Category Archives: ShumpleCare

Shumlin Care, the Vermont single payer health plan

Paying for It

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When I got the bill for my July Obamacare premium, I shrugged it off.

See, I had changed from a Blue Cross Standard Gold Obamacare plan to a Blue Cross Medicare plan as of July 1 and I figured that was just a bill that got mailed the day they got the cancellation.

When I got the bill for my August Obamacare premium on July 5, I shouldn’t have shrugged it off.

When I got the bill for my September Obamacare premium dated August 5 in today’s mail, I couldn’t shrug it off.

Note from your doctor explaining why you were tardyTwo months bill from Vermont Health ExchangeAnd it turns out I wasn’t alone. The Burlington Free Press reported yesterday that billing problems plague Vermont Health Connect, the state-managed Health Exchange that issues and bills for Obamacare policies.

“Terry Libby has received incorrect bills from Vermont Health Connect since last winter when she first signed up for a Blue Cross insurance plan using the state’s new online website.

“Each month she has paid what she owed, called the state’s helpline to report she was being charged double, and received assurance the problem would be corrected.

“A month later, another incorrect bill would arrive.

“A week ago, however, she received a shock — a bill for $4,662.32.”

Four thousand, six hundred sixty-two dollars.

Jeezum. They’ve billed me only $497.06 no $994.12 no $1,491.18. So far. For.A.Policy.I.Do.Not.Have. I feel like such a piker. I’m sure I’ll catch up.

I’m more than a little nervous about screwing with my Medicare policy. Blue Cross carried over my same policy number when I changed from Obamacare to Medicare.

I called VHicks (the correct pronunciation of VHX, the Vermont Health Exchange, according to my Blue Cross rep) to question the bill they sent me. See, I had gone over this very issue in depth when I bought the Medicare policy. Blue Cross said they would cancel me out of the Obamacare plan when they opened the Medicare plan. All part of the service.

The VHicks rep said it wasn’t up to Blue Cross to cancel the policy. He said he’d try to process the cancellation retroactively but no guarantees.

Retroactively?

I called Blue Cross.

“No worries,” that rep told me. “Your Obamacare plan ended June 30 and your MediGap started July 1.” She also said no way VHX had any way whatsoever to cancel my Medigap policy.

I hate this.

“The government is so not trustable about things like this,” Liz Arden said.

“Not so trustable? Can you spell C-H-A-R-L-I-E   F-O-X-T-R-O-T?” Rufus asked only somewhat rhetorically.

“There is no way on God’s green Earth we should be putting up with this level of …. well, it ain’t mediocrity, because that would be far superior to what we are getting.

“You can quote Rufus on that.”

There ya go.

“You don’t want people to get health care!” Annabelle Proctor screeched the last time I wrote. Ms. Proctor holds an undergraduate degree in dance from Bennington College and a graduate degree in Social Justice from Planet Marlboro, Vermont’s two most liberal and free-thinking schools.

My other Liberal friends all seem to echo that.

Nothing could be further from the truth.

I want my doc and yours to do better doctoring than they do today.

I want every citizen to have access to whatever doctor or other healer they want.

I want every visitor to be able to pay Fee for Service to whatever doctor or other healer they want.

I want the cost (not just my bill) to be less than a Moon shot.

Just like it was in 1976 when five days in Cabarrus County Memorial Hospital cost me $254 after a racing accident. That’s less than a hammer, a toilet seat, or a week’s worth of Starbuck$.

And I certainly don’t want the folks who brought us $436 hammers, $640 toilet seats, and $7,600 coffee makers to flush my policy when it gives me a heart attack.

Yep, we’re paying for it now.

 

We’re Number One!

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“I’ve been trying to figure out why businesses aren’t insisting on single payer healthcare,” my old friend Enola “Fanny” Guay said, “and I realized it’s because we’re all in this great shift into being corporate serfs.”

Although I’’ve known Ms. Guay for nearly 50 years and know how proud she is of her experiential learning, I also know she can be a bit blinded by her ideology. She’s a second generation member of Helen and Scott Nearing’s back-to-the-land movement in Vermont. The Nearings bought an old farm house and built a simple, self-sufficient lifestyle here, far from big government and rampant consumerism. Their descendants are now the power brokers and consumers of Montpeculiar.

