Vermont (January 2017)
- Peter Shumlin’s socialist dreams of “universal, single payer healthcare” have mutated into a nightmare
over the past five years. The utopian dream of healthcare for all was never properly explained nor fully understood by Vermonters.
The working poor thought that it would be the “free care” that they saw those on welfare receiving. Most believed
the promises that their healthcare providers and the level of care they were receiving would somehow continue - while the
cost of care would be greatly reduced through streamlining and controls that the state and federal government would impose.
Those who worked for large employers and government believed they would not be affected. None of these assumptions would prove
to be correct.
Green Mountain Care (GMC) quickly acquired the resources of Vermont Blue Cross and Blue Shield (BCBS)
as most of its insured became GMC clients. In the early days of the rollout, GMC and its promotional website Vermont Health
Connect (VHC) failed to deliver healthcare for the small group of self-insured and the employees of small businesses targeted
as the first clients of GMC. Governor Shumlin and his loyal minions on the Health Care Board, lead by a
Burlington restaurateur, had no understanding of the healthcare insurance industry and were unprepared to handle even the
most modest problems as they arose. While the Federal Government abandoned their hapless website contractor
CGI-FEDERAL, Shumlin regrettably decided to continue with them “throwing good money after bad” eventually
spending over $100 million of state and federal funds with CGI on a system that was politely described
as “leaving a lot to the imagination” of the users. The plain truth was that the CGI system would never work –
despite months of “tinkering” and additional monies wasted, the VHC website never reliably allowed users to: create
accounts or access them, employers to edit or update their accounts (if they had been patient and creative enough to create
one) nor could the system collect premiums and in the end could not pay for health care services incurred by its “insured”
clients. Eventually, CGI was abandoned and the BCBS operating system, by default, became the GMC system.
Vermonter’s healthcare system is an unrecognizable husk of the quality network
they enjoyed just a few years ago as the politician’s grand scheme, GMC, has decimated Vermont’s hospitals and
healthcare practitioners - as well as the state’s economy at large. It is sad that there was no way, back in 2012, to
foresee the full consequences that the progressive plans, designed by inexperienced, insistent social architects with big
ideas but no understanding of the complexity of the healthcare system or the health insurance industry that financed it.
As the GMC system sputtered to life in 2014, many providers chose not to participate
as a result of the anemic 105% of Medicare reimbursement rates which barely covered their out of pocket costs and failed to
contribute toward overhead or capital investment costs. Within a year, 20% of practicing physicians and specialist had retired,
moved out-of-state or decided to limit themselves to “fee for service” patients. Nearly 50% of Vermont’s
Oncologist and Cardiologist declined to participate in the GMC program. To fill the void, the Vermont Legislature hastily
authorized nurse practitioners and LPNs to act as primary care providers without direct supervision.
Today, Vermonters receive their healthcare treatment and pay for services in ways unimaginable
just a few years ago. For GMC participants who have their treatment denied by the GMC Review Board and those who have decided
to pay the penalties instead of participating have found that many providers offer deep discounts for cash payment for services
rendered. There are now many “fee for service” care facilities including: MedExpress, UrgentCare,
Got-A-Doc, LabCorp, Dynamic Therapy and others that offer extensive portfolios of services for
walk-in patients on a first-come-first-served basis. Patients pay for services when rendered by cash or credit card with financing
arrangements available for more extensive and costly procedures. While these new facilities, at first blush, seemed questionable;
most are staffed by highly competent and experienced practitioners (many are those that chose not to participate in GMC) and
provide quality care. For those on a budget or in a hurry, Doctors on Call provides internet and phone consultations
on routine and minor medical concerns, allowing many to resolve their medical issue on their own. Additionally, there are
“premium” service providers like Concierge Medical which handle all the details for the medical needs
of the wealthy – lining up the best doctors, treatment facilities and even arrange transportation before and after treatment,
truly door-to-door service.
Possibly the most destructive
aspect of the Green Mountain Care program has been the state’s scheme for financing its ever escalating costs. Governor
Shumlin, for several years, obfuscated and then flatly refused to reveal the amount and sources of the funds required to finance
GMC’s operation until well after his reelection in the fall of 2014. That December, the Governor finally revealed the
three-pronged taxation plan required to generate the $2.9 billion necessary to fund GMC – including: 1 - a 25% payroll
tax with employers paying 17.5% and employees having 7.5% deducted from their paychecks (the self-employed are required to
pay the entire 25%), 2 - a 10% tax on all unearned income – capped at $200,000 per year and 3 - an increased healthcare
claims tax raised from 7% to 14% - this tax, formerly paid by insurance firms, is now
paid by the patients receiving the care. As soon as the Governor had announced the requirements of the “GMC taxes”,
employers implemented plans to “scale back” their Vermont operations or leave the state in order to remain profitable.
By summer of 2016; new layoffs in Vermont totaled over 15,000, including nearly a thousand from the healthcare
industry as they scaled back in anticipation of reduced revenues from GMC.
Hospitals and medical providers,
desperate for additional revenues, began to increase fees for services rendered in patient categories not covered by GMC,
primarily: workman’s compensation injuries, auto accident victims and personal injuries paid for by liability insurance
claims. Insurance providers immediately adjusted their rates to their insured by as much as 25%, worsening Vermont’s
economic and business environment.
Vermont’s healthcare subsidies
encouraged many lower wage earners to quit their jobs and sign-up for the broad spectrum of available social service benefits,
since the new healthcare taxes in addition to state, federal and Social Security taxes resulted in significantly lower take
home pay, insufficient to cover their living expenses.
Governor Shumlin had narrowly won reelection in 2014, in part because the impact of his Green Mountain Care and his ultimate
prize of “single payer” were not fully understood. By 2016, Shumlin had realized that he had little chance of
winning another gubernatorial race and attempted to best incumbent Senator Patrick Leahy in the Democratic Primary –
failing by a wide 3:1 margin.
Ever the opportunists, Shumlin
and his brother, Jeffery, refocused their Putney Travel Service to take advantage of increased interest in “medical
vacations” brought on by healthcare treatment delays and denials by GMC. Putney Medical Vacations
will soon provide complete packages that allow their wealthy customers to avoid the delays and the reduced quality of care
in Vermont by arranging treatment “stays” in exotic venues that include: Bermuda, Costa Rica, Bangkok, Mexico
and Cape Town where patients can save up to 70% under the expert care of orthopedic, oncological, plastic or general practice
surgeons and enjoy recovering on the sun-soaked beaches of the treatment venue.
Scott and the newly elected Republican Legislature are struggling with the consequences of GMC. Vermonters who cannot afford
to avail themselves of “fee for services” treatment find long waits at the “public” hospitals - the
state has been required to take over the operation of most of the formerly independent institutions, closing several smaller
hospitals to control costs. Appointments for non-emergency hospital procedures now require waits of three to five months once
they are approved by the GMC Board.
All of this could have been easily
avoided. The initial concern over 40,000 uninsured Vermonters was discovered to be a gross exaggeration. When those who wished
not to be insured (primarily the wealthy and young individuals) and those who chose to find care through social services (at
the taxpayer’s expense) were eliminated from the equation , the actual number of uninsured individuals who wanted insurance
coverage was less than 9,000. The biggest problem was that none of those involved in the planning of GMC had a thorough understanding
of healthcare insurance or the financial tightrope that these firms walked to successfully balance the costs of care and premium
rates while managing to remain financially viable. The “public financed” political/government alternative has
proved to be a disaster of biblical proportions – out-of-control costs and radically insufficient care.
It is a shame that there is no way to reach back in time and inform Vermonters of the
healthcare troubles in their future.