The Vermont Plan

I’m trying to digest Vermont’s healthcare reform plan. At first glance they appear to be doing some things correctly, e.g. universal healthcare, reduction in administrative costs via single payer plan. The aspirational component of the plan are good, too, e.g. they want to move away from fee for service and towards compensation for patients’ health.

I’m filled with questions about the plan that don’t appear to be answered in the empowering legislation (linked above). How will it be financed? How will they actually transition away from fee for services? Will companies and the self-employed who currently self-insure be compelled to pay for Green Mountain Care? I don’t see how it can work otherwise.

How will out-of-state employees be handled? How will out-of-state care of Vermont residents be handled? Isn’t there a hazard of scads of phony residences being established?

I think that some of the benefits they’re touting are hand-waving, particularly the notion that the plan will make it attractive for businesses to relocate to Vermont. Healthcare is an important thing but it’s not the only thing. I suspect that as many companies will find Vermont’s plan discouraging as encouraging.

I also am disappointed that they don’t seem to be addressing the supply side of the equation. If the new Green Mountain Care is successful at controlling costs beyond the headroom created by converting to single-payer, won’t it induce healthcare providers (physicians, hospitals, etc.) to leave Vermont? If it’s not successful at controlling costs, it will collapse. Furthermore, I’m suspicious of “beggar thy neighbor” policies of which this appears to be another instance.

As the old line goes the devil is in the details and I guess I’ll need to wait for those.