Editor’s note: This op-ed is by Ellen Oxfeld, a member of the boards of the single payer advocacy groups Vermont Health Care for All and Vermont Leads. She lives in Middlebury.
[T]wo new bills (H.207 and S.88) have been introduced with tri-partisan co-sponsorship (Democrat, Republican and Progressive in the House version). They hold the promise of getting Vermont back on track in creating a system where health care is a public good for all Vermonters. They do so by starting at the ground floor in a place that has an impact on all of us – primary care. Primary care is where most of us get most of our care, most of the time. These bills would set up publicly financed, free at point of service, primary care for all Vermonters starting in 2017.
Why should we Vermonters support these proposals? Numerous studies show that primary care is the key medical service in improving population health as a whole and in lowering costs. It makes sense that broad based access to primary care can save money and improve health, for undeterred access to primary care will get people into treatment before their problems are serious, thus reducing their chances of experiencing lengthy hospitalizations or emergency room visits.
But what would this cost? Primary care, though incredibly important to public health, is relatively inexpensive. So, considering and passing this bill would not be a daunting first step for our Legislature to take in keeping Vermont on the road to universal health care. Since primary care is not a large percentage of total health care costs, yearly costs for such a program would be roughly $160 million, or the equivalent of 1.22 percent payroll tax (though it certainly need not be financed by a payroll tax). Furthermore, since state regulations do not allow insurers to reflect charges for services that they do not pay out for, our private insurance rates would need to reflect this change as well. This way we would not be paying double.
H.207/S.88 would help to keep us on the road laid out in that groundbreaking legislation. Instead of creating the entire system at once, though, these bills start out with one sector of care – a sector that all of us need and use.
Since Gov. Shumlin’s announcement that he would not put forward to the Legislature a financing plan for a comprehensive single payer plan this year, there has been much commentary and questioning about Vermont’s road to the vision articulated in Act 48 – that health care should be a universal public good. However, H.207/S.88 would help to keep us on the road laid out in that groundbreaking legislation. Instead of creating the entire system at once, though, these bills start out with one sector of care – a sector that all of us need and use.
If considered by the Legislature and ultimately passed into law, publicly funded primary care would not only make access to primary care universal in our state, but it will also help build the mechanisms upon which a broader based publicly financed system might eventually be organized. Many other publicly financed systems have followed a similar chronology, starting with one sector of care and then adding others (our own Medicare, for instance, began with hospital care).
In short, we should support the initiative to make primary care a public good in Vermont. It is a very positive step in improving health care access and quality, and containing costs, the key ingredients needed for any successful health care system if it is to truly serve all of us.
