Dr.Hsiao's presentation to Health Care Reform Commission on August 5th

[Report from Peg Franzen, Healthcare Is A Human Right Campaign, http://www.workerscenter.org/healthcare]

Below, I have copied Hsiao's outline of the presentation that he gave outlining his teams workplan in developing the design options as called for in S.88/Act 128

There were questions about ERISA and about the cost effectiveness of Single Payer but the one major concern that several members of the Commission voiced was related to the "economic impact on the state's economy, which Dr. Hsiao deemed a low priority area for the workplan.

Dr. Hsaio explained that with the time limits and the small amount of money the project had to work with m it is impossible to do that level of analysis, He estimated it would cost close to a million $ and would probably take over a year.

Jim Leddy, commission member and former VT Senator and president of AARP, commented that it will be important to have such data as we move forward. It was then mentioned that maybe we need to find a grant to do the analysis. Rep. Steve Maier (D-Middlebury), the co-chair of the Commission said that he anticipates a long process before anything is finally adopted.

Personally, I am concerned that Steve, who has been the Chair of the House Health Committee, and perhaps some others on the Commission are not anticipating that a design option gets adopted this next legislative session.

We don't want them to find excuses to not act. We need them to make a moral and human right commitment.

Sen. Ginny Lyons (D-Chittenden), a newly appointed member of the Commission suggested that we not get ahead of ourselves, but we allow Dr. Hsaio to do his work. Sen. Jane Kitchell (D-Caledonia) agreed.

Our HCHR campaign needs to convince them to commit to making it happen.

Below is the text of Hsiao's presentation. Here is a link to the video of his entire presentation: http://middleburycommunitytv.org/video/HSAIO080510.mp4

Here is some other coverage:
VT Digger: http://vtdigger.org/2010/08/06/hsiao-early-diagnosis-of-vermonts-health-...

Times Argus: http://www.timesargus.com/article/20100806/NEWS02/708069897/0/FRONTPAGE

VT Single Payer: http://vermontforsinglepayer.org/blog/2010/08/dr-hsiao-lays-the-groundwo...
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Dr: Hsiao's presentation was entitled the Vermont Option: Achieving Affordable Universal Health Care. His presentation followed an outline that his team had prepared. Below is the outline

MAJOR PROBLEMS CONFRONTING VERMONT

> EQUITY- Lack of universal health insurance coverage and equal access to quality health care for all Vermonters

> AFFORDABILITY- High health care cost inflation rate that makes health insurance and health care less affordable.

> Holistic patient - centered-care- Fragmented health care delivery.

> EFFICIENCY- Duplications and waste in health care; high administrative costs.

PRINCIPLES AND GOALS OF ACT 128 (S.88)

* Universal coverage and access to essential or comprehensive health services, equitably financed.
* Patient-centered, coordinated, community-based delivery with a focus on primary care, prevention, and health promotion.
* Waste reduction, quality improvement and increase in health care efficiency.
* Cost containment and sustainable financing over time.
* Public engagement, accountability, and transparency.

HSIAO'S TEAM APPROACH

> Diagnose the CAUSES OF THE PROBLEMS (Dr. Hsiao stated that Act 128 laid out many problems but not the causes )

> Diagnose policy OPTIONS (remedies) once accurate diagnoses have been made.

> Consider the CONSTRAINTS when designing options:

> Economic: What will it cost, who and how will it get paid for

> Political: Stakeholders/ consumers

> Federal: Waivers, ERISA, maximize federal dollars.

> Institutional and operational: Who will manage and what can be implemented

* Ascertain Impacts of options and compare impacts on different options.

Next Hsiao's handout outlined Vermont's Major Problems and Causes

Major Problems Possible Causes
Lack of universal coverage and access Patchwork delivery system; unaffordable insurance and adverse selection

Quality and continuity of healthcare

Fragmented health care delivery system

Duplications, waste and inefficiency Fragmented financing and delivery systems; fee-for-service(FFS) payment

High health cost inflation Lack of rational system: FFS payment

HSAIO'S TEAM PROPOSED STRATEGIES

OBJECTIVE STRATEGY

Achieve universal coverage and access,equitable financing
Universal Social Health Insurance or Mandate

Single Payer

Improve quality and efficiency; achieve integrated delivery
Reform payment system
system with community-based, patient centered primary care

Reduce administrative costs; reduce waste and fraud; increase
Introduce uniform medical claims processing system and patient records

Transparency

Stakeholder Analysis

Ensure viability and implementability of the plan and thus the ultimate
Assess political and institutional space for reform
success of reforms

Hsiao then talked about what his Work Plan and What they will produce and What they will Deliver

WHAT WE WILL PRODUCE:

* Options:

1. state-run universal coverage and single payer plan; supplementary private insurance.

2. " public option" competing with private plans.

3. a plan designed to be politically and practically viable for Vermont

* Benefit packages required by Act 128 for each option:
. Comprehensive package x 2 different cost-sharing schemes
. Essential package x 2 cost-sharing schemes

* Implementation plan for each option:

. Enrollment process, payment system, global budgets/targets, reform delivery system, health planning, compliance with federal law.

WHAT WE WILL DELIVER:

* A comprehensive design of three options with sufficient details to allow legislators to enact and implement a system that best fits Vermonters' goals, principles and values.

* A detailed comparison of the impacts of different options on cost, insurance coverage, taxes, etc. that will allow legislators to make rational policy choices

* A strategy for integrating and strengthing current Vermont efforts to improve quality and efficiency within a cohesive system framework

Lastly Dr. Hsiao talked about Major and Lower Priorities due to the limited time and budget for the project..

MAJOR PRIORITIES

* Design and analyze:
- a single payer government-run , publicaly financed system
- a " public option" plan
* Design a health system that is politically and institutionally viable, and therefore able to be implemented in Vermont's context.
* Develop and integrate current Vermont initiatives in coherent framework; provide implementation steps and broad recommendations.
* Provide comparative analysis of the strengths and weaknesses of different options, including their impact on total costs, tax implications and other distributional effect on individuals, and businesses, as well as the impact on providers.

LOWER PRIORITIES (project team will rely more on state staff)

* Write proposals for Medicare and Medicaid Waivers
* Negotiate ERISA exemption
* Other matters of federal and state law
* Detailed changes in governance structures, mechanisms, and regulations.
* Detailed implementation plans
* Impact on state's economy