Right now, twenty cents of every dollar we earn as Vermonters goes to pay for health care costs. On top of that, a third of all Vermonters either can’t afford their health insurance, or they have no health insurance at all. Costs are far outpacing economic growth, meaning that for the average Vermonter health care is becoming less and less affordable. This raises the question- what can we do as a state to fix our broken health care system?
Democrat Sue Minter and Republican Phil Scott agree in some areas, but largely in concept. Both speak to a similar problem in our current health care system: The incentives are all wrong. The current “fee for service” system incentivizes a greater quantity of care over a better quality of care. Minter speaks of the need to “reform our system of payment and incentivize health outcomes instead of incentivizing payment for more visits, prescriptions and procedures.” Similarly, Scott has said that the Green Mountain Care board ought to transition to a payment system that “that fairly compensates providers for treatment that emphasizes quality and outcomes, not just the amount of care they deliver.”
As Governor Shumlin and the Green Mountain Care Board move to sign an agreement instituting an “all payer model”, both candidates have expressed support for the underlying concept, while reserving their endorsement until they know more of the details. An “all payer” system is one where health care providers are contracted to provide comprehensive care to large groups of people and are compensated with a predetermined amount through public funds. Care providers are financially encouraged to provide quality care to their patients under an all payer model.
Republican candidate Phil Scott has said that “[the all-payer] model could pull us back towards taking care of the patient.” He worries however that the all payer model “could create a monopoly among health care providers in this state… we need to be better educated before we sign off on anything.” Scott discounted his support for an all payer program further at a forum on health care by saying that Vermonters have a right to be “gun shy” about health care reform following the failure of single payer. Democratic candidate Sue Minter has argued that the idea behind all payer makes theoretical sense, but she would need more details before supporting the concept.
One disagreement between the two candidates is whether we keep our state health insurance exchange (VT Health Connect), or move to a federal or alternative state exchange. Sue Minter has said repeatedly that we need to make VT Health Connect work, and supports keeping the exchange at the state level. She clarified this position in a recent debate saying that she would transition away from the exchange if Vermonters receiving state based subsidies would not lose them, and if a study due to the legislature finds there is a feasible way to move from a different exchange. Minter likes to point out that she is actually a part of VT Health Connect, and really sees its success as necessary step “to restore faith in government.” She has said that “I’m someone who believes in government, knows how to make it function and deliver for the public good.”
Phil Scott has said that we should move away from VT Health Connect and towards the federal exchange or a multi-state exchange. He states on his campaign website that “It’s time to move to the federal exchange or to a multi-state exchange that works and offers Vermonters more affordable health insurance choices. This transition could save Vermont millions of dollars in maintenance and operational costs each year.” Sue Minter has contended that leaving the VT Health Connect for another exchange would result in 19,000 Vermonters losing subsidies. Scott responded to this by noting that 30 other states do not have exchanges and that the state could provide these subsides directly.
Sue Minter and Phil Scott’s reform priorities continue to diverge beyond the issue of what to do with Vermont Health Connect. Minter supports providing public coverage to all Vermonters up to age 26 through the Dr. Dynasaur program, or covering all Vermonters through publicly funded primary care. Scott has said he would not support expansion of Dr. Dynasaur if it resulted in a tax increase. Minter has also supported increasing preventative care through home/community based services that could help save money by preventing people from ending up in the hospital, which her website says is “the most expensive place for care.”
Phil Scott has laid out a differing set of reform priorities including eliminating the mandate that small businesses buy coverage through Vermont Health Connect, which he says “has cost Vermont jobs and put a small local chamber of commerce out of business.” Scott also mentions the need for price transparency. His campaign site states that Scott would like to “fully implement, and enforce, the law requiring price transparency in Vermont’s healthcare system.” Scott says that this will allow Vermont consumers to make educated choices when it comes to their health care.
Scott also has also identified a number of areas where he hopes to institute reform by working with the federal government. He says “about a third of the Medicaid budget is spent on long term care as a result of the Federal government’s failure to create a long term care safety net.” According to Scott, this issue is amplified in Vermont by the ageing population in the state. Scott claims that “as Governor, [he] will work with a bipartisan task force of Governors to work with the federal government to address this growing problem.”
Sue Minter and Phil Scott have fairly divergent views when it comes to their vision for health care in Vermont, but it is clear that both candidates understand that it’s necessary for all Vermonters to have access to high quality affordable health care. With health care costs continuing to rise at unsustainable rates doing nothing is not an option, and the path the state takes will impact the lives of Vermonters for years to come. Whoever our next Governor may be, VPIRG looks forward to working with them to move forward vital reform efforts to improve the health, safety, and well-being of individuals across the state.