Albright: All-payer Health Care

Oct 3, 2016

The new health care model, called an all-payer system, looks logical enough. Simply put, primary care providers would not be paid for individual services. Instead, they could choose to join an accountable care organization, and get a monthly fee for taking care of their patients.

The aims are to encourage preventive care, and to cut down on unnecessary procedures. Laudable goals, but their implementation raises a lot of questions likely to surface in public hearings coming up over the next three weeks.

Actually, my first question is why there are no forums in the Northeast Kingdom, home of one of the largest primary care practices in the state. But I’m hoping lots of people will show up in Norwich, Chittenden County, and Rutland County, and that state officials will explain in jargon-free detail exactly how this attempt to curb rising health care costs will improve, not cut corners, on patient care.

Meanwhile, here’s an analogy for an “all-payer” system. Teachers. We pay them a monthly salary to make sure our kids learn things. We don’t pay them for each test, or each lesson plan. We trust them to apply their knowledge and experience to their important daily tasks.

Used to be, before the era of managed care, we trusted doctors in a similar way. For example, in 1982, when my two-week-old baby ran a raging fever in the middle of the night, I called my pediatrician at his home. He answered the door in his pajamas, felt the top of my son’s head, and whisked us off to the emergency room. No time, he said, to call an ambulance, because the baby had life-threatening meningitis. My son is fine now, a strapping 34-year-old businessman.

That doctor saved his life. Primary care doctors do that, more often than we know. But their hands are increasingly tied by insurers telling them what is and what is not covered, and what should, or should not be done, for their patients. If the all-payer plan allows doctors and patients to work closely together on preventing and treating illness, with less interference from insurance executives, I would be all for it. But if it allows the government and insurers to set rates that don’t cover costs, leading to an even more critical shortage of primary care physicians in rural areas, then I would be looking for a different prescription for what ails our health care system.