justify the tax on health insurance claims to finance giving computers to physicians? It’s not even clear yet what percentage of our physicians and hospitals are fully wired yet, but I haven’t seen any evidence of “savings” that come close to offsetting the millions we are spending.
And then there’s Catamount Health – we were told the “savings” from eliminating uncompensated care cost shift would more than make up for the new assessment imposed on employers to pay for Catamount. Well, uncompensated care has actually grown at an increased rate since Catamount started. (As has the cost of Catamount Health.)
I’ll stop there, but if you’ve spent any time around the health care debate in Vermont I expect you have your own favorite examples. And it has to stop.
And the tactic of getting someone else to pay for Vermont policy decisions? Can you spell “cost shifting?” Private insurance premiums (not tax payers) now pays for $165 million dollars worth of Medicaid-entitled hospital care. Remember how the legislature filled 75% of this year’s budget gap by imposing new provider and insurance claims taxes, all of which gets built into our insurance premiums? Look at what’s happening with the recent mandated coverage for autism spectrum disorder services: services that used to be in the school budgets are now adding cost to health insurance premiums. This new mandate is so costly, in fact, that the legislature didn’t make Medicaid pay for these services, only private insurance.
So I shouldn’t be surprised that as we proceed in our next phase of reform that Vermont is going to try those two tactics again. Listening to the discussion at today’s meeting of Vermont’s Health Care Exchange Advisory Council, I couldn’t help but notice those old themes recurring. Specifically:
In testimony to the House Health Committee during the 2011 session, I was trying hard to make the point that the US Congress would never give Vermont the more than five specific waivers of federal laws that we need to implement the Hsiao report’s recommendations and the “single payer” portion of H. 202.
To emphasize the point, I held up photos of Rep. John Boehner and Sen. Orrin Hatch. (In retrospect, I should have included Sen. Mitch McConnell and Rep. Eric Cantor…) “These are the guys who would have to give Vermont our waivers.” Let’s be real, I exhorted the committee members. “This is not going to happen.” But the “cockeyed optimists” prevailed and H. 202 became Act 48.
In several presentations since the end of the session, I’ve told groups that I won’t be talking about the single payer aspects of the bill because I believe it won’t ever happen; I’m focused on how Vermont implements the Health Insurance Exchanges because that’s what we’ll have to live with indefinitely.
Well, folks, once more, I’m sorry to say: Cassandra Speaks on Health.
According to Politico, a respected blog on all things Congressional, the Wyden-Brown proposal, the one that Obama and our Congressional delegation endorsed to move up the PPACA waivers for states from 2017 to 2014 has been declared deader than a doornail. I would have said “DOA,” but it never even arrived. Says Politico, the bill has “vanished from the Congressional agenda.”
This is significant for Vermont: Wyden-Brown is the bill that many single payer advocates in the state (including commenters to this blog) were assuming would let Vermont go its own way. It’s why H. 202/Act 48 includes language about applying for a waiver in 2013 to implement Green Mountain Care as early as 2014.
Ain’t gonna happen, friends. Not before 2017, if at all …
To her credit, Shumlin’s health care reform engineer Dr. Anya Rader-Wallach has consistently given 2017 as the launch date for single payer, rather than the earlier 2014 date that Act 48/H. 202 allowed, had the PPACA wavier date been moved up. But even 2017 is unrealistic absent a raft of other waivers Vermont would need to do an honest-to-god single payer. Given the political gamesmanship nationally over health care reform (whether you call it ”Obama Cares” or “Obamacare”), Vermont simply won’t be the beneficiary of a go-ahead for the single payer vision of Act 48. The failure of Wyden-Brown to even remain on the radar should be a clear sign of that.
We need to get real about health care reform. We need to build understanding and support for the tough cost containment that lies ahead, if we are to truly make this benefit universal, affordable and sustainable. We should not waste any time or resources challenging the federal laws that are boxing us in. You want single payer? You need to organize a national campaign, in every Congressional district.
You want universal coverage in Vermont to health care that is affordable, safe, and excellent? Then pay attention to what we can do – focus on how the Exchange is built, on how the disparate pieces that now deliver care are organized into budgeted, accountable systems of care. Focus on what we can do, because that’s what we must do.
At the budget hearings, year after year, only employer representatives (such as me) testified. I wanted to hear from single payer advocates, but they never showed up. Which made me wonder: don’t they understand that every year we don’t contain costs just adds to the amount of payroll, income or other taxes we’ll have to raise to pay for the single payer? Aren’t they interested in keeping the base cost of the system lower? Why aren’t they working as hard on cost containment as they are on changing the financing?
A cynical answer might have been: because the vocal advocates for single payer don’t care if the current system collapses. But I don’t think that’s the case. I think most truly believe that changing the checkbook will alone contain costs. They believe that Vermont’s insurance companies are profit-mongering. They believe employers, too, are culprits. All we have to do is get rid of their involvement, and costs will be contained. The Blueprint for Health (which, by the way, has not even demonstrated yet that it can pay for itself) will do the rest.
