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.

you can’t build that here

we’re putting in a sports bar

you can’t move in next door

this area is specially zoned

you can’t buy that book here

people who read that make us nervous

you can’t marry that person

what will happen to our children?

why do you hate America so?

this is the land of the free

hey you can’t teach that in school

we’ll have to call the police

you can’t wear those clothes

it upsets the public well being

you can’t mourn for the dead

or mention the dead or try to stop

any more killing with the traditions

of the heresies you worship

why do you hate America so?

we are one nation under God

God has warned us about your plan

you can’t build that here

we don’t want to be reminded

about fearful things like love

Peter Buknatski

Deb Markowitz recently unveiled a plan for health care reform that leads with a proposal that raised serious concerns to me.

I will launch a pilot program statewide with the largest hospitals and doctors groups to implement standardized billing procedures that will reduce overhead in health care, cost consumers less and eliminate headaches for  medical professionals.

I’d like to make clear that I would support Deb if she wins the primary and think she would be huge improvement over the Douglas/Dubie approach. However, as an expert on this issue in my non-blogging life (I’ve been asked to testify to state legislators on this subject), I feel compelled to raise the issue while we are trying to chose the best democratic candidate in our primary election. The proposal brings into question the depth of knowledge of this critically important state issue.

The problem with this proposal is that there is already a national billing standard, and creating another “standard” would either be unenforceable, or worse, would actually add to the administrative burden if enforced.

I’ll try to outline the details of this issue below the fold without getting too wonky on technical billing issues…

On the campaign webpage, and just now as I am typing this in the VPR debate, Deb Markowitz is touting her plan to reform health care with a central goal of creating standardized billing procedures.

This proposal seems to be ignorant of the fact that there are already “standardized billing procedures” outlined in the Administrative Simplification sections of the 1996 HIPAA legislation. In fact, the current environment is much better than it was in 1996 when insurance companies could each dictate their own standards. Now we have a significant level of standardization across all payers, although ironically state medicaid systems like Vermont’s tend to be the least compliant among payers.

As I said, there are two damaging outcomes that could result from the Markowitz proposal.

First, if VT enacted its own “standards”, they would be in conflict with the national standards, and most insurers who do business in Vermont would simply not accept them and point to the national requirements as a defense. I don’t understand how anyone would make this proposal seriously and expect it to be carried out, if they understood the health care environment.

Without question, even if this was enforced on some payers, Medicare would continue to follow the existing federal standards that they are so integrally involved with. So the other possibility is that somehow VT obtains a waiver in our lifetime to create another “standard” and there is effective enforcement to force all participants other than Medicare to comply. All Vermont providers (and others doing some business in VT) would have to then create and support a parallel programming track to meet these specs when claims go to payers that follow the VT “standard”.

So rather than save money, the best this proposal could hope for would be to be ignored, otherwise it would actually ADD to the already mind-numbingly wasteful health care bureaucracy overhead.

This may seem a bit too technical to get all lathered up about, but it comes down to this – a candidate running for governor (and certainly a governor) needs to know the technical details of a vital issue like health care before they propose something that could be ineffective or counter-productive. I’ve shared this concern with the candidate and the concerns were not recognized, indeed this plan was mentioned again tonight. I hope that Deb will consider these concerns anew and engage in a discussion or explain her rationale further here on GMD.

We need a nominee who has the depth of understanding of vital issues to stand up to Brian Dubie and present a vision of competence and leadership for the general election, and to governing effectively after victory. I’m hoping that raising these concerns here will help us towards an end result of a nominee that possesses those qualities.

I've been undecided about even posting this, but I think it's indicative of the quality of the candidate.

 If you're on Facebook you may have noticed Dan Freilich has been eagerly flogging his web ads, including the one with him on the cow, trying to get as much play as possible. Naturally, he linked to it on his FB page, with this introduction:

Our  video just got covered by Time Magazine (corny or regrettable) either  way people are realizing we know how to tackle serious issues and have  some fun too.

