(Continuing site policy of promoting diaries from officeholders and candidates – promoted by GMD)
On Thursday the House and Senate health care committees heard from Dr. William Hsiao, an international expert on health care system design. I found Dr. Hsiao’s testimony both interesting and encouraging, and he made it clear that we need to take the essential next step of designing a health care system. Dr. Hsiao praised Vermont’s efforts to date (Catamount, Health Information Technology, the Blueprint for Health), saying that we are the vanguard of health care reform here in Vermont.
At the same time, he pointed out that all of our efforts have been piecemeal, and what we need is a health care system to tie all the pieces together. He listed several problems Vermont is facing, including:
+despite valiant efforts, 7 1/2% remain uninsured, and 15% of insured are under-insured.
+costs are escalating and creating fiscal pressure for the programs we have
+we have a fragmented health care delivery system
Dr. Hsiao talked about how our efforts to date haven’t gotten us to the fundamental issues because we have not taken the essential step of designing the whole system.
He talked about what a single payer system is, and how Taiwan has used this model. He described four major features of Single Payer:
1) a single insurance fund – I was interested to learn that there might be multiple ways of collecting the financing for this fund (for example, Taiwan uses employee and employer payroll taxes, as well as insurance premiums), but there is only one payer to pay the providers.
2) a centralized information system – because you have a single payer, all records (provider and patient) are available through that one payer’s database
3) a prospective global budget for the upcoming year – Dr. Hsiao explained that this forces discipline in the allocation of funds and forces providers to live within the budget. In Taiwan, the providers are still paid through a fee-for-service system, but if they go over budget in one quarter of the year, in the next quarter, the fees they are paid are reduced accordingly.
4) a standard payment rate for providers – this eliminates competition on price, and encourages competition for quality because there can be incentives or bonuses for good health outcomes
Dr. Hsiao noted that when Taiwan was designing their system, they looked at several options and then chose the one that worked best for their situation and goals. He said it is important to look at options so that you can see the costs and benefits of the choices that you are making.
For instance, he noted that Taiwan chose to have a co-payment for office visits and hospitalization because the Taiwanese tend to go the doctor for minor issues, and they wanted to discourage abuse of the system. They do cap the amount that anyone has to pay for copayments at 10% of the average income in the region – he said Vermont’s cap under this system would be about $5000. Low income people and children are exempt from co-pays in Taiwan. He also noted that many studies show that if people don’t have to pay for medicine, they don’t take it, so Taiwan chose to make people pay in part for their drugs.
When I asked Dr. Hsiao if designing a few different systems is a good idea for Vermont so we can look at our choices, he replied that any good technical consultant would give us even more than three options, so that we can see all of the ways we can choose to achieve our goals and what each choice would cost. He said that we can all usually agree on the vision, but compromises often happen when the costs are known. He said the Senate Health and Welfare committee members are realists because we need to see which options are more feasible before we can begin implementing a new system.
Overall, I was encouraged that we are on the right track in Vermont with S.88 – the Healthy Vermont bill. This bill passed out of my committee last week with a unanimous, non-partisan vote. My committee members worked hard on this bill, both in and out of committee, to reach consensus. We all listened to many advocates, citizens, and groups, and tried to incorporate the feedback and address the concerns that were raised. Senators Flanagan (Chittenden), Kittell (Franklin), Lyons (Chittenden), Mullin (Rutland) and Choate (Caledonia) all worked together with me to find a meaningful way to move forward, and I appreciate their work and dedication.
The bill creates a board to oversee one or more experts like Dr. Hsiao to design three options for the legislature (and governor) to look at in January. One of these options must be a “single payer” system. All three of the options must meet criteria outlined in the bill. I believe this is the essential next step in health care reform in Vermont – system design for fundamental change. If you agree, please sign on to the bill as a “Citizen Cosponsor” to help keep the bill moving forward.
http://dougracine.com/about/po…
I think we should invest in our future and commit the needed funds to achieve fundamental reform. Please sign on as a Citizen Cosponsor today, and if you already have, please ask your friends to sign on.
Thanks for your activism – without you, we would not have come this far.
Sincerely,
Doug Racine
It’s hard to believe, but an estimated 2.6 billion people in the developing world—nearly a third of the global population—still lack access to basic sanitation services. This presents a significant hygiene risk, especially in densely populated urban areas and slums where contaminated drinking water can spread disease rapidly. Every year, some 1.5 million children die from diarrhea caused by poor sanitation and hygiene.