3-23-15 – John McClaughry’s Comments from “On the Mend” Confrerence

By John McClaughry

These remarks were made on March 21, 2015, Holiday Inn, South Burlington at the “On the Mend” healthcare conference sponsored by Vermonters for Healthcare Freedom, the Ethan Allen Institute, NFIB and the Green Mountain Patriots. 


In my few minutes today I’d like to share with you some concise thoughts for mending health care in Vermont.

First, the overarching policy framework: For the past four years we have labored under an absurd and indeed destructive vision for Vermont health care. Gov. Shumlin and his political allies have constantly sung the praises of a government-managed, price-controlled, mandate-intense, taxpayer- financed monopoly health system that gives everybody their human right to “appropriate care at the appropriate time in the appropriate setting”, at least until the money runs out. That vision will assuredly result in long waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and of course much higher taxes.

When Act 48’s Green Mountain Care vision foundered on its $2 billion dollar a year price tag, the adherents to that foolish idea came up with new variations on the same, tired theme, such as “all payer” and “public utility”. The Progs pushed a section into the current health care bill to create an insider task force to design a new state mandate on individuals, along with the penalties needed to enforce it, and of course a new taxpayer-financed uncompensated care pool to pay for care of those who refuse to obey the mandate, or can’t afford to pay its costs.

It’s overdue for Vermonters to say “out with all that”, and start advancing a new and completely different 21st Century vision: Vermont should adopt and promote a Consumer Driven Health Care model based on personal responsibility, not coercive mandates. Informed consumers would choose among a large array of innovative health care and health insurance options, and use pre-tax dollars to pay for them. A consumer driven government will oversee the suppliers, protect the consumers, and where necessary subsidize people and families of modest means.

Now, here are some specific ways to move away from the abyss of costly, coercive government health care.

  • Strongly reinforce the principle that the primary responsibility for maintaining wellness and paying for health services rests with the informed individual and family, not with the government.
  • Spend public dollars to educate citizens – and especially young people – in the consequences of healthy and unhealthy lifestyle choices.
  • Stimulate, support and recognize a wide range of citizen-led initiatives for maintaining health and managing chronic illness, such as Operation Access (North Carolina), health care cooperatives, free clinics, Remote Area Medical clinics, friendly societies, church-based clinics, lodge practice, health sharing ministries, and facilitated networks.
  • Promote expanded Health Savings Accounts, HRAs, and FSAs coupled with catastrophic major medical coverage. The more that first party payments replace third-party payments, the better.
  • Encourage direct pay to “focused factories”, personalized health practices, urgent care clinics in workplaces, malls, and pharmacies, and independent physician and surgery practices.
  • End the notorious practice of the state declaring more and more people eligible for free health care, then failing to pay the full costs of that care, thus forcing the providers to shift those costs onto private insurance premiums.
  • Offer the acute care Medicaid population a Healthy Indiana plan, where patients purchase care with their contributions to their own POWER accounts, supplemented with matching Medicaid dollars, with performance incentives and state-provided catastrophic coverage.
  • Start paying attention to the literature on the business organization and financial incentives underlying the health care system. We need to allow disruptive entrepreneurial change in hospital and associated enterprises, which do some things well but many things inefficiently, and are of necessity focused on extracting the maximum amount of revenues from third party payers. Give attention – including transitional support – to adaptive reuse of stranded cost facilities.

 

  • Repeal Certificate of Need review, a process that strengthens monopoly power at higher patient costs.
  • Repeal age-based community rating that forces young healthy people to cross subsidize premiums for their older, sicker, but richer grandparents.
  • Replace guaranteed issue with a state high risk pool to pay the exceptional costs of the one percent of the population that is uninsurable,
  • Reduce insurance coverage mandates especially for pregnancy, substance abuse, and ill-defined mental health conditions, especially those that consumers don’t want or will likely never use.
  • Allow premium discounts for healthy lifestyles. This is prohibited by HIPAA, but the state should do it and let Washington try to stop it.
  • Install an income tax based recovery requirement for persons who get medical care, are able to pay for it, but won’t.
  • Encourage use of modern technology, including remote health monitoring devices.
  • Enact medical malpractice reforms, such as a pre-trial medical review board, creating a patient negligence formulary, and imposing fines for bringing frivolous cases.
  • Devise a legal workaround to allow means-tested Obamacare premium credits to flow to consumers purchasing care or coverage in a competitive, dynamic health care marketplace.

When you’ve digested these seventeen points, let me know – I have more.

{ 2 comments… read them below or add one }

John Lindley iii March 28, 2015 at 10:37 am

Add to your list. Rpeal community rating and allow new open insurance market with file and use regulations.

Reply

jim bulmer March 28, 2015 at 12:38 pm

Bottom line, it’s just one more attempt to redistribute wealth. If the common folks cannot afford to participate, soak the “rich”.

Reply

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