On July 7, 2021

OneCare is not the problem with Vermont’s health care

Dear Editor,

Blaming OneCare for the high cost of health care and the sluggish pace of reform grabs headlines, but it does not serve the public or advance understanding of our health care system and its impact on our lives and economy.

OneCare establishes per capita contracts, disburses funds, and aggregates and analyzes data in an ongoing effort to transform the delivery and financing of health care. It has brought 13 hospitals together in an unprecedented commitment to a fixed payment model. This is an enormous step forward.

But OneCare does not regulate or deliver health care. It is but one of many moving parts and interested parties. Many other moving parts have avoided scrutiny.

Gov. Phil Scott, for one, should be leading on this issue, not observing from the sidelines, content to let an unprecedented opportunity flounder. And then there is the Green Mountain Care Board, a powerful regulatory body with little stomach for regulating. If members of this board would make better use of the power invested in them, results will follow — flak no doubt too, but results nonetheless.

OneCare has no such clout and so cannot be saddled with the failure to use it. What it does have as an accountable care organization is a broad view of the health care system as a whole, which — together with explicit data on treatment and outcomes — makes a more efficient, effective and, yes, accountable health care system possible — coordinating and delivering care in better ways. This is not easy, but it is not OneCare that is making it difficult.

Beloved but untenable small hospitals and many physicians in private practice, not to mention Blue Cross Blue Shield, and many self-insured businesses are wedded to fee-for-service and threatened by a transition to per capita healthcare funding. They are dragging their feet while OneCare is pushing forward.

Fee-for-service is the problem. It incentivizes procedures over health and outcomes. It is the reason health care in the U.S. is the most expensive, but not the most effective.  Vermont handled the pandemic as well as it did in large measure because of consistent leadership and no saboteurs. If we want high-quality health care at a fair price and if we don’t want health care costs to overwhelm us, we need leadership and unity on this one.

Michael Long, Burlington

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