Editor’s note: This commentary is by Terry Doran, who is co-author (with Con Hogan and Deb Richter) of “At the Crossroads: The Future of Health Care in Vermont” and “Gridlock: The Unhealthy Politics of Health Care in Vermont.” He lives in Montpelier.
[I]t’s no surprise that Gov. Shumlin decided against presenting a financing plan for a universal health care system to the Legislature. Practically speaking, the numbers were unfavorable. Politically speaking, the Legislature’s mood was unfavorable.
Those of us who have long advocated for a publicly financed single payer universal health care system – often referred to somewhat inaccurately as a single payer system — and who attended the governor’s announcement did not hear him say the word “never,” or that Act 48 – the enabling law passed three years ago by many of the same legislators – is dead.
It will be interpreted that way. Funeral orations are being declaimed all over the state, and nation. But are they right? We think not for at least three reasons.
The first one is: high-quality, affordable health care for all (not just some) Vermonters depends entirely on a system of health care services that are financed by money collected from the public and managed in the public’s name. Opponents of this idea – and there are many from the purely self-interested to the ideologically motivated – can offer no workable alternative. Nearly every other country in the world does it this way, not in far-fetched theory but in practice. And it costs them about half of what it costs us and they generally get better health outcomes than we do.
So, to continue the first reason: For more than 30 years Vermont Legislatures have pursued the moral principle of high-quality, affordable health care for all (not just some) Vermonters without getting there. They’ve tried almost everything, under the guise of “coverage,” and still haven’t made it. Perfectly reasonable expectations tell us that eventually costs will compel adoption of a publicly financed system, or we will experience the slow-motion collapse of our health care services.
Gov. Shumlin is probably right. The Vermont road to a fully developed universal health care system is likely too steep at this time.
The second reason is that Act 48, the legislated road map to a universal health care system, is not dead. It’s been working feverishly for three years. It’s done this mainly in the form of the Green Mountain Care Board (GMCB). Never heard of it? That’s not surprising either. The board is charged with starting payment reform projects, regulating hospital budgets and evaluating any such steps taken in health care. There’s much more and I’d suggest readers check the GMCB website www.gmcboard.vermont.gov.
The board has five members, a staff and advisory panels. You may think its work is deliberately invisible, but it isn’t. Its work is conducted transparently. Anyone can attend and comment at its meetings, usually four times a month, mostly but not entirely in Montpelier. Supporting and contrary opinions are welcomed. For those interested it is a very good way to learn about the problems besetting health care in Vermont and about the variety of solutions offered.
The third reason is that there are what could be called phase-in steps towards Act 48’s universal health care system. These are steps that reflect exactly the indispensable features of a universal health care system, but on a smaller scale. They would be publicly financed, they would provide health care to all Vermonters, they would operate under publicly scrutinized budgets. These are not to be confused with stop-gap measures to expand “coverage.” Legislatures are fond of the latter, but such measures have a 25-year record of falling short. There are good theoretical and practical reasons why.
Anyway, one of the phase-in steps would be to publicly finance primary care for all Vermonters. This could be done for about one-eighth (about 12 percent) of the money that has spooked legislators going into January’s new session. Primary care is where good health care starts. Primary care is a proven way to control and lower subsequent costs.
A second similar, except larger, phase-in step would be to publicly-finance Vermont’s hospitals. The price tag – meaning taxes – would be much larger. But so would the benefits.
A good guess is that the Legislature’s willingness is probably inversely proportional to the size of the price tag, so a primary-care phase-in step would allow them to sleep at night and allow them to claim to have done something really useful for every Vermonter.
Gov. Shumlin is probably right. The Vermont road to a fully developed universal health care system is likely too steep at this time. Still, we advocates for a publicly financed health care system are convinced the road has no realistic off-ramps. “Off-ramps” is a term legislators with the jitters use when they believe there is a way to get out of doing what has to be done.
It’s our belief that what has to be done hasn’t changed, nor will it change. At some future point circumstances will compel the right choice.
