With the first phase of Peter Shumlin’s death march toward “single
payer” healthcare now behind us, it is time to take stock of what has been achieved and the costs of the achievement.
First of all it is beyond dispute that not one person has been or will ever be treated
by Vermont Health Connect or Green Mountain Care, these are merely political vehicles to achieve political objective of seizing
command of the medical resources currently under the control of independent organizations. The
goal is achieved by removing the insurers and employers from the healthcare financing equation and inserting the state government
and the Green Mountain Care Board’s actuaries and payment clerks between the patient and their physician as if these
functionaries are better prepared to choose the best patient treatment than the medical profession with eight or more years
of medical schooling, years of experience and has actually examined the patient.
The real battle
is not over providing the highest and best healthcare outcomes for all the citizens of Vermont that is alluded to by the “universal
care” label. True “universal care” is a fantasy that is impossible to accomplish without unlimited resources
and the “single payer” label only identifies a system devoid of competition. This is exactly what Shumlin and
his social architects desire to achieve. Shumlin-care is based upon the federal legislation of the Patient Protection and
Affordable Care Act (PPACA) passed in 2010, here I assume that Shumlin and his minions are aware of the numerous parts of
the PPACA and their implications and impositions on the medical profession that we will now examine.For years the federal
and state governments have interfered with the medical “marketplace” restricting competition between medical institutions
and professionals as well a prohibiting interstate competition in the healthcare insurance business.. In Vermont, Certificates
of Need (CON) are another regulation that inhibits competition and keeps cost artificially high.
government has placed significant financial burdens on healthcare providers through numerous regulations and mandating them
to provide patient care without reimbursement. Finally the failure to implement tort reforms to reign in the out-of-control
medical liability industry facilitated by a compliant judicial system which adds approximately twenty-five percent to healthcare
costs.The threat of medical liabilities have pitted hospitals, nurses, surgeons, doctors, pharmaceutical manufacturers and
durable medical product providers against one another, in a bizarre adversarial relationship – each positioning themselves
to be held blameless when inevitable “errors and omissions” occur. One common example of this is “physician
brownouts” where hospitals use peer review panels to shift liability to the physicians and away from nurses, assistants
or systemic errors where the hospital would be found responsibility for its agents.
are keen on deflecting blame from themselves to the healthcare insurance providers – making them the straw man for uncontrollable
healthcare costs. Frequently these are the same organizations that provide life, home, auto, business, workman’s compensation
and personal liability coverage – yet they there is no criticism of these protections. All insurance is a pooling of
risks with the insurer administering the premiums and claim disbursements with a reserve to cover administrative costs. There
is no difference between health insurance and auto insurance – it is the politicians that have vilified the industry
as a devious distraction.
Beyond the vilification of insurers and the burdens of frivolous litigation, both the
state and federal governments have imposed an “alphabet” stew of requirements and regulations upon medical providers
– these procedures and protocols have failed to meaningfully improve patient care or outcomes, however the have significantly
increased their financial and administrative encumbrances.Here are just a few of these legal requirements that provide little
in improved care but greatly burden medical providers:
Electronic Medical Records (EMR) Several years ago the medical profession was compelled
to implement a comprehensive system of recordkeeping under the pretext of cost savings. After five years, the system has proven
of little benefit to patient care and all providers have found it necessary to maintain extensive physical documentation (paperwork)
to efficiently review and evaluate patient diagnosis and outcomes. Physicians invested between $50,000 and $100,000 to implement
their EMR systems and continue to experience ongoing costs for computer maintenance and routine “upgrades”.
Treatment and Labor Act (EMTALA) Enacted in 1986, to ensure public access to emergency services regardless of ability to pay.
Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency
services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency
medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required
to provide stabilizing treatment for patients with EMCs. Hospitals that accept Medicare/Medicaid patients are compelled
to provide universal care.
Health Care Quality Improvement Act of 1986 (HCQIA) The act was passed to,
ostensibly, protect the public from incompetent physicians by allowing those physicians on peer review committees to communicate
in an open and honest environment and thus weed out incompetent physicians, without the specter of a retaliatory lawsuit by
the reviewed physician. However, over time the provisions have been transformed into a vehicle that promotes an environment
that protects those physicians on a peer review committee who choose to distort the review process for their own gain, by
maliciously disciplining physicians that may be in political or economic competition.
