Editor’s note: This op-ed is by Cassandra Edson, a member of the Vermont Workers’ Center’s Health Care is a Human Right campaign. She lives in Montpelier.
Over the last several weeks, big business and fake employer groups came out to kill H.202, Vermont’s universal healthcare bill, with their deadly embrace. Hypocritically asserting their support of health care reform, they have been successfully pressuring senators into weakening the bill, thus possibly inflicting death by a thousand cuts.
These opponents turned against ordinary Vermonters who desperately need universal, publicly financed health care, not just another marketplace where insurance companies restrict our access to care while relentlessly driving up costs.
H.202 proposes a slow transition to universal healthcare via setting up a so-called insurance exchange. This exchange is a marketplace that sells health care as a commodity to those who can afford it, and its establishment is required by federal law. Until a waiver for this requirement can be obtained, the transition to universal healthcare follows the scenario outline in Dr. Hsiao’s report. That report also tells us why an exchange alone, even when coupled with a public option, will neither create universal access nor achieve real cost savings.
An exchange will not significantly increase access to health care for Vermonters. In fact, if we want Vermonters to gain coverage, we need a good number of employers to participate in the exchange. If all businesses employing up to 100 workers would be required to join the exchange, we could get coverage for more people. This could also create a reasonably large risk pool that might start reducing costs. These benefits would be very modest compared with what a universal health care system could achieve.
Yet for reform opponents, even this tiny step is too much: They seek to limit the number of employers participating in the exchange, and are trying to water down the bill sufficiently to achieve this. The fewer employers participate in the exchange, the fewer people will obtain coverage and the more expensive coverage will be for everyone, inside and outside the exchange.
Once in the exchange, an individual’s access to care would depend on whether they can pay considerable premiums, deductibles and co-pays. Moreover, not everyone would get the same benefits — some Vermonters would be more equal than others, based on how much money they have. The only hope for making the exchange slightly more affordable, and slightly more equitable, would be to limit the number of insurance companies and benefit plans in the exchange.
Ideally, everyone in the exchange would get the same plan with the same benefits, so that risks are spread among as many people as possible, thus lowering costs for everyone. This would also enable us to simplify administrative procedures and set us on a path toward a single payment channel for providers – a key cost-saving feature in Hsiao’s report. Health financing experts agree that an increased number of insurers increases costs, as this fragments the risk pool, reduces the leverage each insurer has in negotiating prices with providers, and adds administrative costs.
The calculation is simple: the fewer insurers are involved, the larger the risk pool and the lower the costs. This is yet another reason why health care cannot be treated as a market commodity — competition increases rather than decreases prices. We shouldn’t be surprised that by this, their job is to make money and serve their shareholders. But we cannot let our elected officials let them successfully turn our universal healthcare bill into a tool for a profit-making marketplace that limits access to care and inflates costs for everyone.
Vermonters have demanded — and the administration and Legislature have agreed — that we create a universal, publicly financed health care system that provides medical benefits as a public good for all. Everyone participates — individuals, families and businesses — so that everyone can benefit. Like fire departments and roads, a public good is a service that belongs to us, with costs and benefits shared by all. Those seeking to opt out to pursue their own financial gains, threaten the well-being of all Vermonters. We must not allow them to put profits before people.