Steve Howard, executive director of the Vermont State Employees Association, is being quoted as saying his 10,000 person union would not add its numbers to OneCare next year. OneCare is the accountable care organization implementing the state’s all-payer health care system.

Given his remarks, it’s clear the decision is politically inspired and has almost nothing to do with how OneCare works, or its mission. What Mr. Howard does, however, is to give OneCare, and its defenders, a clearer idea of its challenges, and the strategy it needs to adopt going forward.

Mr. Howard is able to say what he wishes because no one really understands OneCare and its mission. And OneCare helps him out by not telling its story, and in so doing creating an informational void.

That void is being filled by people on the far left, as well as the far right. The far left looks at OneCare as being a political power staffed by the monied elite; the far right looks at OneCare as a monopoly, something that will erode individual choice. The far left will oppose anything that is not a single payer system run by the government. The far right will oppose anything that centralizes the decision-making.

To succeed, OneCare has to sell the fact that it is neither. But it has to sell it. It’s not a system whose purpose is guaranteed. If it’s going to survive, it will need to tell its story and to be convincing in the process.

The sales pitch looks easy. It isn’t. It’s enormously complicated and to add to that complication is the fact that OneCare hasn’t been able to get its advocates to rise to the occasion.

Part of that failure is systemic. The state’s health care system, writ large, is inward looking; being an advocate is seen as job for others. It’s analogous to a surgeon who is skilled in the operating room, but who doesn’t have time to address what caused the ailment to begin with.

Part of OneCare’s problem is transparency. It’s fulfilled the basics, including putting forth its budget before the Green Mountain Care Board, and making public its audits, etc. But it needs to take the lead and make everything public that can be made public, including salaries, benefits, etc. There is no downside to doing so. The only downside is not releasing the information.

Understanding this, and acting upon it, will give OneCare the space it needs to then tell its story, and it can use Mr. Howard’s union — all 10,000 of the state’s employees — as a case in point.

Here’s Mr. Howard’s quote: “We have some of the best health care in the country. We don’t want to screw that up just to pursue someone else’s agenda.”

Who would that someone else be?

An agenda?

Then, there’s this: “Our members are not interested in building anyone’s empire for them.”


When OneCare is scaled up to its hoped-for number, it will include us all. That means hospitals, health care providers, insurance companies, and all of us as patients. And the politics?

The OneCare concept began with Democratic Gov. Peter Shumlin, who fought to get the federal waivers necessary. It’s being championed by Republican Gov. Phil Scott. And the system itself was built, based upon some of the knowledge established by Republican Gov. Jim Douglas and his chronic health care initiative.

The OneCare system is regarded as being in the forefront of all health care initiatives in the country because of the work done thus far. It’s being recognized, and pushed, because the system we have is not sustainable. It’s based on the common sense understanding that the only way to reduce health care costs is by reducing usage, which can only be done [absent rationing of care] through prevention.

Mr. Howard’s political play makes the case even more demonstrable.

By Emerson Lynn

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