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Livingston: Health care déjà vu

09/08/09 7:55AM By Judy Livingston
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(HOST) The arguments over health care in Washington remind former legislator and commentator Judy Livingston, of the debates Vermont has had on the issue over the years.

(LIVINGSTON) In Yogi Berra's famous words, "It's déjà vu all over again."

The federal debate/row/kerfluffle, whatever-you-call-it, over health care is a re-creation of a mini version that took place in the Vermont statehouse only a couple of years ago. Same choice of words, same questions and answers, same expressed fears, reassurance, partisan finger pointing. And the same lack of firm cost-analysis.

In the process of creating Catamount Health, the push and pull went on for years before resolving itself in a system that has narrowly covered costs - up until recently.

Curiously, our Vermont Legislature never looks beyond the moment. I call this kind of law-making snapshot legislation. If everyone stays put, earns the same income as right now, doesn't change living patterns, it may work. But human beings being what we are, choosing individual directions to suit our circumstances, the best laid plans begin to break down. Minor shifts turn into major costs and somehow the taxpayer foots the bill for the catch-up.

And abuses are legion. As a Legislator I heard from doctors, dentists, psychiatrists, and others, who report blatant examples - one Medicaid patient arrives in a new pick-up truck loaded with two new snowmobiles, another has a patient who takes a train from New York City to get free care in Vermont.  We're spending scarce Medicaid dollars on folks who are supposed to be - but aren't - low-income Vermonters. These are preventable costs, but the state expends little to support investigation and enforcement. And because of these 'behaviors' Vermont public coverage just went up 31% last week! And these premiums will have to come from somewhere. (Try new taxes.)

Another unintended consequence of our under funded plan: We all want the best care for everybody - that's the given - with a sustainable system. To sustain any program we must have realistic costs and disbursements, guaranteeing payment in full for services provided.  Our state has systematically underpaid healthcare providers with the predictable result - a serious shortage of doctors. Those remaining are forced to limit their practice to public-funded patients - therefore shutting out eligible recipients from access - who then must visit emergency wards. So the expense goes up, the care goes down, and around it goes.

So back to Washington: With all the reported misuse and redundancy compounding daily in both the Medicare and Medicaid systems, statewide and nationally, wouldn't it make sense to invest one small bit of those trillions in scrutinizing those unnecessary costs? Even President Obama has admitted that Medicare will be out of funds in seven years! So why can't we mend and streamline our existing healthcare programs before piling on another?

When we have well-run, sustainable and efficient Medicaid and Medicare, then we'll talk trillions - not before.

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