Integrity and Protection Data Bank (HIPDB) This information base was established under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). Administered by the U.S. Department of Health and Human Services (DHHS), acting through
the Office of Inspector General (OIG) and the United States Attorney General (USAG) HIPDB was created to combat fraud and
abuse in health insurance and health care delivery. The database contains information regarding civil judgments, criminal
convictions, or actions by federal or state licensing agencies against a health care provider, supplier, or practitioner related
to the delivery of a health care item or service. In 2013, the National Practitioner Data Base (NPDB) and the information
services of the National Association of Boards of Pharmacy (NABP) were consolidated into HIPDB eliminating substantial overlaps
among the systems. Formerly the NPDB had been proprietary information for the healthcare industry however the consolidation
made the information more widely available HIPDB acts as a clearinghouse for information related to the professional conduct
and competence of physicians, nurses, dentists and other health care practitioner to support professional peer review
by encouraging hospitals, state licensing boards, professional societies, and other health care entities to identify and discipline
health care practitioners who engage in unprofessional conduct and contains information about health care practitioners’
malpractice payments, adverse licensure actions, restrictions on professional membership, and negative privileging actions
Health Insurance Portability and Accountability Act of 1996 (HIPAA) Enacted in 1996,
Title I of HIPAA protects health insurance coverage for workers and
their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions,
requires the establishment of national standards for electronic health
care transactions and national identifiers for providers, health insurance
plans, and employers. The act gives the right to privacy to individuals under 18, but at or above 12. The provider must have
a signed disclosure from the affected before giving out any information on provided health care to anyone, including parents.
This portion of the act has caused significant problem during emergencies and impeded in identifying lost and injured patients
who are unable to identify themselves. HIPPA standards are intended to improve the efficiency and effectiveness of the nation's
health care system by encouraging the widespread use of the data base while maintaining security and privacy.
Common Procedure Code System (HCPCS), originally the Common Procedure Coding System (HCFA) administered by the Centers for
Medicare and Medicaid (CMS).The system was established in 1978 to provide a standardized coding system for describing the
specific items and services provided in the delivery of health care reimbursement for Medicare, Medicaid and other health insurance programs to ensure that insurance claims are processed in
an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of HIPAA) the use
of HCPCS for transactions involving health care information became mandatory. International Classification of Diseases
(ICD) established by the World Health Organization (WHO) was designed to promote international comparability in the collection,
processing, classification, and presentation of mortality statistics and provides a format for reporting causes of death on the death certificate.
The coding supposedly improves the usefulness of mortality statistics by giving preference to certain categories, by consolidating
conditions, and by systematically selecting a single cause of death from a reported sequence of conditions. The Centers for Disease Control and Prevention (CDC) and DHSS have mandated that
the ICD will replace the HCPIC codes to identify illnesses and injuries for administrative and billing purposes. Currently
ICD-9, a system of 13,000 identifiers, is used throughout the U.S. medical field. Unless rescinded ICD-10CM/PCs, a wholly
new and different system of 70,000 identifiers, will replace ICD-9 in October of 2014. Most in the medical community believe
that the new system will “dramatically slow doctors work due to the unnecessary complexity” and volume of different
codes and subsets that must be learned and used.
Saving the worst for last!
Medicare Payment Advisory Commission
(MPAC) This congressional committee is responsible for setting reimbursement rates for Medicare and Medicaid patient treatment.
It is also used as a base line by the healthcare insurance industry and others to calculate their allowable reimbursements.
Green Mountain Care has adopted a reimbursement schedule pegged at 105% of the Medicare, MPAC rate. On April 21, 2014; proposed
$500 billion in Medicare cuts to be accomplished through rate reductions of 25% for general practitioners and 50% for specialists
implemented in steps over the next five years. The current Medicare rates barely cover providers out of pocket (variable)
cost and fail to contribute to overhead and investment (fixed) costs – the revised rates are untenable and will result
in the blanket refusal of Medicare, Medicaid and GMC patients.
Conclusion If Shumlin or Obama
truly sought to reduce healthcare costs and improve the delivery of services, there were many areas that cried for change
– from tort reform and eliminating ineffective regulation to increasing competition in both healthcare delivery and
insurance. The free market complemented by charitable and governmental support for those unable to pay for healthcare on their
own would have been far better plan than disrupting and destroying the quality system currently in place – the best
healthcare in the world.
Shumlin’s Green Mountain Care like the PPACA are ill-conceived and have been poorly
executed by individuals with little knowledge or experience in the healthcare delivery or insurance industries. Their failure
is by design since their objective is not to provide a improved system to pay for care, but to take control of the healthcare
delivery system, substituting socialized “single payer” with its necessary rationed care.They feign that they
seek to reduce costs and provide universal coverage – their efforts will accomplish neither. Everyone who works in the
medical field or relies on them for treatment will be injured – both financially and by reduced quality of care.
is truly a War on Doctors and their Patients.