• Not cart before horse
    February 21,2013

    Not cart before horse

    As Robin Lunge, director of health care reform for the state of Vermont, notes in her opinion piece, our health care system must deliver better value for Vermonters: improved clinical outcomes at a more affordable cost. Lunge’s conclusion in her op-ed, however, that a “single-payer” approach is the best way to achieve that goal oversimplifies the magnitude of Vermont’s health care reform challenges.

    Fixing our health care system requires a combination of thoughtful analysis and bold action on how we can care for people and use health care dollars wisely. It will require new and effective strategies for keeping Vermonters healthy so they need less medical care in the first place. Simply changing how we foot the bill will not improve care or reduce costs.

    Through the leadership of the Green Mountain Care Board, Vermont hopes to soon receive a groundbreaking four-year federal grant to help address these challenges. Among other things, this initiative will help all payers — Medicare, Medicaid and commercial payers — systematically change how hospitals, doctors and other providers are paid. It offers an unprecedented opportunity — enabling providers to reduce fragmented care, decrease waste and improve patient outcomes — the only results that will bend the cost curve. This approach is essential, but will not be smooth, quick or automatic.

    By asserting “Single payer is a clear choice,” Ms. Lunge suggests that public financing will cure all our system’s ills. Let’s not put the cart before the horse on the important work we still have to accomplish.

    Bea Grause

    President and chief executive officer

    Vermont Association of Hospitals and Health Systems


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