(Markowitz responds to a commentary from earlier today. Promoted as part of our standard policy regarding seekers of statewide office. – promoted by JulieWaters)
A lengthy essay posted this morning raises what its author calls “serious concerns” about the health plan I announced earlier this month. The only ones with concerns about my proposals should be pharmaceutical companies and the insurance industry – the real players in our current bloated and wasteful health care system that has anything to lose by keeping things the way they are. I may not have sat through committee hearings in the State House, but I have spoken with doctors and other health care professionals throughout Vermont and they tell me insurance forms not only increase costs for doctors and consumers, they are also being used to confuse patients and deny legitimate claims. My experience is just different than those in this Democratic race. I don’t believe all of the answers to our problems lie in Montpelier. In fact, they rarely do.
Specifically, this morning’s post accuses me of failing to understand “that there already is a national billing standard and creating another ‘standard’ would either be unenforceable, or worse, would actually add to the administrative burden if enforced.”
My proposal involves building on the already standard Medicare and Medicaid forms and creating and enforcing uniform standards or their use. This is not just a good idea, it is the law. The health care reform bill passed by Congress and signed by President Obama earlier this year requires the adoption and implementation of uniform standards for the electronic exchange of health information by 2013. My proposal involves making Vermont one of the test labs for this program. The GMD essay assumes that the federal government would never agree to this. In fact, Washington is already looking for places to create pilot programs as a first step toward implementing the law nationwide. Vermont is the perfect size for such a pilot program. Therefore, Vermont’s request for a waiver to establish such a program, far from being a waste of time, is something the system actually requires.
In Vermont, all of our insurance companies use separate forms. Doctors and patients must fill out maze-like paperwork to get reimbursed for care. My proposal is simple: If you want to do business in Vermont as an insurance company, you will use one standardized form.
Doing this is especially important because, as a study published in the June 2010 issue of the respected medical journal Health Affairs found, “excessive administrative complexity costs physicians nearly 12 percent of their net patient service revenue.” The article proposes simple billing and paperwork reforms that would meet the mandates of the new law and, in the process, save both doctors and their staffs many hours per week. The resulting efficiencies, if implemented nationwide, could save Americans $7 billion in annual health care expenses. This is what we mean when policy wonks talk about ‘bending the cost curve’. It is exactly the sort of reform that must be implemented nationally if we are going to fix our health care system, and for which Vermont is an ideal laboratory.
Furthermore, this standardization of paperwork is only the beginning. The Health Affairs study focused only on billing issues in doctors offices, but notes that the savings it foresees there will ripple through our entire health care system.
Make no mistake: Vermonters cannot afford to keep things the way they are. I have long said that I support a health care system where everyone pays for care and everyone receives care. Streamlining the maze of paperwork now associated with health care is not only the best way to begin cutting costs – it is an absolute necessity. My proposal will make Vermont a national leader in this effort rather than simply throwing up our hands and declaring the current system bad but inevitable as both Brian Dubie and the original poster do.
Here is the real question Vermonters, and all Americans, must face going forward: are we willing to work together, take on the insurance companies and build a health care system designed to put patients, rather than corporate interests, first? If the answer is yes, then we should be look for creative solutions for containing costs and embrace the opportunities afforded by health care reform for Vermont to become a national leader. Doing that will require careful study of professional data like the study in Health Affairs, not simply declaring that the insurance industry’s way is the only way.
for a well written and informative rebuttal that doesn’t dodge the issue. You’ve dealt with voters concerns in a refreshingly straightforward manner!
…that I do not have a thorough knowledge of the ins and outs of billing practices so I don’t feel qualified to make a judgment about the specifics of this, but I want to thank you for this response. I look forward to seeing how our expert responds to it.
Deb,
Thanks for your thoughtful diary. I agree that confusing and inefficient administrative costs are a major problem in our health care “system” that needs to be addressed. Undoubtedly, the proposed plans that will be presented by Dr. Hsaio and his team under the Act 128 contract will also address this issue.
I have a couple of questions about your statements:
1) Could you please elaborate on what you mean when you write, “I don’t believe all of the answers to our problems lie in Montpelier. In fact, they rarely do.” If I understand you correctly, you are proposing that the state of Vermont (after obtaining a federal waiver) regulate the insurance industry – by requiring that insurance companies use standardized insurance forms when doing business in Vermont. How is this not a “Montpelier” solution – isn’t this a regulation imposed by “Montpelier”? This is fine with me – I have no problem with appropriate regulation, in fact I think it is frequently necessary and desirable. So why do you find it necessary to jump on the popular (right wing) bandwagon of belittling “Montpelier” solutions in the same breath?
2) What do you mean by, “a health care system where everyone pays for care and everyone receives care”? Is this what you really mean to say? That the unemployed pay for care? The severely disabled? Impoverished children? I’m sorry if I seem like I’m splitting hairs, but this statement makes me uncomfortable. Universal health care means a system in which those who can pay their fair share, but in which quality health care is available to all, regardless of the ability to pay. This is not the same as, “everyone pays.”
Thanks for taking the time to participate in the discussion on GMD. While I don’t necessarily agree with you all the time, I do appreciate your willingness to engage in the discussion.
Sincerely, I’m sure everyone who visits GMD appreciates your very thorough and informative engagement on this issue and response to my original diary.
I share your driving goals of taking on the corporate insurers and finding ways to contain costs.
Your new explanation that “My proposal involves building on the already standard Medicare and Medicaid forms and creating and enforcing uniform standards or their use” sounds much more promising than creating one new single Vermont claim form.
The new reform bill does not call for new standards, it tries to strengthen the existing ones. For example, one section of the bill calls for the insertion of the word “uniform” in the original 1996 legislation requiring standard billing.
Unfortunately, Vermont is limited in ways it can lead alone on this particular issue without increasing the administrative burden on health care providers. We can however, work on getting our state’s medicaid system into better compliance with the existing standards and ready to comply with the more tightly defined and enforced uniform standards to come. There are also non-billing forms and processes that will be standardized in the new reform bill that can lead to cost savings, again, on a national level to avoid the need for overlapping systems.