Analysis: Knowing The Unknown Key To Any Health Reform Plan

Apr 16, 2014

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 problem is that while virtually everyone agrees the current system is not sustainable financially, no one knows enough about the way the current system is paid for. For example, how are people who work for small businesses that don’t provide insurance for their employees getting their health care now?

The problem is that while virtually everyone agrees the current system is not sustainable financially, no one knows enough about the way the current system is paid for. For example, how are people who work for small businesses that don't provide insurance for their employees getting their health care now?

Some don’t have any insurance; others are covered by, say, a spouse’s insurance plan.

Some employees have really good health care coverage – such as school teachers – while others have really poor coverage, with high premiums, high co-pays and deductibles, and very poor benefits. How does a reform scheme shift that reality to something that is more fair?

Judgments like this are critical, because if the public and the Legislature decide that they don’t like the way that health care financing is redistributed across the population – if they conclude that there are too many losers and too few winners – that could stop health care reform in its tracks.

In order to address this problem, both the administration and the Joint Fiscal Office, acting on behalf of the Legislature, are now trying to decide how to retain a consultant to build a sort of health financing profile of the Vermont population.

It is obvious that it would be much cheaper to hire just one consultant rather than two, but the tensions that are roiling the relationship between the administration and the Legislature are making that kind of cooperation difficult.

In his news conference Wednesday, for example, Gov. Shumlin rejected the idea of a Plan B, or alternative to his single payer theory. He dismissed the work of Ken Thorpe, the consultant who has been talking to various members of the Legislature about just such an alternative.

On the other hand, there is considerable unhappiness and lack of trust within the Legislature about the way the governor has handled his single payer proposal. The fact that the Legislature hired Thorpe in the first place is clear evidence of that.

The point remains, however, that in the absence of a pretty detailed profile of the distribution of insurance benefits now, it will be difficult to impossible to figure out just how many winners and losers there are with a proposed new system, and hence no really good way to compare one reform plan to another.

In any event, the discussions about how to obtain the needed information needs to conclude fairly soon. The work would be expensive and therefore would probably have to go out to bid. And the results need to be available by late this fall at the latest in order to inform the proposal that Shumlin aims to unveil early in the 2015 session of the Legislature.