Vermont Attorney General T.J. Donovan held a forum in Burlington Tuesday evening on health care.
The forum hosted by Vermont’s chief legal officer focused on the cost and structure of health care. T.J. Donovan was joined by five panelists representing a range of health care interests to Burlington to discuss medical costs and possible solutions. Donovan, a Democrat, says health care is a consumer protection issue and argues individuals should understand what they are paying. “Given information in plain language that consumers can understand can empower folks in this incredibly complicated complex industry as health care. I want to be clear there’s no easy answers. We know that.”
The Attorney General began by discussing terminology and acronyms which he says can be barriers to the public’s understanding of the health care system. As the conversation progressed on costs and eligibility for Medicare and Medicaid, Amy Cooper, Executive Director of Health First, an association for small independent physician owned medical practices, noted there is often confusion between the two programs. “The main differences are Medicare is for seniors. So everyone over 65 and it’s a federal program, federal only. Medicaid is for low income, people with disabilities and it is a state program. It is somewhat funded by the feds and somewhat funded by the states but the states are making the decisions, more or less, around their Medicaid populations and how they’re funding it. So Medicaid is state and low income. And Medicare is seniors and federal, generally.”
The panel discussed the all-payer health care system. Green Mountain Care Board General Counsel Judy Henkin described it as a complex concept to eliminate the more common fee-for-service system. “And it says basically that we are going to take this pot of money and we are going to care for this many people with it. And the healthier they are the better you do because they’re going to be less expensive.”
While the Attorney General intended to read audience questions from notecards, at one point Dr. Allan Ramsey, a former member of the Green Mountain Care Board regulatory board, began an extended conversation from the auditorium floor. “I want to know if our regulating entities are going to insist that we do like every other country in the world – spend more on primary care, mental care and community based services.”
Sitting in front of Ramsey was Vermont’s former Commissioner of Mental Health and former Deputy Secretary of Human Services Patrick Flood: “The all-payer model is a great opportunity to reshape how we pay for things if we actually get it up and working.”
Colchester psychiatrist Dr. Sue Deppe says there would be a bigger impact on costs if greater investments were made in primary care, mental health and substance abuse treatment. “And we would also be able to save the workforce which is imploding in psychiatry and primary care because of insurance administrative burdens and low pay.”
During the discussion, Jessica Early criticized the panel for putting “band-aids” on a fundamentally broken system. Early worked in the VA as a nurse practitioner and says it provides a more rational health care delivery system. “The VA is the only national system we have in this country that is essentially a single-payer publically funded health care system. It is just a much more rational patient-centered system that does invest in the things that people were talking about in this panel.”
Attorney General T.J. Donovan hopes information from the forum allows people to better engage the state regulatory board. “It’s about how do you empower people to be engaged in the Green Mountain Care Board process. I mean that’s really the key here right? That is the regulatory body. How many people understand that? How do they get in touch with the public advocate? How do they make their voice heard? And information’s key here.”
The Vermont attorney general said he hopes to schedule future health care forums.
