TimesArgus.com - We Are Vermont

Blue Cross/Blue Shield is a quasi non-profit, fee-for-service organization granted incredible advantages over all other private insurers, by members of our Vermont State Legislature. Originally intended as our "insurer of last resort" (and, thus, the reason legislatures all across this country granted them these advantages), the fact that the collapse of the West Virginia Blue Cross/Blue Shield, during the early 1990s, led many Blue Cross/Blue Shield organizations to revamp into profitable insurers. The collapse of West Virginia's Blue Cross/Blue Shield organization led to another state wide, taxpayer bailout in order to address unpaid claims.

Vermont's own Blue Cross/Blue Shield program, also, experienced similar fiduciary concerns, during that time, and a significant reorganization of their company's leadership was implemented. Advantageous legislation which directly led to a much higher market share, here in Vermont, was the result of our Democrat controlled government, at the time.

Many legislators reacted to the "crisis" of skyrocketing health care costs by throwing out all private insurance competition. Claiming, at the time, "That private insurers were only interested in profits, and, besides, health care costs would be easier to manage if we only had a couple of companies in our state."

After engineering our own Blue Cross/Blue Shield "bailout bill", this time through restrictive legislation fully intended to stamp out private insurers, the result was that 84 out of 89 private insurance companies left this state within 31 days. All that premium tax money was lost, forever. Without competition, health insurance plans, whose monthly rates were a reasonable $238 for a family plan skyrocketed to more than $900 month. Yes, you guessed it. With far less benefits and much higher deductibles, as well. Small businesses in Vermont panicked. Legislators turned a blind eye on small business owners.

Business owners across this state well know that this year's 33-34% increase in premiums are not the first significant increase that entities, such as Barre City, has had to endure. For 30% increases were the norm, beginning 16-18 years ago. Especially for small businesses and their employees. Many small business owners whom stayed in Vermont decided to scrap all health insurance benefits for their employees, yet, many people were laid off with those firms who did keep some semblance of a health insurance benefit package. Productivity with many Vermont businesses plummeted, and the result was the relocation of thousands of good, clean business entities out of state. As Bill mentioned, we only have ourselves to blame for continually electing the same people, over and over again, whom place a government solution as the final answer to any "crisis." A "crisis" is any politician's favorite word. Its use is fully intending to frighten the public into falsely believing that only a government solution will properly handle said "crisis."

Bill brings before the public a couple of very good points. In order for Barre to circumvent the "middle man" (known as the insurance company), he suggests that our city self-insure to take the "profit" out of health care. For many self-insured plans, approved by the US Department of Labor under ERISA (Employee Retirement Income Security Act of 1974, Amended), certain guidelines must be in place before approval. For instance, the plans require a claims administrator to address each and every claim. Now, who do you think would be chosen to administrate such claims? Oftentimes, our own Blue Cross/Blue Shield company is chosen as the TPA (Third-Party Claims Administrator). As a result, the profit margins remain. Only, this time, on a similar contractual arrangement as if Blue Cross/Blue Shield were the actual insurer, but this time, without any of the risk. That's a hell of a deal for any insurance company. They would simply administrate the plan according to City and ERISA guidelines, and the taxpayer would still be on the hook for any increases in premium.

Unionized contracts require that Barre City provides each and every employee with negotiated benefits, and no union officials or negotiators worth their salt would ever let these hard fought, benefits just disappear, overnight. However, all of Barre City's excellent employees will have to sit down and seriously look at the overall picture. Do we agree to go with a lower benefit package, or do we look for employment elsewhere? These are the two most fundamental questions our Mayor brings before the general public, our employees whom charge these unions to negotiate contracts which are fair and equitable, and the company who wishes to increase our premiums.

It is the taxpayer whom ultimately pays the price, regardless the hefty premiums fairly charged to the City of Barre, VT, based on claims experience. Surely, no one should ever wish for anyone to be sick, or in pain. We have no problem with employees and their dependents seeking honest medical advice. But, at what price does the taxpaying public say, "Enough is enough?"

Which brings us back to one of Bill's points, the possible negotiations with a provider or providers to extend health care directly to all city employees. Well, essentially, that is already happening with extended contracts requiring an employee to choose their primary care physician. HMOs (Health Maintenance Organizations), PPO (Preferred Provider Organizations), and other contracts with the medical community are the results of such a demand that Bill suggests. Within these limited contractual obligations the medical community provides wellness care at a nominal fee, and many providers are actually paid bonuses for finding the root cause of a diagnosis using far less tests, than before. Emergency benefits are extended beyond this mandate, however further benefits beyond the primary care physician always require a referral.

While it is true that companies of yesteryear negotiated directly with a common provider, it is also true that the benefits offered were, usually, extremely limited, resulting in many deaths, prematurely. Today's implementation of medical care, while very expensive, provides a much better choice to the patient for survival, in any number of areas. Is it worth the price? That is something the citizens of Barre will have to ultimately answer.

Does that mean that Barre City's citizens will have to go without or endure less services? Probably. Remember, this city has 90-plus employees with a population of only 9,280 (last census) and next to nothing when it comes to private industry, anymore. Long gone are the private mills, the private engineering firm of Casselini and Venable, the private entities known as Montgomery Ward, Grand Union, Sprague Electric, and several of our predominant, private granite manufacturing plants. far too many people believe the word "profit" is a dirty word. Well, only when it comes to the profits of OTHER people.

Barre City's tax base has shrunk, significantly, because some of these prime real estate areas were replaced by state or city run entities (which pays zero taxes) instead of private entities (which all pay property taxes). Thus, the tax burden falls on the home owners. If 10% of our property owners fail to pay their property taxes, on time, well that's a *huge* amount of money Barre City cannot do without. In our declining housing market, that 10% number is not far from the truth.

I am your very concerned neighbor,

Tom Boyce
Barre, VT

---