Tuesday, August 16, 2011

Vermont's Single Payer Model: Evolving or Naive?

And so it shall be.....
Newly launched pharmaceuticals and medical devices follow a predictable business cycle. Powered by glowing research reports, there is an initial period of marked enthusiasm and high sales.  Then, as experience accumulates, reports of limited real world effectiveness and side effects unanticipated by all those smart scientists rudely intrude. Sales peter out and the market awaits the next miracle, the next Blockbuster, the Next Big Idea.

Is the same pattern true for health care policy?  Will Vermont’s foray into a “single payer system” fall victim to the same cycle of frothy acceptance followed by bitter disappointment?  Those questions were on the Disease Management Care Blog’s mind when it read Amy Wallack’s self-assured two pager New England Journal perspective “Single Payer Ahead – Cost Control and the Evolving Vermont Model.” 

As the DMCB understands it, the Swedish Green Mountain People’s Republic has decreed that its health insurance exchange (HIE) will offer a “public option” insurance plan that will be designed and funded to drive other insurers out of the state, including Medicare and the military’s health plan, TriCare. Capitalizing on the widespread frustration with fee-for-service provider reimbursement, Vermont will launch a payment system packed with the latest darlings of health reformists everywhere, including “medical homes,” “bonuses,” “quality metrics,” “pay for performance,” ”global payment” and “bundled payment.”  Top this off with an “Green Mountain Care Board” that can set provider fees, deny coverage for unproven “technology” and review competing commercial insurers’ rates, and 650,000 Vermonters will be participating in a cluster of top-of-the-enthusiasm-cycle policy preferences that, until now, liberals and progressives could only fantasize about.
Snarkiness aside, thousands of regular DMCB readers know that every one of the reforms described above have not consistently fared well in the real world.  While glossed-over statistics, idealistic generalizations, selective interpretations and a neo-European ideology have convinced much of the political class, the inconvenient truth is that we simply don’t know how this will work out for the patients being cared for by the docs at Vermont’s 14 community hospitals.  It also remains to be seen how a government-run insurer will be any more responsive, cheaper or better quality-wise than a similarly sized not-for-profit health plan – outside of its ability to dictate take-it-or-leave-it prices and hide costs by spreading them out over a tax base.

The good news is that any possible damage will be contained to a single state, versus the slow-motion car wreck that could happen under a similarly contrived one-size-fits-all nationwide plan.  Which is why, in the end, the DMCB is all for Vermont’s foray, just like it thinks the Massachusetts plan was a good idea.  If Vermont’s model works out for its citizen-patients, the DMCB will be the first to congratulate Dr. Wallack and her colleagues on the Governor’s staff for a job well done. 

If not, the DMCB will be there to help think – and be simultaneously cautious - about the Next Big Idea.


Anonymous said...

This comment is beyond the meaning of ridiculous, for one, single-payer systems work wherever they have been tried. It is our system that has failed. Do you see Sweden adopting the usa's costly and class/racial oriented health care system? No. Our system is the failure. A complete failure.

Jaan Sidorov said...

Anonymous raises an excellent point but divergent histories, cultures and building blocks have left Europe and the USA in completely different places. Toss in politics (a large constituency that doesn't believe there's a failure) and trying to go the Swedish way will also be a complete failure. As I said, I wish VT good luck, but doubt they'll pull this off thanks to medical homes and ACOs.