Is Vt.’s single-payer failure a harbinger for R.I. reform?

The Vermont single-payer initiative, which was cited both locally and nationally as a transformational model for a lower-cost health care system, collapsed in the latter part of December. It couldn’t work because it tried to replace the employer-based system – one in which a majority of consumers receive health insurance from their employer – with an impractical proposal that would have required $2.5 billion in additional funding (in fiscal 2012, the state had only $2.7 billion in total tax revenue).
The outcome in Vermont may have looked very different had they engaged employers in an effort to control the cost of the existing system rather than trying to “blow it up” in favor of a state-run single-payer plan.
In Rhode Island, we have seen a different approach that is not trying to “blow up” the existing system but rather to work with the system and demonstrate that the state can be a “primary change agent.”
In July 2014, Rhode Island submitted a State Innovation Model II – or SIM II – health care reform grant application to the federal government and was awarded $20 million over a four-year period to test the “change agent” theory.
The SIM II grant incorporates, under the auspices of the Healthy Rhode Island Steering Committee – an ad hoc group of government agencies, payers, hospitals or hospital groups, physician practices, behavioral health providers, and other social service providers – the ongoing work of various groups in the state that have developed processes and regulatory-based programs measuring quality, improving primary care effectiveness and regulating health insurance, and that are working toward making health care prices available to the community. Some of these programs, however, are not effectively coordinated, rely too heavily on regulation and have yet to demonstrate a return on investment. In September 2014, the business community petitioned for representation on the Healthy Rhode Island Steering Committee. The request was denied a month later.
There are two reasons why business input into this process is critical. The first is business is skilled at rolling out new ventures. Thus far, for example, the SIM II grant does not “hedge its bets” in any way should we find ourselves, like Vermont, having to face the potential reality that one or more of these programs is unable to “bend the cost curve” sufficiently to reduce health insurance premiums.
The second reason is that with employers at the table, Rhode Island will need to develop a business case for addressing health care costs that includes evaluating the effectiveness of existing programs, making course corrections where appropriate, and deploying metrics that are easily understood and used by business and the community to achieve a lower-cost health care system for Rhode Island.
The new administration has a genuine opportunity to avoid Vermont’s pitfalls by developing a broad-based reform initiative that is practical, engages the existing system, and benefits from the support of Rhode Island’s business community. Let us hope that it takes full advantage of that opportunity. •


Albert Charbonneau is the executive director of the Rhode Island Business Group on Health and a retired administrator who worked in the Rochester, N.Y., region for more than 30 years, including participating in the 1980-99 Hospital Experimental Payment Program, which produced health insurance premiums that were 33 percent less than the national average.

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