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Reducing Barriers to Obtaining Health Care Records

In the 2016 legislative session, Representative Teo Zagar introduced H.554 on my behalf after I wrote to him explaining how costly it would be to obtain a copy of my health care records.  At the time Teo and I corresponded (December 2015), a copy of my records would have cost $438, which is what’s allowed by statute  ($5.00 flat fee or $.50 per page, whichever is higher).  I hope the bill will get picked up this coming session and reintroduced in the House Health Care Committee.

There’s a strong argument that consumers should be able to obtain a copy of their own records for free.  In the bill I drafted, I suggested that consumers be allowed one free copy of their records per year.  Even if a personal copy of one’s records isn’t made available for free, the cost should be reduced from $.50 per page to a rate more comparable to the actual cost that it takes to produce the records.

The $.50 per page copy fee is substantially more than commercial printing costs which are around $.10 per page and while providing one free copy may seem like an administrative burden and an extra cost on providers, it would certainly benefit the public at large for consumers to have easier access to their own medical records.  The legislature may want to emulate Vermont Public Records law by allowing for the first 30 minutes of labor to be free and to require that records be produced at actual cost.

Similar to public records law, any time there are cost barriers placed in front of consumers, these barriers make health care  generally less transparent.

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Vermont’s Affordability Crisis: Are We Solving the Right Problem?

Originally published on Vermont Digger in November 2018

Would Vermont be more affordable if property owners could be confident that policy changes made in Montpelier, and at the local level, would not negatively impact property values? Any serious effort to address our affordability crisis and demographic trends should contemplate this question. High property values, and more specifically, high land values, is the unifying theme across a variety of challenges, whether it’s development of affordable housing, education spending, growing businesses, renewable energy development, or increasing the amenities that would make Vermont more attractive to new residents. High land values act as a growth constraint and there’s a deep underappreciation in Montpelier for the impact land values have on making Vermont more affordable. State government cannot do much to affect the cost of materials, but it has a great deal of influence when setting policies that affect land prices. Indeed, some towns in Vermont, such as East Montpelier, have already recognized a need for a shift in approach (“we’d like to see development that may be skewed toward the younger crowd that would bring children to the school.”) Continue reading “Vermont’s Affordability Crisis: Are We Solving the Right Problem?”

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Vermont’s ‘Homevoter’ Effect

Originally published on Vermont Digger in August 2016

Our land-use policies have served us well for close to 50 years having thwarted the kinds of development that would otherwise jeopardize the beauty of Vermont and the Vermont brand. But have we become victims of our own success? I believe Vermont is at a turning point in terms of land use planning and development priorities, directly affecting the health of our economy and issues of affordability.

Continued revenue shortfalls, despite increases in taxes, suggest that Vermont’s economy suffers from fundamental structural issues. A 2016 VPR/Castleton Polling Institute poll results show that the economy/jobs/cost of living is the No. 1 concern. Stunningly, that same poll found that 70 percent of respondents believe job opportunities are “just fair” or “poor” and 75 percent believe that wages are “just fair” or “poor.” Improving wages largely depends on increasing job opportunities and our land use policies could very well be the main constraint keeping us from improving both.

I believe the main impediment to our long-term economic well-being is the “homevoter” effect, a term coined by Dartmouth College professor of economics William Fischel and described in his 2001 book the “The Homevoter Hypothesis: How Home Values Influence Local Government Taxation, School Finance and Land-Use Policies.” Continue reading “Vermont’s ‘Homevoter’ Effect”

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Balancing Vermont’s Climate Change Priorities

Originally published on Vermont Digger in March 2016

Balance is a desirable objective, whether it’s within one’s personal life or under the Golden Dome in Montpelier. Balance in the public sphere is an awfully difficult thing to achieve, but achieve it we must, especially in the context of further becoming the kinds of stewards of our state and our planet that climate change requires. We are and will be faced with a multitude of challenges and addressing these challenges will strain our resources far more than they already do today. In short, we need to develop laser-like focus on what our priorities should be and develop some basic outline on how to organize them.

This commentary offers a basic framework which I hope will aid our leaders in thinking about and structuring each initiative we undertake for the sake of assessing whether there is balance across the policies we adopt. While other “frameworks” exist, the ones I have seen are just too complicated for our citizen-legislators to use in their decision making (but this should not stop agencies from getting into the nitty-gritty). The risk of not being focused is that we may spend too much time, energy and money on one thing and less on others. I think we also need to start letting go of imaging perfect outcomes and realize that being practical is our best hope. At end of the day, there is only so much we can do with limited resources. This is not a “glass half empty” approach, but rather a clear-eyed way at addressing our future needs. We can be hopeful and realistic at the same time. Continue reading “Balancing Vermont’s Climate Change Priorities”

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Bridging the Renewable Energy Divide

Originally published on Vermont Digger in December 2015

Renewable energy continues to be a divisive issue in Vermont, whether siting issues or Vermont’s renewable energy policies in general. As many in Montpelier have noted, Vermont has experienced substantial growing pains over the past several years with the rapid build-out of renewable energy projects. According to Dr. Asa Hopkins’ September presentation to the Solar Siting Task Force, Vermont has built 120 megawatts (MW) of solar with 75 megawatts in progress on about 1,000 acres of land. Those numbers have probably grown since September.

According to the same presentation, by 2032, Vermont is expected to have 500-750 MW of solar requiring about 200-350 acres of land per year. Certainly, the growing pains will continue. In order to be successful, we cannot continue to allow the issues that divide us to fester. Both sides of the debate bear responsibility for the divisiveness and both sides should take steps to move closer toward each other. Continue reading “Bridging the Renewable Energy Divide”