Fanny Guay really really really believes in single payer. “All Americans have a constitutional if not a moral right to health care,” she says, “and a single payer plan would cover everyone by default for doctors, hospital, preventive and long-term care, mental health, reproductive, dental, vision, prescription drug and medical supply costs.”

Be nice if we knew how to pay for that.

“We won’t need as much money under single payer,” Ms. Guay said. “With all the patients under the single system, the payer has clout. The VA, for instance, gets a 40% discount on drugs because of its buying power. This monopsony explains why drug prices in other countries are lower than here. That’s how Medicare forces hospital and doctor costs down as well.”

Be nice if we knew how to pay for that.

“See, there is already plenty of money in the system now to pay for it because we already pay for health care.”

Erm, no. Rutland City Treasurer Wendy Wilton’s analysis shows that there is no pot of gold in taxpayer pockets.

She looked at all current state revenues. The property tax, already earmarked for education, is maxed out. Vermont is number four in the nation in property taxes, and just .05% behind number three Connecticut. (The property tax raises 42% of the state revenues.) General sales taxes plus the tariff on gas and booze runs a close second, raising 30% of revenues. State income tax, no longer coupled to federal, is likewise maxed out.

Vermont may grow rocks but there’s no more blood in the stones.

In fact, CNN ranked Vermont number one, numero uno, primo supremo, in the tax wars with a total state and local tax burden of 14.1% of per capita income. That’s far more than New York (13.8%), New Jersey (11.6), or California (11.5) or even Florida (10%).

“That does seem high, but we are a small state and we have a great quality of life.”

Can’t hide from the facts. Vermont will need another payroll tax.

“But we don’t need new taxes!” Ms. Guay said. “We just need to tap the insurance premiums we’re already paying.”

Ms. Wilton found that the state will need a new 14.5% payroll tax but is still going to run $300 million yearly budget deficits even with that new tax. She believes the Shumlin Administration is over-estimating the cost savings a single-payer system can deliver.

She also believe the Shumlin Administration is playing hide the walnut with how much they will have to raise taxes this year, next year, and the year after that, and so on ad infinitum.

The new Vermont legislative session begins Thursday. Guess what’s first on the agenda.

Ms. Guay wondered “why businesses aren’t insisting on single payer healthcare.” Pretty simple, really.

  • Gov. Shumlin’s plan will drive the couple of remaining insurance companies out of business here.
  • Gov. Shumlin’s plan will make it illegal not to provide health insurance to all employees.
  • Gov. Shumlin’s plan will double the size of government (which doubles the size of taxes) overnight.
  • Gov. Shumlin’s plan will drive the couple of remaining Vermont employers out of business here because a business can’t do business if they can’t predict how much their taxes will go up every year.

And no business wants to be legislated into being sort of a serf to the state.

Be nice if we knew how to pay for all that.

 

Will Free Surgery Take this Screw out of My Backside?

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ShumpleCare = ShumlinCare. You say “rose,” I say “tomato.”

Vermonters will spend about $5 Billion on health care this year.

Last year, Harvard’s William Hsiao developed three models to reform this state’s health care system. Dr. Hsiao, an economics professor, and his team recommend a Single Payer Health Care System. It should be financed, they reported, by a payroll tax of 9% on employers plus 3.5% on workers.

The payroll tax would be imposed on all employers whether they currently provide insurance or not, whether they have a self funded ERISA plan or not. That idea scared Vermont’s largest private sector employer, IBM, which self-insures its thousands of Vermont employees as well as every small business owner in the state.

Five billion dollars.

New state revenue.

There is not a politician in the world not attracted to five billion dollars in new revenue.

The Vermont Assembly passed H.202, the UNIVERSAL AND UNIFIED HEALTH SYSTEM, last week. Governor Peter Shumlin is expected to sign it today.

ShumpleCare (H.202) has four principle components. It institutes a Health Insurance Exchange. It concocts a new bureaucracy, The Vermont Health Care Reform Board. It commits to single payer as the future of health care in Vermont. And it spawns Green Mountain Care to operate the single payer system.

Gov. Shumlin visited Northwestern Medical Center on April 25. The governor dispelled rumors of hospital closures under H.202. (He had told the St. Albans Messenger that some smaller hospitals would be closed.) Hospital CEO Jill Bowen noted that NMC and the governor “disagree on the need to understand the financial and operational details of healthcare reform before it is passed into law.”

Did Gov. Shumlin actually say there is no need to understand the financial and operational details of his healthcare reform plans before they are passed into law?

