Two interesting points from today's discussion with national experts Nancy Turnbull of the Harvard School Of Public Health and Andrew Hyman of the Robert Wood Johnson Foundation.

One (not surprisingly) is that controlling costs remains the most significant challenge for states trying to overhaul their health care systems. Turnbull pointed out that efforts to fund Maine's Dirigo Program have run into a political buzz saw and the plan hasn't been able to cover as many people as affordably as originally planned. You can read about the problems facing the Maine program in this article in the Bangor Daily News: http://bit.ly/eH8r89. In Vermont, Catamount Health has run into a similar problem of not being able to provide large enough subsidies to make coverage affordable.

Hyman says efforts to control cost have to get at changing the way we pay for health care. In his words, "Doing rate reviews of insurance premiums and reducing insurance premiums...can be helpful for the consumer but they don't address the specific problem that we have in seeing health care prices and spending going up and up." Hyman says we need to base payment on outcomes and not on how many tests and services are provided.

The other point, made by Turnbull, is that the plan Governor Shumlin and Vermont legislative leaders are supporting hasn't been attempted in other states.

Here's how she put it: "It's a very big and bold and ambitious proposal of a kind that's never been tried in the United States before. Unlike the law in Massachusetts and the other states...which were mainly incremental changes, the proposal in Vermont really makes fundamental changes in the financing system. The biggest one to me would be to essentially cut the connection between employment and health insurance for people...its a very, very ambitious and different approach."

You can hear the entire discussion with Turnbull and Hyman here: http://www.vpr.net/episode/50901/