Kenneth Thorpe is chair of the Department of Health Policy and Management at Emory University in Atlanta and a former deputy assistant secretary of health policy in the Clinton Administration. Last year he was the Vermont Legislature’s consultant on healthcare reform - the legislature that finally produced and passed the Catamount Healthcare Reform Bill that’s scheduled to go into effect this coming October. You remember?
The “reform” bill that AARP Magazine gave Republican Gov. Jim Douglas an award for signing?
Recently released figures indicate Catamount may not cover as many uninsured Vermonters as it originally promised to, giving critics, including promoters of a single-payer system along the lines of what exists in Canada, France Great Britain and other European countries, fuel for their fire.
On Wednesday, I bumped into Ol’ Ken outside the office of House Speaker Gaye Symington. We grabbed a couple chairs and sat down for a little one-on-one.
Q. What’s your snapshot of where we are in Vermont on this?
Thorpe: I think where we are is Vermont passed the most far-reaching, important healthcare reform package in the country. The reason it’s different is that most of the reforms were aimed at making health insurance more affordable for the 90 percent of Vermonters who have health insurance. That is a major part of the Vermont healthcare reform that other states - Massachusetts, the California proposals really don’t address the affordability of healthcare. And that’s one thing that really distinguishes Vermont’s healthcare reform effort.
Q. For example?
Thorpe: For example - two major ways we’re going to reduce the cost of private health insurance. One is by more effectively managing people that have chronic illness. Most of the healthcare spending in the Vermont system is for patients that have chronic disease - 75 percent of it. We want to more effectively manage it and provide better quality care. That’s going to reduce costs.
The second way we’re going to reduce costs is “pull” a cost-shift out of private health insurance by reducing the uninsured, by increasing, over time, Medicaid rates we can reduce the cost of private health insurance. And both of those are going to be important for Vermont businesses and families.
Q. To the consumer out there who may not be as sophisticated, the argument defined by our political left Progressive Party is: let’s get real here - there’ll be no real reform until we go to a single-payer like the rest of Western Civilization. What do you say to them?
Thorpe: Well, I think the reforms are much broader-sweeping than even a single-payer. We’re going to the heart of the affordability problem. We’re going to manage chronic illness. It’s not an insurance issue. This is a management issue of people that have chronic diseases.
Ironically, the Canadians, the Europeans are facing the same problems we’re facing. In fact, I’m going to a conference next week in Europe to work with the Canadians, a single-payer country, to build the same type of integrated delivery structures that are embedded in Catamount Health. They are facing the same problems and pressures in their system that we’re facing in ours.
Q. So the insurance industry - their cut - that’s not a problem in the cost and availability of healthcare in this country?
Thorpe: I think the cost of administering healthcare is too high. Catamount Health includes several provisions that will reduce administrative costs: going to a single claims form; reducing reporting requirements on physicians. We’re going to really make sure that we do everything we can to simplify the physicians lives and pay them adequately to manage chronic illness.
A lot of what we’re going to be doing this session is putting in new approaches, new ways of paying physicians, and really making this promise a reality.
Q. You’re hopeful?
Thorpe: I’m very hopeful. The devil’s in the details. We did a lot of hard bipartisan work to pass this last year. Now we have a lot of work to make sure that it’s actually implemented in a very effective way and that will be a challenge.
Thorpe said they will do everything they can to simplify physicians lives and reduce administrative costs. Thorpe will be in Montpelier for two days this week, Wednesday and Thursday, meeting with the leadership of both chambers as well as the members of the health care committees in House and Senate.
P.S. Unfortunately Ol’ Ken’s a little late. On Wednesday, I got a phone call from my Primary Care Physician at UHC. Been with him since 1995 when he brought me back from double pneumonia at the Mary Fanny. The Good Doctor informed me he’s leaving the medical profession next week. He’s only 43.