 I posted a snarky little comment to the effect that he should let us know when he gets around to tackling serious issues, but then, the next day I noticed that my comment is gone, so I just posted another comment that I noticed he's now deleting negative comments.

Here's his response on my FB wall:

CaptainDan Freilich                      

when someone is being a petty-prick, we tend to not have any affiliation with them.

Nice, huh?

Correct me if I’m wrong, but isn’t this the same guy who is crying about being “silenced”?

St. Albans Messenger endorses Deb Markowitz.

Ever since respected Addison Independent editor Angelo Lynn threw his support behind Matt Dunne,  some of us (not many, mind you) have watched with interest to see whom brother Emerson Lynn would annoint.  This gripping question was answered in today’s Messenger editorial:

We need a leader who understands the need to break the bureaucratic inertia that retards innovation…who understands the future is not about the person who occupies the office but about the next generation of Vermonters…Of the five Democratic candidates running for governor, Deb Markowitz is the one who best fits this profile.

He goes on to cast a few roses at her feet; but take care, there are some hidden thorns:

She understands… that efficiency in state government is a must, regardless of whom it offends.  When she became Secretary of State that need was evident in her office, and she took on the union to get it done.

or how about this:

Politics is about self-interest, the art of governing is blending these self-interests into a common theme that can be sold, and that is her strength.

The remainder of the editorial is basted with more oddly chosen and lukewarm praise for Markowitz, artfully phrased so as to target zingers at the other four candidates.

Matt Dunne, we are told

…shares some of Ms. Markowitz’s strengths.  He has the same level of grass roots understanding and ability to organize effectively.  He is a creative thinker and excels above the others – even Ms. Markowitz – in effectively using the bully pulpit to inspire.  In today’s world that appeals.  His weakness is that he overpromises…

Of Doug Racine he observes:

Few know state government better.  No one has a better heart…It is Mr. Racine who through his allegiances(?!), has gathered the lions share of the unions endorsements.  But his temperament is for another time…We fear his allegiances (again with the allegiances?!) would act more as a prison than a springboard.

Clearly, this guy doesn’t approve of unions; but why would he think an anti-union endorsement would appeal to Democratic voters?  Is he just messin’ with us?



Peter Shumlin gets it most directly in the chops.  Continuing the theme of left-handed compliments, the volley begins with a tip of the hat:

Peter Shumlin is the master tactician in the race….but to say he stands on his principles is objectionable to anyone who has watched him work.  He will say whatever he needs to say as long as he is the one who benefits.  Period.

Oo..kayy?  No need to go any further with that quote.  Clearly, there are some issues here.

To Susan Bartlett , he gives a nice pat on the head and the assurance that:

If a Democrat wins in November, look for her to be a name considered for a top post.

Hello?  Earth to Emerson, this isn’t the West Wing!

So, there you have it: The Messenger endorses Deb Markowitz.  Why do I have the lingering suspicion that  Brian Dubie approved this message?    Deb, you have my sincerest sympathy; and I, for one, won’t hold it against you!

“I am the only person running for governor who has sponsored every single single payer bill that’s ever been introduced as long as I’ve been in the legislature.” I know there was a recent dust-up concerning Shumlin’s claims about his support for single payer legislation, but I think the way he speaks his position here, he is on solid ground. And this interview predates the controversy (July 9), so he was not correcting the record in his statement.  Enjoy listening to Pete most directly call out the insurance industry as he explains the politics and policy behind S. 88.  

In underlining the value of the progressive blogosphere in this governor’s race, Shumlin breaks down some of the math. In a five-way primary, he posits 50-70 thousand voters, and the winner will probably only need 15-20 thousand votes. We’ll see how those numbers hold up; I still can’t tell if this is going to be a “independents and repubs join in too” primary due to the quality of the field, or if it is going to be very much an “only engaged Democrats show up” primary due to its spot on the calendar. We’ll know soon, but Pete’s larger point is that communities like the one represented here at GMD could have an outsized impact.