“Universal health care means universal,” David Karindler, a Vermont Workers Center organizer, said as he decried an H.202 amendment that excludes undocumented workers.

“This is the first time such hateful language has been put in legislation,” he added. “We’re all about inclusion in this state. This is about undocumented people flocking to the state. Why would they flock to a place with no housing and no jobs?”

Did Mr. Karindler actually say this is a bad law because it doesn’t cover people in this country illegally?

The Hsiao report predicted $580 million in savings. The law should spend $395 million of the expected savings to cover the uninsured and under insured, to provide basic dental and vision services, plus another $50 million to recruit new and retain current primary care providers. Wow. An extra $135 million for the Demorats to spend! Woo hoo!

Rep. George Till wouldn’t vote for ShumpleCare until the bill removed all traces of the term “single payer” and replaced it with the words “universal and unified health care system.” Wow. We changed the words. That makes it all alright. Rep. Till, a Democrat, represents Jericho, Underhill and Bolton in the Vermont State House. He is in his second term.

A rose by any other name still falls under Title 32, Chapter 233, §9772 of the universal and unified tax code.

To recap:

  • Vermont’s legislators want to control five billion new dollars each year.
  • Vermont’s governor told us not to sweat the details like cost.
  • Vermont’s lefty loons are revolting because the bill doesn’t cover illegal aliens.
  • Vermonters are left holding the bag. Again.

One great part about living in Vermont is our access to public officials. I’ve called four of the last five governors by their first names; several of them have sat in my living room. I don’t know Peter Shumlin. Yet. One great part about living in Vermont is our ability to talk to public officials. As long as they listen.

As Vermont goes, so goes the nation. Don’t say I didn’t Warn You.

I Told You So.

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But did anybody listen? Nooooooooooooooooo.

And so it begins: Vermont Governor Peter Shumlin has proposed a budget for the new year. Gov. Shumlin is a “Big-D” Demorat but one who won’t raise taxes. Gov. Shumlin’s budget increases the provider tax on Vermont’s hospitals by $17.4 million.

A “provider tax” ain’t a real tax, right?

The gov says this increase will simply “maximize the draw down” of matching Federal Medicaid dollars to help fill the State’s budget shortfall. It will tax hospitals, physicians, Home Health Agencies, and pretty much any other healthcare providers. Probably even WalMart because they (used to be able to) sell prescriptions for $4 which makes them a provider.

“Hey, Dick! I get my scrips from Wally now,” Raul Garcia told me. “Did you know that some of the stores charge me sales tax on them some of the time. Some don’t.” Mr. Garcia is North Puffin’s best known hypochondriac and was our most respected grant writer until that little trouble with the Feds. He ended up serving 18 months of a four year sentence for fraud after he used the $4 million he “borrowed” from a major pharmaceutical company as the matching funds for an $8 million corporate gene splicing study at North Puffin College of Veterinary Medicine. The Pharma got their “investment” back when the grant came in. It wasn’t the first time. Even so, he says he has not yet determined which phase of the Moon determines the sales tax boondoggle.

Back on point. Northwestern Medical Center is a small, friendly, not-for-profit, hospital in St. Albans, Vermont. In the interest of full disclosure, I served on the Board of Incorporators for NMC for more than a decade. This regional, primary care facility offers a broad range of high-tech medical equipment and services to the area.

For that one local hospital’s privately insured patients, the added tax means sharing an increase of $350,000 in tax expense alone in the coming year. Yeppers, ObamaCare is gonna reduce the cost of medicine.

And Gov. Shumlin is right at the forefront of that reduction. Newspeak. Word.

No small town hospital is more vital to the community and none is better liked. NMC has earned national Avatar awards for the last three years for patient satisfaction but that’s just part of the story. They sponsor local events like the ArTrain and the Summer Sounds concert series. They field teams for the United Way. And 600 of our friends and neighbors work there.

The original St. Albans Hospital was built in 1883. It has grown and morphed from two hospitals into one that now cares for 1,900 inpatients each year. The E.R. sees over 28,000 emergency patients and 7,000 people already walk in to the new Walk-In Clinic in Georgia each year. 400 babies arrive via storks at the Family Birth Center. That all adds up to more than $129 million of patient care each year.

Gov. Shumlin “proposes to increase the tax assessed on hospitals by $17.4 million from 2011. This increase will be used to draw down Federal funds to help address the State budget shortfall,” NMC Chief Executive Officer Jill Bowen told the St. Albans Messenger. “However, the State no longer returns the provider tax to the hospitals in full after it has secured the matching funds.”

