John McClaughry Traces the History of Vermont's Health Care Reform

Libertarian John McClaughry of the Ethan Allen Institute traces the history of health care reform in Vermont, a seemingly futile effort to control costs. Yet, less than 8% of Vermonters are not covered by some form of health insurance, a good outcome, but certainly not perfect. So access is really not the problem in Vermont. Cost is the culprit as it is everywhere. Vermont's proposal to go down the single-payer road is analyzed in historical context.


John's history posted on Vermont Tiger is worth a read, but for me here's his key point:

"The advocates are intoxicated with the fiction that “health care is a human right”. They harbor a deep seated animus to insurance companies, corporations in general, and anything smacking of informed consumer choice. They are convinced that their dissatisfactions with today’s health care are the result of “market failure” – even though most if not all problems can be traced back to an unwise policy choice, tax or mandate from either state or federal government.
The Senators ought to know better, but the majority party’s continued support for single payer seems to be a remarkable example of willing suspension of disbelief. It is also a major disservice to the people of Vermont, who are in line to bear the brunt of single payer’s inevitable – and possibly tragic - consequences."

Of course, the wild card in all this is the outcome of ObamaCare, which in its current form is by no means certain given the increasing pressure to constrain federal deficits...and the results of the 2012 elections. 

The Economist's View of U.S. Fiscal Policy

Paul Ryan's plan makes a better start point for resolution of America's love affair with deficit spending. Will Americans wake up to the crisis facing the country? I'm waiting eagerly for the proposal from the Senate's 'Gang of Six."

http://www.economist.com/node/18530111?story_id=18530111&fsrc=nlw|hig|07-04-2011|editors_highlights

From the Economist: “Unlike Mr Obama, Mr Ryan puts fiscal responsibility at the centre of his plan: it aims to bring the budget into primary balance as early as 2015 and federal government spending down to below 20% of GDP in 2018. He also outlines a simplification of America’s mad tax code, bringing the top rate for both individuals and businesses down to 25% by eliminating loopholes. Above all, he aims at the core of the problem, the ever-rising cost of health care for the elderly.At the moment, retirees in America are entitled to Medicare, an all-you-can-eat buffet of care provided by the private sector but paid for by government-run insurance. Under Mr Ryan’s scheme, future retirees would have to take out private insurance plans, helped by a government subsidy. The effect would be a bit like changing from a defined-benefit pension to a defined-contribution one. The savings come because the subsidy would not cover everything that is currently provided: people will either end up with less lavish care or have to pay more.Mr Ryan also wants to turn Medicaid, government-financed health care for the poor, over to the states in the form of “block grants”. This would force them to manage their budgets more responsibly than they have needed to when they have been able to send much of the tab to Washington.”

In Budget Debate, Democrats and Republicans Reassess Government's Role - NYTimes.com

The good news is that Congress finally seems to be paying sufficient attention to the impossibility of continuing to borrow more than 40% of every dollar it spends. The bad news is this will be an arduous and brutal battle between ideologies likely punctuated by, if not culminating in, the 2012 election.

   This election will likely be a referendum of the these competing ideologies with the future well-being of the country at stake. I think the 'limited government' view of necessity has the upper hand now because the status quo will lead to bankruptcy. [update 041811... S&P creating a negative outlook for U.S. debt should not be ignored]

   The class warfare symbolized by the mantras of 'tax the rich' and 'punish the less fortunate' I hope will fall on deaf ears and lead to a relalistic compromise such that all elements of our citizenry have skin in the game leading to a rational solution ... in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity...'

"The battle ahead “is the big one, and goes to the very major questions about the role of government,” said G. William Hoagland, a former Republican staff director of the Senate Budget Committee. “This is going to be a very fundamental clash of ideologies.”The Democratic and Republican Parties have their own internal tensions to address as the debate goes forward in Congress and on the presidential campaign trail. But in its early stages at least, it is liberals who are on the defensive.The aging of the baby boom generation and the costs of maintaining Medicare and Social Security have put the two pillars of the social welfare system on the table for re-examination. The growing weight of the national debt has given urgency to the question of whether the government has become too big and expensive."

The whole Stevenson column is well worth the read.

Interest on the Public Debt

What a mess! Consider the implications if interest rates rise! Congress MUST rein in spending. Many plans are or soon will be on the table. Will Congress seriously deal with the issue of will tis become just another special interests fight? If history is our guide, expect 95% rhetoric and 5% action.

VP Biden Sleeping During President's Speech?

Perhaps VP Biden's closed eyes epitomize the attention most Americans pay to the deficits and the national debt created by Congress that threatens to bankrupt the country if not soon fixed with a plan to reduce government spending to more realistic levels.

Vermont and New Hampshire Property Tax Comparison

Another comparison of VT with New Hampshire. Overall, NH wins the two state tax comparison with no sales or income tax. The good news for homeowners is that VT's residential property values did not suffer in the housing bust as did most other states.

