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Creative Health Care Thinking

04/20/05 12:00AM By Mary Barrosse-Schwartz
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(HOST) This week, VPR commentators are taking a Hands-on Health Care approach to considering what it may take to cure Vermont's Health Care ills. Today, commentator Mary Barrosse Schwartz admits that she isn't completely convinced by either of the two competing Health Care recovery plans currently being debated in Montpelier - but she thinks that both proposals reflect some creative thinking.


(BARROSSE) Could the answer to Vermont's burgeoning Medicaid deficit be as simple as the State taking over as the sole insurance company as the Legislature proposes? Or will the Governor's plan solve the problem? I think there are interesting concepts in both.

One advantage of a single payer system is that cost savings are achieved by eliminating the profits made by insurance companies on insurance premiums. Also, hospitals and doctors offices don't need to invest as much in billing and collections as they do now.

With global budgeting, limited resources are allocated regionally. This element creates a financial incentive to avoid higher medical costs within a community. Having a set budget to manage the health of a certain population would naturally encourage preventative care, such as community screenings for cholesterol levels, which aren't paid for in the current system. But it would also require hospitals to budget in advance for a projected volume of business. If there is unforeseen volume growth, the money just runs out, meaning a cut in services.

From the Governor's proposal, one element stands out as having significant long-term benefits. This is the Chronic Care Initiative, which seeks to address the needs of the most seriously ill and most costly patients in the health care system, in part through improving self management and better medical office practice through the use of technology and other proven efficiencies.

Another important initiative from the Governor is malpractice reform. We don't pay a lot more in the overall scheme of things for malpractice insurance, but some experts believe that health costs are seriously inflated by doctors who practice a defensive style of health care, ordering all possible tests so that nothing is ever missed.

But apart from both these plans, I'd like to know more about what doctors, hospitals and insurance companies would suggest to provide high quality health care to people who can't afford it, or those who are struggling with catastrophic medical situations. The best possible outcome can't be just about saving money, but also about making people healthier.

And if we do adopt a whole new health care system, how do we secure the 3.5 billion dollars needed to make such a radical shift? These potential changes will affect our lives and those of our children and parents for many years to come. The questions concerning who will pay and how much are critical and must be deliberated statewide.

The goal of providing high quality health care for all Vermonters at an affordable cost is a challenging one. It will take many minds looking for solutions at both the community and the state level to meet it.

This is Mary Barrosse Schwartz in East Dorset.

Mary Barosse Schwartz is a freelance writer who is researching and writing a book on healthy aging with her physician husband. She spoke from our studio at Burr and Burton Academy in Manchester.
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