Proposal: AKA "John Kerry Should Be Ashamed Of Himself"
I did a little research. Actually, I did three hours of research (for which -- in a perfect world -- John Kerry would have to reimburse me). One thing stands out: Governor Dean tells the truth to his citizens. If we don't have the revenue, we can't provide every service. He has said the same, and should continue to say the same, as part of this campaign. Don't promise everything when you're also promising decreased taxes. It can't be done.
Point by point rebuttal of Kerry (go here to see what I'm talking about):
1. Kerry first quotes from Dr. Dean's 2002 Budget address, selectively choosing the sentence in which he "regretfully" requests that they cut the VSCRIPT program.
The entire text of that speech is here.
John Kerry does not, of course, quote the entire relevant passage. Here it is:
The Medicaid budget will present significant challenges this year. Every Vermonter deserves to have access to health care, and I will continue to fight for that principle. But we cannot afford to provide all the services that we currently offer.
In this budget I once again ask that you modify Medicaid to ensure the state-covered plan resembles insurance packages offered in the private sector.
In addition, pharmaceutical costs are eroding the budget of every state in the union. In 1998, Vermont's Medicaid program spent $40 million on prescription drugs. In 2002, we will spend just under $100 million -- a 150 percent increase.
Last year I recommended an increase of 67 cents in the cigarette tax. The Legislature declined to raise this tax, leaving our rate at only 44 cents a pack. In Washington State, the tax is $1.50 per pack, and just last week New York state agreed to increase their cigarette tax by 39 cents to $1.50 per pack.
Smoking is a public health emergency, and the lack of an adequate cigarette tax is an emergency for all Vermonters who depend on the state for health care.
This budget does not include revenue increases -- such as the cigarette tax -- that the Legislature has previously opposed. Therefore, I regretfully recommend to you that we eliminate the expanded VSCRIPT program in its entirety, which is 100 percent funded through state dollars.
I also ask that we impose a 50 percent co-payment on pharmaceutical benefits through both the Vermont Health Access Plan and the remaining VSCRIPT program. These pharmaceutical programs are among the most expensive and rapidly growing parts of the Human Services budget.
If the Legislature does not raise revenues, we have no choice but to reduce the programs.
2. Kerry quotes the reactions from the AARP representative and Community of Vermont Elders. They didn't like the cuts. They said so. They should have; it was their responsibility to fight for their constituents as hard as they could. It was the Governor's responsibility to keep Vermont solvent. Most other states did not make cuts like these. They are in dire financial trouble now. Vermont is not, and their seniors are well-served by this fact.
3. Try as I might, I couldn't google the AP quote Kerry gives. Let's assume it's true. See speech excerpt above.
I was fascinated to discover that Vermont's current Republican Governor Jim Douglas stated, in May of this year, "“Vermont’s system of long term care is among the best in the country, and we are committed to keeping that way."
It's also interesting to note that some of Dr. Dean's long-term care proposals mirror those of Governor Douglas in the area of providing choices for care and flexibility in waivers. Tell me again how Howard Dean is the most liberal of the candidates?
This article is a look at the pragmatic way that Governor Dean learned to govern -- and how it paid off for Vermont.
4. Kerry quotes an AP report: "Vermont and many other states reimburse nursing homes far less than what it costs the facilities to provide patient care, a national study claims. Vermont ranked second worst in the country in the size of the financial gap between the state's reimbursement and costs, according to research by an accounting firm for the American Health Care Association."
Once again, I couldn't manage to google this exact report, but I did find some interesting information that seems to indicate that this is a serious misrepresentation of the facts by Kerry. First of all, this statement by the American College of Health Care Administrators, indicates that they found the problem to be one at the national level and, oh, by the way, in that list with Vermont? Massachusetts. This site and this one also refer to this as a "Medicaid shortfall." The implication seems to be that the nursing homes the listed states were providing services at a certain cost and that Medicaid could not cover those costs. So...those decisions would lie with the owners and administrators of the nursing homes, wouldn't they? A quote: "The study contends lack of access to adequate federal reimbursement may reduce the quality of care available to residents as well as further impact the current staffing shortage." This was not a problem created by the states.
