This commentary is by Rachel Block of East Greenbush, New York, She is a program officer with the Milbank Memorial Fund and was the founding executive director of the Vermont Health Care Authority from 1992-94.
VTDigger’s reporting and publication of letters on the health reform process in Vermont are very welcome. The issues are complex, the stakes are high and the demands are hard to balance. We want a high-quality, accessible health care system, and we also want the system to be affordable for households, employers and the state itself.
To achieve these goals, a comprehensive approach to health reform is needed but there doesn’t seem to be much agreement on how this should work. However, without a clear state policy direction, unsustainable cost growth will continue with broad impacts on the health care system and the state economy, and it will only get harder to fix it.
Solving the health care system’s problems means making a solid diagnosis using the best evidence available, determining if there are efficient and effective ways to abate or cure problems identified, and, importantly, acknowledging we probably can’t afford to do everything that everyone wants.
Perhaps it is not fair to expect one regulatory agency such as the Green Mountain Care Board to adjudicate all of these issues, although I believe the Board has made sustained good-faith efforts to do so. But ensuring that decisions are made in the public interest requires government leadership, and that means the governor and Legislature need to affirm the best decision-making process and outcome.
The good news is there are models for the state to follow. One recent proposal for comprehensive health care reform was recently published based on policy research leadership from the Milbank Memorial Fund and the Dartmouth Institute. The proposal identifies the problems of unsustainable health care cost growth and disinvestment in the primary care and community services sectors -— and a set of complementary strategies fit to those purposes, including setting a target for statewide health care cost growth and creating global budget provider payment models to sustain fragile rural health hospitals and practices. But perhaps the most important feature of the proposal is simply that it takes a comprehensive, not piecemeal, view of the problems and feasible solutions.
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The time is ripe for a fresh discussion so Vermont can move forward with comprehensive health reform. The Centers for Medicare & Medicaid Services’ AHEAD model provides a framework for federal participation in the process which is essential for Vermont to succeed.
The governor and Legislature have kicked off the new year with a focus on improving affordability for Vermonters. It is the perfect time to kickstart the process and create the state’s future sustainable health care system.
Read the story on VTDigger here: Rachel Block: It’s time to create a sustainable health care system for Vermont.