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Minimum of 200 words per reply and one scholarly citation from the last 5 years in AMA format for each, there are two posts in the attachment below and you need one reply for each.
Post #1: Megan
I found the Green Mountain Care article to be very insightful and an interesting look
into many of the issues that our country may face as we look towards the future. As
more and more individuals agree with the idea that healthcare is a human right, I
believe we will see a continued push towards single payer healthcare. While the article
focuses on many aspects of this challenging issue, there?s two that stood out to me.
1. The role of insurance companies and their influence on healthcare decision making:
In many single payer models, the healthcare is entirely government funded and run,
therefore eliminating the need for health insurance companies. These companies,
which employ thousands of Americans across the country, would certainly be opposed
to any model that does not give them a seat at the table or reduces their ability to fulfill
their shareholders? expectations.1 Some models try to include a variety of ways to
include these companies, such as running government-paid but insurance-companyexecuted healthcare, however it still appears to create an obstacle to health insurance
companies.1 With health insurance companies having a substantial lobbying force, we
can be certain they are influencing legislators to avoid a likely industry-ending decision
to move towards government-run single payer healthcare.
2. The impact of decreasing reimbursement rates on health systems, particularly rural
hospitals: While many people in the general public have an impression that healthcare
systems are making substantial amounts of money, that is not the case for many
hospitals, particularly those in rural areas. For many of those smaller hospitals,
decreased reimbursement rates for government-funded healthcare in the past decade
have led to decreased revenue and therefore less ability to accommodate advances in
healthcare technology for their patients. Many hospital systems have to rely on
employer-funded healthcare and other private health insurance to ?offset? the
decreased reimbursement from patients on Medicare and Medicaid, a number that has
increased over the past decade with the ACA. As the Green Mountain study found,
paying reimbursement rate of 105% of Medicare would be an almost 17% decrease in
payment. This would inevitably lead smaller, particularly rural hospitals to be unable to
continue providing healthcare, which could easily lead to increased missed care.2 This
missed care often leads to worsened healthcare outcomes and even decreased
lifespans of those who live in these areas.2
All in all, I think the idea behind the Green Mountain Care is a good one, that we
recognize our responsibility to care for our neighbor. Matthew 25:35-36 alludes to that,
discussing that when we cared for our hungry, sick, imprisoned, and in-need neighbor,
we were truly caring for the Lord. However, the Green Mountain Care article discussed
many of the shortfalls of this single-payer model and will serve as an example of areas
that proponents will need to address moving forward.
Post #2: Hanan
Having read Chapters 9 and 10 of the textbook, as well has having reviewed the Case
#9, Green Mountain Care, one of the first elements that stood out to me in terms of
explaining why the prospects of universal care in Vermont did not succeed in
implementation was the discord among the various members of the populace. This is
best represented by the ?key interests and concerns of different sectors? as discussed
in the case study.1 For example, members of the population that were associated with
hospitals ?would vehemently oppose reductions in their reimbursement
rates.?1 Meanwhile, many businesses preferred a third party administrative control
system where political influence would not be a factor.1 It is also telling how the varied
the interview subjects were. While it made sense to glean opinions and interests from
so many different people, including ?legislators, members of the executive branch,
hospital administrators, healthcare providers, representatives of large businesses and
small and medium businesses, union officials, health reform advocates, advocates
from other issue areas, and insurance company executives,? it was inevitable that a
uniform opinion would not be elucidated.1 Ultimately, this uncertainty came to fruition
as governor Peter Shumlin dissolved the Green Mountain Care act, stating that he had
learned of the limitations regarding state-based financing, federal law, the local tax
capacity, and the economic sensitivity of the local populace.1
There are also several explanations regarding the demise of the Green Mountain Care
Act, specifically from a political perspective. For example, there was the clear
dissipation of public support.1 There was no clear mandate.1 Legislature provided only
weak support.1 Significantly, the state budget being raised by 45% naturally brought
about concerns regarding the response of the public.1 While Shumlin was initially
supportive of the single-payer system, his running opponent in the 2014 election was
opposed to such a system, and Shumlin only won that reelection by a 1%
margin.1 Unsurprisingly, a poll in April of 2014 demonstrated how the populace was
essentially split in opinion with regards to a single-payer system.1
There are some comparisons to be made between the demise of the Green Mountain
Care act and the continual demise of the Affordable Care Act. Some researchers have
pointed to the lack of uniformity as a reason for the failure of the ACA.2 In particular,
while several million people have benefited from the ACA, ?middle-income families
without employer-provided coverage and small businesses? have been done more
harm than good.2
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