Health Care Reform Enters the Action Phase

by Hamilton E. Davis

   In the spring of 2011, the Vermont Legislatures set the state on a path to the most far-reaching health care reform project ever attempted here or in any other state. Last week, the state completed work on the final piece of architecture needed to make the plan a reality.
   It took five and a half years of grinding effort to reach last week’s milestone. Now comes implementation of the plan, and that effort promises to be even more difficult. Changing the way the state’s doctors, hospitals and other providers deliver more than $3.5 to $4.0 billion in health care to the Vermont population will require a fundamental change in the way that money flows to the providers, and that in turn will require a fundamental reorganization of the system itself.
   In other words, we are on the brink of a huge upheaval in the cultural and financial environment of our health care system.
   This upheaval will take place in an atmosphere fraught with a lack of understanding on the part of the public, the press and the legislature, and in fact, in much of the medical community itself. There is also an important block of more or less explicit opposition to health care reform in all of those elements in the state.
   A personal note: I have been following the reform effort since its inception in 2011, and it is the most complex issue of public policy I have seen in more than 50 years working in that particular vineyard. There will be a little hiatus in the frenzy now that the All Payer Model has been signed. In 10 days we will know who the new governor will be, not to mention who will be the new president.
   The biennial shift in government will be particularly far reaching in Vermont. We will get not just a new governor, but a new lieutenant governor. In the Legislature we will get a new House speaker, and a new Senate President Pro Tem, accompanied by at least some committee changes. The state bureaucracy will get a whole new leadership structure.   
   After that, we will have two months before the new Vermont Legislature takes office. And in that interregnum we will begin to see the way that health care reform will affect the organization and functioning of the health care delivery system itself.
   In the past, I have dealt with the myriad issues involved by writing very long articles that often covered multiple facets of the reform project. I am going to try something different now. I’m just going to start at the beginning and go forward to the current situation in smaller bites that I will publish as quickly as I can write them.
   I’ll start with the need for reform, and sketch the failures of the past. I’ll lay out the architecture of the Vermont plan and then deal with each aspect separately. I can only hope that these efforts will cohere sufficiently to give my readers a clear-enough picture of the project to make judgments about it.
  Hey, it worked for Dickens.
  First up: Why we need reform and how the Vermont plan was built to meet that need.