The tools we already had in place (Certificate of Need, budget reviews, quality and cost transparency, patient safety) just didn’t attract their attention.
Meanwhile, hospitals in Vermont continue to plan for growth (Check out their capital budget plans for the next five years – before the single payer takes hold: the base is gonna grow quite a bit), consumers continue to demand more care and faster service, private insurance coverage shrinks and more people go onto government programs that pay providers less, shifting more costs without containing them. Hospital budget narratives talk about “demands” they must meet: demands by physicians who order stuff for patients, demand from patients for faster and state-of-the-art services.
I’ve been getting a lot of criticism for not being a full-throated advocate for single payer. Well here’s why: it’s not because I’m in love with private insurance. It’s because for the 30 years that I’ve been working with employers and employees trying to contain costs, improve quality and promote a safer system, I have never once seen a single payer advocate at the table helping. I’ve seen dozens and dozens of exceptional hospital employees, practitioners and state agency staff. But never, ever a single payer advocate: not at a budget hearing, a CON hearing or an advisory panel for the hospital report cards, infection and patient safety reporting and improvement.
This leads me to deduce that they don’t care about these things as much as they care about who holds the checkbook. But why don’t they see the connection? If we have to eventually pay for all of this with taxes, shouldn’t we all share a concern about controlling cost, waste and errors?
Am I wrong about this? Prove me wrong, full-throated single payer folks! Don’t just criticize insurance companies — they only pass through the system’s costs to you. Changing the checkbook isn’t enough. Show up at the hospital budget hearings and make a case for reduced cost shifting, and tying budget approvals to improved safety and quality. Show up at a CON hearing and argue that because we are going to put the health system on the state budget, we have to rein in growth and change our expectations. Do the hard work of attending the advisory council meetings that design the public information for consumers on system and practitioner performance. Hold practitioners accountable for the millions of dollars we have invested in their electronic medical records that are supposed to improve efficiency and quality. (Don’t just repeat the mantra that it will improve efficiency and quality: go look and see if it has. Make sure it does. Assuming nothing. Question authority.)
Sit down with your loved ones and finally get that Advanced Directive completed. Work on stopping the obesity epidemic. Join the community groups creating a Healthy Retailer program for grocery stores.
If all you focus on is the checkbook, you are going to run out of checks pretty fast …
For starters, here’s a link to information on the upcoming hospital budget hearing. It is being held via VT Interactive Television on Thursday, August 4th in the afternoon. You all packed the VIT hearings on H. 202. Now the rubber is meeting the road. Now the work begins in earnest. Will you be there?
Answer: it wouldn’t be much different from prior years, when fewer than a handful of us pleaded with the Public Oversight Commission (POC) to ask tougher questions. Who were we? Folks who pay for private insurance and wanted someone to stop the cost shifting, who wondered about the explosive growth in outpatient surgery, who asked about the inexplicable variations in hospital use from region to region, who wanted the POC and BISHCA to connect the budget permission with requirements for improving quality and safety, and so on.
I was there as a cost containment, quality and patient safety advocate. But it was lonely. I wanted more of the employers, unions and employees paying for coverage to be there. I wanted to hear the single payer advocates’ viewpoint, but they didn’t show up either.
It’s not surprising, then, that the Public Oversight Commission was disbanded by Act 48 (H. 202) this year, and the usual two weeks of hospital budget hearings collapsed into a single afternoon over VT Interactive Television. One would have surmised from prior years that hardly anyone cared.
This year the Shumlin administration will be arguing they have tamped down system growth — to below 4% (once they give the hospitals “deductions” for numerous items that really, actually did drive up hospital costs, and for which hospitals will have to collect money from private payers). Whether you use the revenue figure before or after the tens of millions of dollars in “deductions,” however, should not draw attention from the rate increases to be charged to private payers. (See my blog on this topic.) This continues to be unsustainably high.
And once more, people ask: why are the rates charged to us going up at twice the rate of hospital revenue growth? Because of government cost shifting. Because we have to pay our share of the needed revenue growth, AND Medicaid’s share, AND Medicare’s share. And, we have to pay hospitals back for the provider tax the legislature and Shumlin Administration imposed on them this year. And down the line, we’ll pay the new tax on medical and dental claims. All of this drives up our insurance premiums faster than the rate of underlying system growth.
We are not given many opportunities to talk back to government about these things. The hospital budget hearing (August 4th, VT Interactive Television sites around the state) is probably the only chance we’ll have until the next session of the legislature.
So, show them it matters to you. Show up for the hearing. Tell them to stop the cost shifting and the shell games with provider and insurance claims taxes. Make them take responsibility today if insurance rates climb in January 2012.
Don’t accept the answer that the single payer will fix everything – that is, unless you can wait until 2017 (ETA or Estimated Time of Arrival for the single payer) for that to happen. It’s never too early to start cost containment.
Here’s a link to information on the August 4th hospital budget hearing. It is being held via VT Interactive Television.