3. Vermont
> Average Property Taxes as % of Median Income: 5.4% (3rd Most)
> Average Median Property Taxes Paid on Homes: $4,618 (3rd Most)
> Unemployment Rate: 5.6% (5th lowest)
> Average Median Income for Home Owners: $77,161 (7th Highest)
> % decrease in Median Home value (2006-2009): +9.0% (20th largest increase)

Vermont residents spend 5% of their net incomes on property taxes, the third most in the country. The median homeowner income is the seventh-highest in the U.S., at $77,161 per person. An additional boon for state homeowners is a 9% increase in home values between 2006 and 2009, well above the national average. Unemployment is low, which in theory should mean the pool of potential homebuyers should be greater than in many other states.

2. New Hampshire
> Average Property Taxes as % of Median Income: 6.38% (2nd Most)
> Average Median Property Taxes Paid on Homes: $4,168 (2nd Most)
> Unemployment Rate: 5.4% (4th lowest)
> Average Median Income for Home Owners: $72,489 (13th Highest)
> % decrease in Median Home value (2006-2009): -2.8% (11th Greatest Decrease)

Vermont’s neighbor, New Hampshire, has an even higher rate of property taxes as a percent of resident income, at 6.38%. The state’s residents also pay the second-most overall on taxes, a median of $4,168 per household. Unlike Vermont, property values decreased by 2.8% between 2006 and 2009, the  11th highest decrease in the country. New Hampshire has comparably low unemployment rates and median income for homeowners, meaning residents are probably more capable of paying these large property taxes than the residents of less well-off states.

Read more: The Ten States With The Worst Property Taxes - 24/7 Wall St. http://247wallst.com/2011/04/05/the-ten-states-with-the-worst-property-taxes/#ixzz1IwBG57fz

Employers Testify Against Vermont Healthcare Reform Plan

    Dealer.com and IBM testify against the rush to single payer in Vermont to VT Senate Committee on Health Care. (Credits: TrueNorthReports for the video clip.)


    Vermont's Democrat-controlled Legislature and Gov. Shumlin are hell-bent on rushing to health care reform that runs a very high risk of failure to meet cost containment goals. Multi-state companies who self insure health care for employees will not pay twice nor will employees stand for reduced (yet-to-be-defined) benefits. Who knows if they will pass these extra costs on to their employees? They certainly will not choose to pay twice for Vermont employees.


    The state will be downright stupid to take an action that at great risk of driving multi-state employers and jobs from Vermont.


    If Vermont chooses to eventually exempt companies in this category, that will further reduce the number of people who will be enrolled, because Medicare eligible folks will apparently not participate. ShummyCare as presently envisaged in H.202 is a mirage with no guarantee of success in reducing costs or providing any significant quality improvement. Wat we can expect if this plan comes to reality is RATIONING of services.

A Comparison of Per-capita Expenditures by State

Vermont spends nearly 3 times New Hampshire's level per person. How is it that two states sharing a common border are so different in their desire to spend and tax? Some differences may exist in how education is funded in the two states. NH may fund education with more local dollars than Vermont and we also know that NH pays for some of it's transportation costs via tolls, but the stark difference clearly shows that Vermont is off-track in it's fiscal policies and philosophy compared to most other states.

Vermont Medicaid Hospital Taxes - FY 2012 Budget

"The Association does not oppose the fee bill (H.436). As you know, the fee bill contains, among other things, the hospital provider tax. The House Ways and Means committee supported the Administration’s recommendation to increase the hospital provider tax to the greatest extent possible. The $17.4 million proposed tax increase for SFY 2012 brings the total tax paid by hospitals to $111.5 million. These tax revenues, when matched with federal Medicaid funds, generate more than $230 million – $48 million more than the state eventually pays hospitals and employed physicians to care for Medicaid patients."
--Quote from open letter to Vermont Legislators on H.202 from M. Beatrice Grause, RN, JD

President and CEO,Vermont Association of Hospital and Health Systems

I'm no expert on Medicaid and health care funding, but let me be sure I have this right. Hospitals will be taxed more to help balance Vermont's FY2012 budget. This will mean that additional Federal Medicaid dollars will flow into the state to help pay hospitals for services to Medicaid patients. Meanwhile, our Federal government now borrows  about 42 cents of every dollar it spends, including Medicaid dollars flowing to the states.

So, if all states do what seems to be a cool deal to get more Federal dollars from Medicaid, the Feds are required to borrow more to pay for the additional Medicaid support. It seems to me this tactic will drive up Federal Medicaid spending and more deficit spending/borrowing, some of which apparently will flow back to hospitals, at least in Vermont.

This seems to me a scheme to 'rob Peter (Federal budget in dire deficit mode) to pay Paul (Vermont's hospitals)' and exemplifies one of the problems with our present U.S. health care system. I remain unconvinced that ObamaCare or ShummyCare will solve this problem.

Granted, this is fundamentally a national issue that requires deep restructuring of entitlement programs. But Congress seems to have little stomach for that. Despite the rhetoric, we have yet to see any real action from Republicans or Democrats to reduce deficits.

Meanwhile, states will continue to milk 'the system' for their own benefit. In Vermont's case, the budget will be balanced partially via increased federal deficit spending, not unlike the use of ARRA funds in the previous two budgets.

Opera Live-at-the-Met

Went to Live-at-the-Met at Palace 9 in So. Burlington this afternoon for Donizetti's Lucia di Lammermoor. What a marvelous performance! I have never been an opera fan, but these HD live performances are (for me) better than being there in person because of all the extra behind-the-scenes features.