Lawmakers and administration officials abandoned their push for a single-payer health care system over a year ago. Advocates of a publicly funded program haven’t given up on the concept, however, and a new report could re-ignite a debate over whether to socialize portions of the health care system in Vermont.
Dr. Deb Richter is head of Vermont Health Care for All, and was among the leading proponents of single-payer health care in Vermont. When the proposal fell off the rails, she proposed an alternative: instead of publicly funding the entire $5 billion health care system, the state could start with just primary care.
“Every other country that has a strong primary care infrastructure has been shown to lower their overall costs and improve their indicators, like life expectancy and infant mortality,” Richter says.
Richter and others convinced lawmakers to spend $100,000 to study the idea. Last week, the Shumlin administration unveiled a report detailing cost estimates for a universal, publicly funded system of primary care, and Richter says it reinforces the case for moving forward.
“I’ve always said if it were a drug we’d never think twice about investing in it,” Richter says. “You get such good value for the money.”
The report pegs annual costs of universal primary care at a little north of $280 million a year, assuming no out-of-pocket costs for people when they go to see a doctor. If policymakers wanted to provide better reimbursement rates for primary care doctors, then the price could go as high as $415 million annually.
The report doesn’t offer any proposals for how to fund this primary care system, or whether it would put downward pressure on overall health care costs. Robin Lunge, director of health care reform for the Shumlin administration, says regular checkups can help identify medical conditions before they become more expensive to treat.
“That may save you costs five, 10, 15, 20 years down the line, but it doesn’t not necessarily save you costs in year one,” says Lunge, who oversaw production of the report.
"If everybody has two coverages, the amount of coordination of benefits increases, and thus the administrative costs increase, that may save you costs five, 10, 15, 20 years down the line, but it doesn't not necessarily save you costs in year one." — Robin Lunge, director of health care reform for the Shumlin administration
That means universal primary care might actually increase costs to the state in the early years, since the report suggests that it would spike administrative costs by as much as $34 million a year. Lunge says that’s because people would still need regular insurance for hospital services and other non-primary care treatment.
“So if everybody has two coverages, the amount of coordination of benefits increases, and thus the administrative costs increase,” Lunge says.
House Minority Leader Don Turner says he thinks it would be great if every Vermonter got access to primary care by virtue of residency. But he says the state cannot afford it. And he says Democratic lawmakers need to stop spending money on studies that he says have done nothing to improve patient care.
“And it seems like this ideology of single-payer is taking lots and lots of money and it’s not helping one single person at this point,” Turner says. “We’ve got to take some time, take a deep breath, take a step back, and let us see what kind of reform is going to work without trying to put more on the table.”
Burlington Rep. Chris Pearson, vice-chairman of the House Committee on Health Care, says Vermont can’t afford to wait. Pearson says the existing system is collapsing under the pressure of rising costs. With the push for single-payer shoved aside for now, he says lawmakers need to find more cost-effective ways to deliver health care to all Vermonters. And he says publicly funding portions of health care might yield the efficiencies needed to save the system.
"We can't simply stop and say, 'well, the big prize of health reform didn't work so we can't do anything.' We have to do something." — Burlington Rep. Chris Pearson, vice-chairman of the House Committee on Health Care
Lawmakers will also consider a proposal this year to provide publicly funded universal coverage to all residents age 26 and younger.
“We can’t simply stop and say, ‘well, the big prize of health reform didn’t work so we can’t do anything.’ We have to do something,” Pearson says.
Pearson says a universal program might also help alleviate some of the financial strains that have led to primary care shortages in pockets of the state. Paul Harrington, vice-president of the Vermont Medical Society, says the issue of compensation for primary care doctors is far more consequential than how the state pays for it.
Cost estimates for universal primary care are $281 million a year, at current provider reimbursement rates. Lunge however says the administration opted to include projections for what it would cost to run the system with higher reimbursement rates.
“It’s my sense that there’s general concern in the Legislature and others that we could use some increases in primary care,” Lunge says.
Upping reimbursement rates by 25 percent add an additional $67 million to system-wide primary-care costs.
“I think that’s the real take home of this report for the Medical Society,” Harrington says. “It quantifies the cost of adequately reimbursing primary care physicians, and we’ll encourage legislators to focus on that facet of the report.”
Lunge says the administration isn’t opposed in concept to the universal primary care proposal. But lawmakers aren’t likely to see the governor investing any political capital in moving it forward in 2016.
“Our main focus in the next year will be on payment reform, and ensuring that we are creating a system that is sustainable, where costs are contained, and taking steps toward doing that,” Lunge says.
