Hamilton E. Davis

Hamilton E. Davis is a longtime journalist, who has written for the Providence Journal and the Burlington Free Press.

Toby Talbot / AP

During the cold war, American intelligence experts would often try to divine what was going on in the Soviet Union by looking at photographs of Kremlin public events. If Ivan Somebody was in the picture two places from the Russian leader in March and again in May, but was gone in a similar photograph in July, that meant something. Most likely that Ivan was toast.

Vermont’s 14 hospitals have submitted budgets for the fiscal year starting Oct. 1 that increase by just 2.6 percent over the current year’s budgets, the smallest annual increase for the Vermont health care delivery system in four decades.

Proposed spending for fiscal year 2015 came in at $2.229 billion, compared to the $2.172 billion approved by the Green Mountain Care Board for the current fiscal year. The 2.6 percent increase amounts to just under $57 million in new money.

Toby Talbot / AP/file

An often-forgotten backdrop to the current focus on Gov. Peter Shumlin’s single-payer health care reform plan is that we have been through this exercise once already.

The first legislative effort to install a single-payer system came in January of 1991 when Sen. Cheryl Rivers, a Democrat from Stockbridge, introduced S-127, a Canadian-style single-payer plan for Vermont. Canadian style means that it would cover everybody in the state, it would be financed entirely by taxes and it would leave the delivery system – the doctors and hospitals – in the private sector.

Figure: madebymarco/Thinkstock / Illustration: Angela Evancie/VPR

Both the Vermont legislature and the Shumlin administration are quietly gearing for next year’s single payer health care reform financing challenge by hiring consultants to provide an unprecedented level of detail about the way we pay for health care now and how a new system might recast that structure.

Toby Talbot / AP

The Legislature’s adjournment last week marked a third birthday of sorts for Gov. Peter Shumlin’s single-payer health care reform plan. The campaign has done well in some areas, not so well in others. It probably deserves a smallish cake.

At the birth of the single-payer push in mid-winter of 2011, the Shumlin team had to accomplish four fundamental tasks, all of them difficult:

Angela Evancie / VPR

The Green Mountain Care Board has informed Vermont’s 14 hospitals that their budgets for the next fiscal year should increase no more than 3 percent, with up to an additional .8 percent allowed for projects that advance the cause of health care reform in the state.

The total for the hospital system for fiscal year 2015, starting in October, would be $2.69 billion, an increase of $66 million over the current year’s base budgets. If the GMC board approves the full .8 percent for reform infrastructure, it would add $17 million, for a total of $83 million in new money for the system.

The Green Mountain Care Board ruled Tuesday that a New Hampshire-based group of emergency room doctors does not have to get state permission to open walk-in health care centers in five Vermont cities and towns.

The group, called ClearChoiceMD, said it expects the urgent care centers to supplement the care now offered by hospital emergency departments. They said their facilities would relieve the pressure on overcrowded hospital E.R.s, and would be less costly. The centers would be located in Brattleboro, Burlington, St. Albans, Barre and Rutland.

Toby Talbot AP

Anya RaderWallack, the principal architect of Gov. Peter Shumlin’s single-payer health care reform initiative, announced Monday that she has agreed to advise Dartmouth Hitchcock Medical Center on health reform issues across Maine, New Hampshire and Vermont.

Bob Kinzel talks with contributor Hamilton Davis about the "Plan B" alternative to Governor Shumlin's single payer health care reform.

The political ruckus over the last few days about the prospect of a Plan B alternative to Gov. Peter Shumlin’s single payer health care reform project has masked an important fact about both reform schemes: neither his administration nor the various Plan B advocates have enough information yet to build a credible plan for changing the current system.

The consultant hired by the Vermont Legislature to advise lawmakers on health care reform has developed a concept that differs significantly from the single-payer plan now being pursued by the administration of Gov. Peter Shumlin.

Angela Evancie / VPR

When Gov. Peter Shumlin launched his single payer health care initiative in 2011, the effort promised to be the policy equivalent of a moon mission, one of the most far-reaching and complex reform projects ever undertaken at the state level. It would be very hard, yet still doable. And critically important, given that the health care system both in Vermont and in the U.S. is simply not financially sustainable.

Angela Evancie / VPR

From the opening days of Gov. Peter Shumlin’s single payer health care initiative, House Speaker Shap Smith has been a rock-solid supporter of the campaign. In 2011, he delivered Act 48, arguably the most far-sighted health care reform blueprint in the country, by lining up his huge Democratic house majority behind it.

Christophe Boisson / Thinkstock

One of the key arguments by opponents of Gov. Peter Shumlin’s single payer health reform initiative is that it mirrors the single payer system in Canada, which they say has serious problems. The opponents have a point about Canada’s problems, but they are entirely wrong about Canada’s relevance to Vermont. You could fairly call the Vermont design the “un-Canada.”

Angela Evancie / VPR

As lawmakers begin to focus on how to pay for Gov. Peter Shumlin's single payer health plan, they want to know if the plan will work as promised to control costs and provide universal coverage.

In this analysis we examine the challenges ahead, including the legal thresholds that must be cleared for single payer to proceed and the conflicting financial projections.

Part 1: The Legal Threshold

Toby Talbot / AP

The Vermont health care exchange came out of the starting blocks this fall limping badly and it’s not clear yet how long it will take Gov. Peter Shumlin’s bureaucrats to get it back on track. It’s not too early, however, to try to assess the effect the troubled launch will have on state politics in 2014 and on the fate of the Shumlin reform initiative out into the future.

Anya Rader Wallack

When Gov. Peter Shumlin launched his single payer health initiative two years ago, he set up a three-part structure to deal with the various problems that have to be solved to get to his goal.

The Green Mountain Care Board has tied up the loose ends on its second year of work, finalizing the budgets for the state’s 14 hospitals.

The increase in annual spending for the hospitals and the roughly three quarters of the state’s doctors who work for them was the lowest since formal oversight of the system began in the 1980s.

The final figure for fiscal 2014, which begins on Oct. 1, was $2.2 billion ($2,181,770,664), an increase of 2.7 percent.

AP/Toby Talbot

When someone writes the history of health care reform in Vermont, he or she would do well to look closely at the Green Mountain Care Board hearing last week on Fletcher Allen Health Care’s proposed fiscal 2014 budget.

There are 14 hospitals in Vermont and they and the doctors that work for them spend upwards of $2.1 billion a year to keep Vermonters healthy. Fletcher Allen accounts for a billion dollars or so of that amount, nearly half the system. No other hospital comes close to its size and influence.

AP/Toby Talbot

A series of developments in health care reform over the last couple of weeks has demonstrated how tangled this policy problem is and how knowledgeable people, including former Vermont Governor Howard Dean, can make a hash out of it. The public is the loser every time.

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