What happened to Sabra Ewing, could have happened, as she put it, to anyone. She had a high deductible ($20,000) health insurance plan for her family. For years, doctors had told Ewing she was healthy, and she stopped going in for annual checkups to avoid the expense. Then one day she found a dark spot on the side of her heel. It took her three weeks to get an appointment with a dermatologist. By the time Ewing was diagnosed, she had stage three melanoma.
Ewing, of Vershire, said if she had kept up with regular checkups it’s likely the spot would have been detected early and her cancer would have been more readily curable. As it stands now, she said she is receiving treatment from top experts.
“I may not survive,” Ewing said. “I’m not thinking about cost containment. I’m thinking about my 19-month-old grandchild.
Cost containment has become one of Heather Lochlin’s main preoccupations – but not by choice. Lochlin, of Ludlow, who is insured by BlueCross BlueShield of Vermont through Catamount Health, says she has been denied coverage “every step of the way.” Though she has been fully insured throughout her illness, she said there has been “repeated systemic pressure” to limit her care through loopholes in the guidelines and vague information about coverage.
“Denials shouldn’t be based on cost-cutting,” Lochlin said. “The idea that any of us has insurance is a mirage.”
Lochlin and Ewing were two of the more than 70 Vermonters who spoke at a public hearing about H.202, the health care reform bill that would fundamentally alter the existing system, which is now based on a commercial insurance system and fee-for-service reimbursements to doctors and hospitals. Under H.202, the state would be the first in the nation to attempt a conversion to a single payer health care system in which state government would manage the provider payment system and essentially cut commercial insurers out of the loop. All Vermonters, regardless of pre-existing conditions or ability to pay would be covered under the plan.
Advocates for H.202 outnumbered opponents 4-to-1 in the virtual hearing via Vermont Interactive Television at 15 locations around the state. About 70 Vermonters spoke; many more watched the proceedings.
Lawmakers from the Senate and House health care committees attended most of the regional meetings. The hearing was held as a precursor to sure movement on H.202; the bill is slated to be voted out of committee this week.
In two-minute blocks of time, participants shared war stories about run-ins with the insurance industry, opined about the inefficiencies and “inhumanity” of the existing system or expressed reservations about the financial cost of a single payer health care plan.
Battle lines were drawn from the beginning: Advocates and citizens involved with the Vermont Workers’ Center’s Health Care is a Human Right campaign packed the Montpelier VIT site, wearing red T-shirts and the by-now familiar campaign buttons, which feature Rosie the Riveter. About 14 people in the anti-single payer camp spoke up.
The single-payer proponents sounded familiar themes: They called for equitable, universal coverage and an end to medical industry profits at the expense of human health.
A young woman named Rebecca from Johnson told the audience that her brother was in a bicycle accident last year in Winooski and injured both legs, knees and arms. He couldn’t move his legs at first, she said, but he refused to go to the hospital because he didn’t have health insurance. A year later, his pain hasn’t dissipated.
“Insurance companies must get out of the way,” Rebecca said. “People don’t need the middle man. If my brother had health insurance, he wouldn’t be feeling pain he’s feeling today. Make health care affordable to everyone so we can all get the health care we need.”
Many of the speakers talked about the rising cost of health care—even for people who have insurance. Several participants said they had gone without coverage at one point or another.
Detractors questioned the quality of a health care system that would be based on a uniform payment system. Several doctors expressed concern about the impact of low Medicaid reimbursements – should the administration of Peter Shumlin succeed in folding the Catamount Health Plan into the Vermont Health Access Plan.
Patricia Leahy Meriam said specialty doctors are afraid they will lose income if they stay in Vermont and they’re looking at “exit strategies.” She warned that special treatment of diseases will be harder to access in the new system because it will place too much emphasis on primary care physicians – at the expense of specialty docs.
Dianna Scholl, a hospital chaplain at Porter Medical Center in Middlebury, said health care workers are put in an immoral and unethical position because of the inequities of the system.
“The problem is the current system doesn’t cover everyone equally at a price we can afford,” Scholl said. “I have seen people with Cadillac insurance get the care they need. The private pay folks and (people with) limited insurance are not able to get care they need. It’s a very basic inequity that is hard to deal with.”
Scholl said she has seen insurance companies override physician’s treatment recommendations. “It was all about the money, it had nothing to do (with whether) we had the right equipment or drugs. It was just about the money. How can we provide compassionate care when we are sending people away or because people don’t have the deductibe or copays.”