5. Kerry's fifth headline reads: "Vermont In Bottom Three States In Spending on Nursing Home Complaints"
The GAO report Kerry refers to is here. I downloaded the entire document and read the methodology. Pertinent facts: The bulk of the report is based on case studies in three states that the auditors visited: Michigan, Maryland, and Washington. State auditor reports for 10 additional states -- none of them being Vermont -- were also examined.
Vermont appears in the tables, located in the Appendices, that list all states and their expenditures. Here is the footnote that accompanies the tables:
1 The information presented in tables II.1 and II.2 was developed by HCFA in collaboration with GAO. It is based on Medicare and Medicaid certification expenditure data, workload data and state licensure percentages reported by states to HCFA. When states investigate a complaint as part of annual inspections, HCFA requires states to separate work hours between complaint and annual surveys, but some states may neglect to distinguish complaint hours. Therefore, complaint expenditures may be understated in some states. The estimates are based on certification expenditures only, so that if a state places any portion of its certification responsibilities within other noncertification-related Medicaid-administered expenditures, this portion will not be reflected in the expenditure amounts. Also, the state licensing percentages were reported by the HCFA regional offices after verification by the states. While 77 percent of federally certified nursing homes participate in both the Medicare and Medicaid programs, there are some homes that participate solely in one or the other. The state licensing percentage is affected slightly by this mix of facilities’ certification in each state. Some, but not all, of the state licensing percentages reflect a mix of facilities. This may slightly vary the federal and state shares in those states where mix of facilities was not reflected in the state licensing percentage. Data on U.S. territories are reflected in the national numbers.
Does Vermont fall into any of these "exceptions," making the data that Kerry quotes questionable? The report doesn't specify. Kerry doesn't seem to have a problem with this.
6. Kerry states, "Vermont Higher Than National Average in Harmful Facilities" citing a 2001 Vermont Department of Aging survey that shows 22.7% of VT facilities having harmful deficiencies as compared to the U.S. average of 21.4%.
First of all, remember that Vermont is a small state and percentage changes will seem to be greater because of its size compared to other states. In fact, the very AHCA study Kerry cites earlier points this out in its own statistics.
Do you want to read the Department of Aging's Customer Satisfaction Report for 2001? It's right here. An independent firm did the survey. Guess what?
"Consumers of the State’s long-term care services indicated overwhelming satisfaction and approval for the programs in which they participated. Satisfaction and approval ratings were consistently high across all measures. For the third year in a row, consumers were most satisfied with the courtesy shown by their caregivers, with 93% of consumers indicating they felt caregiver courtesy was either “excellent” or “good.” Additionally, at least 85% of long-term care consumers statewide indicated similar levels of satisfaction with the quality of assistance they received (89.3%), the reliability of service (87.9%), and communication with caregivers (87.8%)."
Also:
"In 2001, the percentage of consumers who felt long-term care programs were a good value for the services they received remained consistent with 2000 results, at about 80%. Furthermore, an overwhelming majority (89.1%) of consumers felt the help they have received from long-term care services had made their lives “much” or “somewhat better.” Over 80% of consumers statewide felt it would be “difficult” or “very difficult” to stay in their homes if they did not receive long-term care services."
Horrifying, isn't it? Except, the opposite of that. Oh, and check this out:
"Long-term care consumers statewide were less satisfied with the amount of choice and control they had when planning their long-term care services, although their satisfaction level increased significantly in 2001 compared to 2000. Whereas only 71.7% of consumers rated the amount of choice and control they had as “excellent” or “good” in 2000, 81.0% rated this service element as “excellent” or “good” in 2001." Hmm. And "choice" is a big part of Howard Dean's Long Term Care Program. Gee, do ya think he actually read the reports his DOA produced? Someone should tell Kerry. I'm sure he'd correct his site right away.
http://home.att.net/~opus163/rebuttal1.html 
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