Thursday April 4, 2013

DAVE GRAM

Associated Press

MONTPELIER (AP) -- A group of Vermont doctors and mostly Republican lawmakers gathered Wednesday to warn that if Vermont goes ahead with its plan to push toward a Canadian-style, single-payer health care system, the state will "regulate the private practice of medicine in Vermont out of existence."

At a news conference called by the group Vermonters for Health Care Freedom, which has been critical of the single-payer plan championed by Gov. Peter Shumlin and crafted by a Democratic-controlled Legislature, the lead spokesman for the physicians, Burlington psychiatrist Robert Emmons, warned that the state’s efforts to control health care costs would force them to reduce quality.

"When you control how the doctor is paid, you control the doctor’s clinical decisions," Emmons said, calling Green Mountain Care, the name the state has given to the single-payer plan to begin operations in 2017, incompatible with medical ethics.

Dr. Deb Richter, a physician and longtime advocate for single-payer health care in Vermont, called the idea that medical ethics would be influenced by money "really insulting. There’s nothing in the Hippocratic oath about that."

She argued that what’s unethical is a health care system that turns patients away for an inability to pay, or that "patients have to be treated differently because of their insurance."

At the news conference, doctors backed an amendment defeated by the Vermont House last month that would have barred the Green Mountain Care Board from setting salaries and rates for doctors and protected the right of patients to enter into voluntary financial agreements with their doctors.

Rep. Mike Fisher, chairman of the House Health Care Committee, called the measure premature, saying the Green Mountain Care Board had not begun to set up the financial structure of the coming single-payer system. Other lawmakers said the amendment would allow the establishment of what one called a "high-profit, high-cost niche in our health care economy," and the amendment was defeated.

Both Mark Larson, commissioner of the Department of Vermont Health Access, and Robin Lunge, Shumlin’s director of health care reform, called the complaints voiced at Tuesday’s news conference premature, saying the Green Mountain Care Board had not made any decisions about how and how much doctors would be paid in 2017 and going forward.

Larson said there would an extensive public process before that system is established "so it’s not like it’s going to sneak up on anybody."

Larson did acknowledge one concern voiced at the news conference: the 2011 law gives the Green Mountain Care Board the authority to set rates to be paid for various medical services. Providers operating under contract with Green Mountain Care would not be allowed to charge extra for their services for patients in the system. To do so would be a "violation of the provider agreement," Larson said.

Penalties for such a violation have not been established. Under the current Medicaid system, a provider who violates the agreement by, for example, trying to charge patients extra on top of what Medicaid pays, can be kicked off the system.