N.H. Hospital Watches Vermont Single Payer Debate

March 02, 2011


Lebanon, New Hampshire - March 2, 2011

Dartmouth-Hitchcock Medical Center's Frank McDougall knows a lot of people who impact the health care industry in New Hampshire and Vermont, and all the way to the White House.

"We can't go on the way we are going," said McDougall, the VP of government relations at DHMC. "The system is significantly broken, the financing system. The percentage of our Gross National Product is getting to the point where we can't afford this, can't sustain it."

Dartmouth-Hitchcock is located in New Hampshire, but Vermont is a big player.

"About 40 percent of everything that happens at our Lebanon campus, for Dartmouth-Hitchcock Medical Center is Vermont," McDougall said.

Over 300,000 Vermont patients visited the facility last year alone. And 2,300 Vermonters work at the medical center, which has an annual payroll-- solely to Vermonters-- upwards of $160 million.

"The fact is the Green Mountains pretty much divide the market," McDougall said.

So as the Shumlin administration moves forward drafting a single-payer health plan for Vermont, DHMC has a keen interest.

"Theoretically, it makes all the sense in the world," McDougall said. "Last year Dartmouth-Hitchcock, we billed 650 unique insurers. There were 650 unique insurers that got separate bills with separate codes at separate addresses for patients that had health insurance here. That's not counting private payers, that's not counting Medicare or Medicaid, so clearly there is a significant bureaucracy around the whole payer mechanism."

McDougall says savings-- from an administrative perspective-- make sense. But a key question remains: Who will end up footing the bill for a single-payer system? A payroll tax has been offered as a possibility.

"DHMC would not be subjected or could not be subjected to a Vermont payroll tax, but we may have the option of our Vermonters, the 2,300 DHMC employees who are Vermonters, we may have the option of covering them in the Vermont plan through a contribution to the Vermont plan," McDougall said.

But what about small business owners who struggle to pay for their own insurance, let alone thousands of employees in the case of this hospital?

"If I got employees I'd be concerned," said Ken Blaisdell of White River Junction. "I'm not sure exactly what the cost would be."

Reporter Adam Sullivan: Because right now you don't pay for employees, but the question is if you were to hire employees would you be required to pay for them?

Blaisdell: Right, right. And that would be difficult especially if I would have to pay something similar to what I have to pay.

Blaisdell runs a small shop in downtown White River Junction. He buys his own medical insurance at a cost of about $5,000 a year. If a single-payer system would lower that, Blaisdell says he's on board.

"Simplify the system and hopefully the costs would go down for small businesses," Blaisdell said.

Cost concerns on the state level are impacted by Medicaid reimbursements, which are administered through the states. In New Hampshire, reimbursement rates are about the lowest in the nation.

"We lost about $57 million last year to cost to New Hampshire Medicaid and that number is only growing," McDougall said.

A gap that McDougall says highlights the need for reform, and yet another reason why he's watching the single-payer debate in Vermont closely. He says making care more cost effective is a good idea, but will Vermont's choices be good for the hospital?

"We are absolutely at a crossroads with regard to health care reform," he said. "And whether it is at the state level or at the federal level, we are all in agreement that something has to give."

McDougall says he has been a part of about four attempts to reform the health care system in the past and each time he says there has always been a loud voice lobbying for the status quo. But he says he's not hearing that this time around, which he offers as proof that everyone is calling for reform-- no matter what party.

Adam Sullivan - WCAX News