In case you missed it, the State of Vermont told the Feds they took in beaucoup bucks as matching funds to increase the “grant” money funneled back to the state. Then the State of Vermont gave most of those beaucoup bucks back to the hospitals.

“Hey, Dick?” Raoul Garcia said. “Isn’t that what I went to jail for?”

Exchange?

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Jody Beauregard is a sweet, gentle man who has worked on Tom Ripley’s garbage truck for a decade or so. Before that, he schlepped shingles up ladders for Dean Russell when Dino still had his business in North Puffin.

Providence smiled on Jody three years ago. He scored an indoor job with dental insurance and regular hours. First time he had ever worked 40 hours per week and with a building contractor, so he got to see the “comfortable” end of the construction business.

Until the comfortable got dissed in the meltdown. The contractor laid him off a year later, on his 65th birthday.

Jody didn’t mind too awful bad. He was collecting Unemployment and had enough quarters in to retire. He likes to take off every fall to hunt anyway and expects to put up enough meat to last him through the year then but retirement, ah retirement, would let him feel more relaxed at deer camp.

Or not.

Jody collected about $280/week in UI but he also qualified for $1,286/month net in Social Security. And, of course, he qualified for Medicare. He signed up for Part B. He was in double dipper’s clover. Until Unemployment ran out. And the Unemployment extension ran out. And the extended Unemployment extension ran out.

Early last year, the Great State of Vermont decided to “give” him some medical coverage and to pay his Part B Medicare insurance premium. He was in pig heaven. I’m a pretty fair reporter but I still don’t know how he got on Vermont’s Health Access Plan (VHAP) list or what the requirements are.

It’s an elegant, enchanting, thought-provoking system. In August, September, and October of last year, for example, Social Security charged Jody nothing for his Part B coverage. He was still receiving Unemployment compensation during those months. In November, Social Security deducted the Part B premium from his check. He has received no Unemployment payments that month or since. In December, Vermont paid the Part B premium. In January and February Social Security deducted the Part B premium again but some time last year, he got an unexplained $142 extra deposit from Social Security. Confused yet? I am. The premium Jody pays Vermont has also bounced around, month-by-month, between $15 and $50 per month with no explanation.

A Vermont minion told Jody that the reason the state is not paying his premium anymore is that he “makes too much money.” And yet, his unemployment ended in October and his Social Security check — his only income — is unchanged for the third year in a row. No COLA, doncha know.

They have yet to send statements or bills to him. He has asked for but never received an Explanation of Coverage so he has no idea what the $15 (or $50) he pays each month buys him. Vermont has an sensational online presence but no account Jody can log in to, so he has never known how much the premium for the medical coverage they give him is. “I’m pretty sure it is the Plan B I signed up for plus prescription coverage,” he told me. Sheesh.

The Vermont rep told him he makes too much money but still won’t tell him what poke he gets for his pig.

These are the very people who want to run our car manufacturers (and other businesses) and our statewide health care system.

Gov. Peter Shumlin wants to set up a Health Insurance Exchange. In exchange for what?

“Exchange” as a verb usually means to trade someone one something for a different something else that person has or to replace (perhaps defective) merchandise with its working equivalent. As a noun, we say it is that same something that was given or received as a substitute for something else. Sometimes an exchange is a place, like the Stock Exchange, for buying and selling commodities or securities. That kind of exchange is typically open only to members.

Vermont lawmakers got their first thorough look at the guv’s plans for his beloved single-payer health care system last week. Mr. Shumlin plans to start this year by setting up the same state health insurance exchange the constitutionally-challenged Obamacare calls for.

Mr. Shumlin wants more. His state health insurance exchange will help drive the last commercial insurers out of Vermont and serve as his springboard to moving the state to a single-payer system in micro-steps. This year, he will create a new Vermont Health Reform Board not to control health system costs but rather to dictate how much the state will pay providers for services.

The administration will not unveil its financing plan for the new system until 2013, two years after the system is in place.

Perhaps one year after Mr. Shumlin is no longer in place.

“It’ll be good, Mr. Dick,” Jody Beauregard told me. “I can exchange my plan for something even better.”

Uh huh.

Remember Jody’s experience. Guess who made his life so easy? Happy Valentine’s Day, Jody.