V ERM Of<f T,M ES' OCTO'EJl5, 1994--15

P olitics '94
ton, wecan actually reduce health
care costs and improve health
careaccess. Until single-payer fl-
nancing is secured, the citizens
of V ermont will be injeopardy of
having corporations make per-
sonal, private health decisions,
and they will need protection,
developed first at the local level
and then supported, where nee-
essary and possible, by federal
action.
However, I am skeptical of
large organizations. And monopo-
lies, whether in the public or pri-
vate sector, are particularly prone
to abuses. Without the threat of
competition, monopolies can be-
come overpriced and unrespon-
siveto consumers' needs.
The appropriate role of gov-
ernment in handling these alli-
ances is similar to the successful
role the V ermont state govern-
ment played in reforming health
careinsurance. Working with the
late Governor Richard Snelling,
in 1991, other legislators and I
stood up to the predatory prac-
tices of health insurance compa-
nies to protect V ermont
consumers from discriminatory
pricing and denial of benefits.
Likewise, state government
should take the necessary steps
to ensure that aily alliance con-
tain costs while maintaining ac-
cess and quality of care.
What wedon't need is control
and management of these insti-
tutions by government, or the
"one size fits all" rules handed
down from Washington.
Government's role is to prevent
the abuses that could occur in the
absence of real market competi-
tion. Government's role is not to
take over the health caresystem.
After all, there is no monopoly
more overpriced or unresponsive
than the federal bureaucracy.
By dealing with health care
alliances at the state level, by
creating a partnership between
the government and the private
sector, we can reap the benefits
of lower prices that come with
larger organizations while avoid-
ing the harmful effects of dimin-
ished competition.
W h o W i l l S h a p e R e f o r m ?
Congressional candidates Sanders and Carroll discuss
the role of government in regulating health care delivery.
Editor'snote: This week'scover
stor, "The Birth of a Health Care
Giant," explores the merger of
Fanny Allen Hospital and
MCHV-an entity now known as
Fletcher Allen Health Care.
Chittenden County's new health
care delivery system resembles
large regional alliances forming
throughout the U.S. We asked
Congressional candidates Bernie
Sanders and John Carroll the
following questions:
As managed care alliances
form throughout the U.S., what
isthe role of government in terms
of regulation and oversight of
these entities?
How will consumers be sure
these huge allionces-which will
have few regional competitors-
will result in lower medical costs,
quality care and a user-friendly
system.
of an individual's medical condi-
tion, diagnosis and treatment
plans - once considered privi-
leged information to be held con.
fidential bydoctors inthe interest
of their patient's privacy - must
now be shared with managed.
care corporations who second
guess the plans made by doctors
and patients.
This is a far cry from the doc-
tor-patient relationship that V er-
mont physicians are about, th.at
V ermont consumers need and
that V ermont's non-profit, chari-
table hospital system was estab-
lished and received federal and
state tax breaks to provide.
We need to develop a health
system in which doctors seek to
provide the best services possible
to their patients and inwhich the
only allegiance of doctors, hospi-
tals and other providers isto their
patients.
Itis important to note that as
recently as J une, 1992 the Con-
gressional Budget Office issued a
staffmemorandum, "The Effects
of M anaged Care on Use and
Costs of Health Services, n which
concluded that managed care of-
fered little hope of controlling
spiraling health care costs. This
alliance shows no evidence of reo
ducing the health care costs of
V ermont, but will restrict access,
create a managed care organiza-
tion that stands between doctors
and patients, increases the diffi-
culty of physicians doing their
job, increases the paperwork bur-
den, and makes all health care
providers in V ermont subject to
more regulation.
There is a better way to re-
form health care in V ermont.
The real cost crisis inV ermont
health care is unnecessary ad-
ministration. Twenty-four cents
of every health care dollar in the
United States is spent on paper-
work, not on patient care. A
single-payer health care system
makes savings at the administra-
tion level and, therefore, leaves
the practice of medicine to physi-
cians in consultation with their
patients.
V ermont is at achoice point. If
welet the corporations take over
the management of health care
in V ermont, relationships be.
tween our physicians, our hospi-
tals and consumers will be
seriously damaged. Costs will
continue to increase at the ex-
pense of newjobs, economic com-
petitiveness and income for all
V ermonters.
If, however, V ermont estab-
lishes a single-payer system,
aided by federal policy, which I
have led the fightfor in Washing-
J ohn Carroll
The managed care alliances
that are forming throughout V er-
mont and the United States are a
natural response to market forces
and the need to provide more
affordable health care. The pro-
viders that have voluntarily
sought each other out in these
mergers are part of a trend in
finding greater efficiencies to
deliver health care. The fact that
larger institutions create savings
is what leads to the creation of
these alliances.
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GENERAL ELECTION
FORUM S '94
Channel 17 Town M eeting Television
General Election Coverage
LIV E: M AJ OR STATEWIDE CANDIDATES
simulcast onWKDRAM 1390
Friday 10/7 7PM Lt Governor Candidates
Repeat Friday 10/14at BPM
Thursday 10/13 7PM Governor Candidates
Repeat M ooday 10/17at 7PM
Thursday 1 O / Z 0 7PM U.S. House Candidates
Repeat M onday 10/24at 7:30PM
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Repeat Tuesday 11/1at 7PM
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LIV E: M INOR STATEWIDE CANDIDATES
simulcast onWKDRAM 1390
Bernie Sanders
The merger of Fanny Allen
and M CHV is part of a national
trend whereby hospitals, physi-
cian groups, insurance compa-
nies, pharmaceutical companies,
and managed care organizations
are forming new corporations,
often for-profit corporations, to
provide health care and to regu-
late what health care individual
citizens receive. Increasingly,
managed care organizations -
rather than physicians - choose
what therapeutic prescription
drugs a patient can receive. In-
creasingly, the intimate details
onfOU.
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