Pete closes out this clip with a compelling compare and contrast of the two sessions of this past biennium.

Part 1 is HERE

Stay tuned for Part 3.

[Note: No endorsement implied. Just continuing the VTblogosphereTV tradition of showcasing the qualities of the guest.]

Pete Shumlin’s campaign website

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Watch it, folks, it’s being enforced. The GMD Patriot Act, that is. And, in case you didn’t get the memo, it goes like this: Behave or be banished. And by “behave” that apparently means not asking uncomfortable war questions of our beloved candidates.

Meet Petey. The first victim — oh, how liberal of him. Petey got banned here for a period of time that has become a bit wishy-washy. But never mind about the length of the banishment, because Petey also got the entire archive of his illustrious time here at GMD deleted. Whammo.

Bad, Petey, bad.

There will be back and forth about this and that, but…censorship is censorship. I offer this musical moment in support of Petey.

UPDATE: I may not have made it exactly clear as Doug Hoffer mentions in the comment below there was no asterix prior to Doug Hoffers press release. So it was a retro-active CYA on Salmon’s part.

Wednesday of last week, Democratic candidate for state auditor Doug Hoffer publicly asked Auditor Tom Salmon to explain why his office has not released an audit of the Vermont Yankee decommissioning fund requested by the legislature almost three years ago.  

Today Hoffer points out and questions why Tom Salmon lists the Vermont Yankee Audit and two other reports on his reelection webpage as accomplishments (followed by a discreet asterix [*] noting they are drafts not yet fully accomplished).

Hoffer believes Salmon should explain why his campaign website lists these three reports as “accomplishments” even though the reports have not been released. “It’s a little puzzling why the State Auditor feels the need to puff up his record with reports that haven’t been released” said Hoffer.

Says Hoffer: A section of Mr. Salmon’s campaign website entitled “Activities and Accomplishments since the 2008 Election,” includes these three titles: Monitoring and Management of the Entergy Vermont Yankee Decommissioning Fund, Situation Report at WNESU, and Comparison between a Unified Supervisory District and a Multi-Board non-unified Supervisory Union.  

Salmon, who has been back in the state almost a week after attending a national state auditor’s convention (according to the Vermont View), is not returning reporters phone calls and has apparently not responded to Hoffer’s initial query. Certainly he will answer phone calls and respond at some point because, as he says on his webpage:

“Politics is calling for warriors. Step up and tell the truth with civility; people are starving for it.”  -T.M.S.

I’m on vacation with next to no internet access, and here it is the last financial filing before the primary! What’s a political junkie to do?

Sigh. Guess I just have to wait for the press releases. In the meantime, here’s a quick guide to some of the coverage out there leading up to next Tuesday:

• Noise. Interesting in a really political geeky sense, but… eh… not that it shouldn’t be reported, but… maybe I’m just getting fatigued.
• It’s raining.
• The prize.
• And the camera adds 10 pounds, I hear.
• And the All-star voting is NOT over…

I thought this was a great comparison between a letter George Washington wrote on tolerance compared to today’s  discussion on Ground Zero

http://www.washingtonpost.com/…

Two hundred twenty years ago today, the Jews of Newport, R.I., wrote a proclamation for President George Washington on his visit to their synagogue the next day.

“Deprived as we heretofore have been of the invaluable rights of free Citizens,” the Jews wrote to their famous visitor, we now “behold a Government, erected by the Majesty of the People . . . generously affording to All liberty of conscience, and immunities of Citizenship: deeming every one, of whatever Nation, tongue, or language, equal parts of the great governmental Machine.”

Washington’s reply the next day, a simple letter titled “To the Hebrew Congregation in Newport,” set a standard for religious tolerance that guided the nation through two centuries. Here is that message in its entirety — along with some alternative thoughts on the topic occasioned by the proposed mosque near Ground Zero:

It is well worth reading in full.  

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