Getting Beyond Incremental Steps

Your 'Recommendations for 2008 Legislative Session Draft' continues the multi-year incremental march to nowhere.

I want to be the record regarding what can be expected from Catamount.

1. With a lot of new dollars and new complexity added to health care in Vermont you will;
   • Cover several thousand people who otherwise would not have been able to afford health care.
   • In an upcoming very difficult fiscal year and longer term softer economic environment you will spend even more than you had estimated.
   • As many people as you will cover with Catamount, about an equal number of new people will have dropped coverage, resulting in no significant net increase in the number of people insured in Vermont because of the unarrested rising cost of health care.
   • And, in one of the most challenging upcoming budget processes to be seen in Vermont in many years, the funding of Catamount will come at the expense of many other important programs and challenges that the State is facing.
2. Why is the above likely?
   • Catamount has already reduced its estimate of coverage by 2010 from 96% of Vermonters to be covered to 93% of Vermonters covered.
   • And the net numbers, based on a historical view, will end up being about 90%, essentially where we are now.
   • The new 93% estimate is comparable to the level of the insured achieved in 1997, when the number reached 93.2%.
   • The track record of other state's efforts at incremental reform which were billed as major reform, similar to pronouncements in Vermont, have failed











3. Each of these 'reforms' have time to work, but have not, as they have been unable to compete with the rising cost tide.
4. Do we have to wait a minimum of 5 years to see the same trends, and watch the cost of health care double again? (When Senator Kitchel and I participated in the ill fated Hogan Commission in 2001, health care spending in Vermont was 2.5 billion. Today, in 2007 health care spending is 4 billion. By 2013, about the time when it will so very clear that we haven't made a dent in the uninsured, health care costs will have doubled again. Do we have to wait that long to do something significant?
5. Reality has set in among many Vermonters now that they are beginning to see that the high rhetoric surrounding the passage of Catamount will not be fulfilled.
6. I have carefully read the reports of your work groups.
   • They are all incremental ideas
   • Even if all the ideas were implemented they cannot stem the cost tide.
7. The Universal Hospital benefit bill, H 304, is an idea that is systematically and intentionally being ignored by this committee.
   • a. It's big enough to make a difference
     • The JFO has produced believable numbers that support the idea of longer term cost control
     • The JFO has produced numbers that show a scenario for financing such an effort.
     • Why isn't the bill on your list of recommendations?
     • It is possible that good ideas can come from beyond the 'work groups'?