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The Road to Montpelier ... and Back

Posted by John McDonough  December 12, 2011 11:45 AM

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The recent move to Vermont by three Massachusetts health policy experts to become part of that state's unfolding health system transformation prompts the question: why not Massachusetts? 

This past weekend, Lindsey Tucker packed her belongings and moved to Montpelier to start a new job as Deputy Commissioner for Vermont's new Health Insurance Exchange. I know Lindsey from her work running the Affordable Care Today (ACT!!) Coalition at Health Care For All (HCFA); more recently, she worked at the Blue Cross Blue Shield Foundation of Massachusetts.

This past summer, Georgia Maheras moved to the Green Mountain State to head up the Vermont Health Care Administration. Georgia had previously worked for HCFA and Health Law Advocates, and was a terrific consumer advocate with the National Association of Insurance Commissioners.

In early 2011, Anya Rader Wallack left the MA Blue Cross Foundation to become Special Assistant to Vermont's new Governor, Peter Shumlin, who was elected in 2010 on an explicit platform to lead Vermont to the creation of a single payer health care financing system. Anya is now the Chair of the Green Mountain Care Board, the focal point of planning for a Vermont single payer system.

Someone once said one is a point, two is a trend, three is a pattern, and four is a movement. So we're one shy of a movement. And it begs a question: why is there no noticeable conversation in Massachusetts about emulating Vermont's intention to create a single payer (aka: Canadian, Medicare for All) scheme?

Last June, the Massachusetts Health Policy Forum sponsored a forum in Boston on the Vermont project with 250 friendly participants.  Anya Wallack spoke as did Don George, the President and CEO of Vermont Blue Cross Blue Shield, a surprising supporter of Shumlin’s proposal.  Also participating was William Hsiao of the Harvard School of Public Health who produced the original report for the state analyzing the financing prospects for the plan


Since then, Vermont has continued its planning and progress and the topic has dropped off the radar screen in Massachusetts.  This is not surprising.  Massachusetts is now engaged in a complex legislative policy process to reform the payment system – leaving little room for alternatives.  And yet, if payment reform works as well as possible, it will shave a few points off the yearly rate of growth of a health system already massively more expensive than it has any right to be.  When, where, and how do we address how to lower the cost of a system already bloated with excess costs? 


Since the mid-1990s, the advocacy group, MassCare, has been raising the single payer flag; its current leader at the State House is Senator James Eldridge.  The MassCare legislation has never gone past the committee stage, and prospects look no different in the current session that ends most of its work next July. Not much sign of life there.


And yet


The path ahead for most Massachusetts consumers is has two realities: increasingly limited choice of providers through restricted networks and rising cost sharing in the form of co-pays, coinsurance, and deductibles.  The choice most important to consumers is the power to pick your physician and that is diminishing for growing numbers of middle-income families.  It is far less important for consumers to choose which insurer is going to play the role of restricting your choices.


Unlike in Vermont, it is difficult to see our Massachusetts Great and General Court (aka: the Legislature) making a move of such magnitude.  Speaking as a former and proud member of the House, I don’t think the public would tolerate the Legislature making a decision as momentous as this.  Still, Massachusetts is one of a handful of states east of the Mississippi that permits citizens to propose their own laws and put them before the voters, every November in the even-numbered year.  Seems pretty improbable – but many things are improbable until they happen.


Last I checked, the road to Montpelier runs in two directions.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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