Roper: Time to embrace a different approach to health care reform

By Rob Roper

In a study released in the fall of 2020, State Auditor Doug Hoffer reported that Vermont’s healthcare costs had increased by 167% between 2000 and 2018. Keep in mind that those years saw a number of “reforms” that promised to reduce costs while increasing access and quality, including Catamount Health, Green Mountain Care (the failed attempt at single payer), and the latest debacle that is OneCare Vermont. All of these programs shared some common characteristics: they were all top-down, government centered, and bureaucratic.

RELATED: State auditor June 2021 report: All-Payer ACO Model costing more than it’s saving

It’s time to try a new approach, lowering costs by increasing transparency, restoring direct doctor/patient accountability, and eliminating expensive regulations and unnecessary middlemen.

Rob Roper is the president of the Ethan Allen Institute.

There is a plan for such a framework coming together under the banner of “Healthcare For You,” personalized healthcare delivery, developed by Physicians for Reform and the Job Creators Network. The groups describe their combined effort as the result of extensive market research, drawing on the input of more than 25,000 patients, doctors, and health care professionals, and “health reform that Americans want, not a backroom plan that politicians tell them they want.”

Key features of the Healthcare For You include transparent prices (doctors and hospitals would be required to publish a “menu” of prices for services), choice (giving patients the resources and flexibility to shop for the insurance and medical products that fit their needs), and restoring direct doctor/patient relationships by eliminating middlemen, third party payers, and bureaucratic red tape wherever possible.

The plan would allow individuals to use tax free dollars to purchase health insurance, which would be connected to the patient, not the employer, meaning no one would lose their coverage because they lost or changed jobs. It would allow states to reform insurance markets to allow individuals to choose what kind of policy they want, anything from a catastrophic plan to a Cadillac plan. Patients with pre-existing conditions would be protected through Guaranteed Coverage Pools.

Expanded access to Personal Health Management Accounts would allow employers to contribute tax-free dollars directly to employees for healthcare related purchases. This, in turn, would empower individuals to pay for medical care directly — options like membership-based primary care cooperatives, surgical centers, labs and imaging centers, etc. — without going through insurance companies. This will lower costs two ways, by incentivizing providers to provide higher quality and lower cost services to attract customers, and by eliminating the costs and inefficiencies of going through middlemen. Such transparent, direct payment systems have demonstrated that they can produce higher quality care that is approximately 50% lower than insurers’ negotiated rates.

Finally, it is time to implement tort reform for medical malpractice cases. Even when Vermont was contemplating a single payer system, the architect of the plan, Dr. William Hsiao, called for moving to a no-fault legal framework such as those used in Scandinavia and New Zealand in order to reduce costs related to malpractice insurance and to curb “defensive medicine” (the expensive practice of conducting unnecessary tests and procedures to protect against potential legal liability rather than the best care of the patient).

Rising healthcare costs are crippling so many aspects of our economy. Businesses can’t afford it. Public sector benefits are consuming disproportionate amounts of public resources to pay for it. Families are being bankrupt because of it. This should be motivation enough to abandon the failed policies of the past and embrace a different approach to reform. However, this logic doesn’t seem to resonate with our political class at this point. Perhaps the Supreme Court taking up California v. Texas this month, the case that could potentially declare the Affordable Care Act (aka Obamacare) unconstitutional, will force their hand with a decision requiring new solutions.

You can learn more about Healthcare For You, and Personalized Healthcare, at

Rob Roper is president of the Ethan Allen Institute. He lives in Stowe.

Image courtesy of Public domain

4 thoughts on “Roper: Time to embrace a different approach to health care reform

  1. This is so compelling. The vision here is that functioning individual liberty/responsibility trumps forfeiting our life decisions to others. The more control individuals/citizens/patients/parents have over their lives the better.

  2. Act 46 was supposed to improve education outcomes and lower costs too. OneCare has the same deficiencies – specifically these programs don’t support a consumer/producer free market. Subsidize healthcare and education to your heart’s delight. But without free market incentives, outcomes and costs will continue to be unmanageable.

  3. Elephant in the room: Why are more people looking outside themselves as they get sicker and sicker beneath the toxic soup we are inhaling, ingesting, drinking and when that fails, jabbing ourselves to be sure we get good’n sick…when its our personal choices and abdication of responsibility to maintain and care for ourselves, ourselves…and when we allow by ignoring the obvious indicators that we live in a toxic soup we are actually PAYING FOR out of our pockets, these crimes against humanity to continue the great culling – that we are paying for don’t forget that – paying for the privelage of getting sick and too often dying – why are we ignoring that is our own negligence towards our own state of being, and our own complacency and opening the door just a little bit and letting just a little bit of evil in…abdicating our free will and capitualating to coercian and fear…
    WHY are we ignoring the obvious?
    If we want to be well, first, foremost and always…CHOOSE TO BE WELL.
    That drinky poo you had last night, the cigarette you had first thing this morning, that sugary pop you had yesterday, the poptart you had this morning, the day your ignored the air health warnings and breathed the air anyway, the fluoridated water you drink with your coffee, the abdication of our wellness to ‘other’… ALL are the elephant in the room’s clothing.
    Fess up – first to yourself then to others – that you’ve been abdicating your health to someone health.
    And OWN that you CAN be healthy IF you choose to make healthy choices for yourself.
    Or not. And ask someone else to fix you.
    Can anyone say co-dependency? Addiction? Munchausen syndrome by proxy? Stockholm syndrome? Hubris? Arrogance?

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