After Vermont Gov. Peter Shumlin dropped his long-sought goal of a universal, publicly funded healthcare system this past week, key members of his healthcare team immediately got back to work picking up less ambitious pieces of the plan.
Appearing Wednesday before reporters and two boards that had advised him, the second-term Democrat said there were steps the state can still take in a bid to reduce healthcare costs.
The less ambitious steps described by aides include pushing hospitals and health systems toward "global budgets" in which they are given a set amount of money each year for serving the health needs of a certain population and away from the traditional "fee-for-service" system in which the more procedures are performed, the more health providers get paid.
"You can never 100 percent get away from that," said Al Gobeille, chairman of the Green Mountain Care Board, which has spearheaded much of the health overhaul. "But you can for a majority get away from that."
Health costs covered by Medicare have been growing by 0.8 percent per year recently, Gobeille said, while those covered by commercial insurance have grown 10 times as fast. Gobeille said he would like to see both growing at about 3.5 percent per year.
To pursue that goal, the state needs a special "all-payer waiver" from the federal government to give it greater flexibility in the use of Medicare funds, officials said. Gobeille said that would come only if the state can guarantee current Medicare beneficiaries don't see their coverage reduced.
Shumlin said he wants legislation to give more authority to the five-member board. Robin Lunge, a top healthcare aid to the governor, said one goal is more regulatory control over Vermont Information Technology Leaders, a nonprofit that has been working to enhance electronic communications between different layers of the healthcare system.
Dr. Marvin Malek, a hospitalist at Central Vermont Medical Center and state director of the group Physicians for a National Health Plan, said streamlining the software used by health professionals is crucial to trimming costs. "Better software looms so much larger than any other strategy" for controlling costs, Malek said.
Shumlin said he wants to see health care treated like a public utility and Lunge likened the role the Green Mountain Care Board could have to that long used by the Public Service board, which regulates electric and other utilities.
Officials said the governor is likely to seek more funding for the state Blueprint for Health program, which encourages better coordination between primary care, mental health, substance abuse treatment and other providers.
Shumlin said he decided to scrap his single-payer goal because the state's fragile economy could not absorb the 11.5 percent business payroll tax and a new personal income tax — ranging up to 9.5 percent — that would be required to pay for a quality program.
The announcement drew a cacophony from both left and right.
Leaders of the Health Care Is A Human Right campaign said Shumlin had "burned" them and that his "career is toast."
Conservative groups, meanwhile, crowed. "We are proud to have played a role in educating the public as to the many pitfalls of single payer, and are gratified that the ill-conceived program is dead, at least for now," said Rob Roper, president of the Ethan Allen Institute.
"At least for now" may be the operative phrase, as Shumlin made clear he still holds the dream. Medicare took 31 years to pass — in 1965 — after it was first proposed by the administration of President Franklin Roosevelt.
"Our time will come," the governor said.