Video: Tom Huebner, president and CEO of Rutland Regional Medical Center, addresses the audience Tuesday at the Leahy Conference Center in Rutland.

By Patricia Minichiello

Despite a presentation by state officials Tuesday at Rutland Regional Medical Center on the benefits of the new “all-payer” model for health care in Vermont, attendees in the packed house voiced concerns.

The new plan, recently approved by the federal government for Vermont, would change the way providers get paid.

In the current “fee-for-service” model, doctors get paid for each service they provide. Under the new system, doctors would be paid on a monthly basis, based on the health of their patients.

A handout on Tuesday outlined the plan in detail, its goals and benefits to both providers and patients.

More than 150 people attended the two-hour forum with many wondering, what happens if funding is depleted before people get the proper treatment they need.

“How is a rationing of care prevented? That’s my question,” said Howard Fairman.

“That’s a great question,” said  Al Gobeille, chairman of the Green Mountain Care Board.

He explained that the Accountable Care Organization or ACO wouldn’t get all of the money up front.

“The point is that the ACO does not have to choose total risk for that amount of money. So that’s their budget and if they go over, they may be at risk for a portion of that and if they go under, they may get a portion of that back.”

Dan Mccullough also commented on the scenario of rationing health care.

“What this plan does is give an arbitrary cap on how much money can be spent every year on health care and then the dirty word that no one is talking about, the providers are going to have to ration care.”

Gov. Peter Shumlin, who said Tuesday’s event in Rutland was the largest attendance for a public forum on the matter to date, spoke about the urgent need to get away from fee-for-service health care.

“In a fee-for-service system, there is no incentive to factor in the costs when you sign someone up for addiction. In fact, everybody makes a lot of money off addiction,” he said.

Children, he said, are the many victims of addiction and the fee-for-service system is failing us to help them in this crisis.

Lewis Meyers a hospital physician at RRMC has seen a lot of changes in health care in his 27-year-career and he said, “those who don’t learn the lessons of history are doomed to repeat them.”

“We’ve heard this will reduce the work load for physicians. Not true. … they have to spend more time going down checklists to look at quality indicators.”

He compared the new all-payer model with the recent attempt by the federal government to engineer education with the No Child Left Behind Act.

“Clearly the federal government failed to engineer education… and I’m concerned it’s going fail in this regard.”

Patricia Minichiello is a freelance reporter and editor of You can reach her at