This commentary is by Jessica Early of Burlington, who is a registered working nurse and family nurse practitioner. She is also a health care justice organizer for Rights & Democracy, a grassroots organization working to build strong communities grounded in health care, economic and environmental justice in Vermont and New Hampshire.Mike Smith’s June 11 VTDigger piece “Does Anyone Know Where We’re Headed on Health Care?” highlights some serious issues in Vermont’s current health care system as well as raises some important questions about its future. Unfortunately, Smith does not identify the root cause of Vermont’s health care woes, nor does he name the most significant threat to our future.
In Vermont, as in every state in our country, our “health care system” is not a system of health care at all. Instead it is a dizzyingly complex patchwork of profiteering private insurers, who market medical services as a commodity to increase their own bottom line and underfund public payers. This lack of any real “system” is the root cause of both our inability to control costs and ensure access to care for all Vermonters.
In this medical marketplace, high quality health care — the desired goal of patients and the nurses, doctors and other health care professionals, like myself, who care for them — is not the priority. It is this failure to actually prioritize the health and well-being of patients and their families and communities that has mired us in the challenges and crises Smith describes. Vermonters will continue to face lack of access, poor health outcomes, and rising health care costs until we build a true “system” in which health care is available to all people as a fundamental human right and public good.
Smith also fails to mention the dark cloud over health reform looming in the form of current efforts by Republicans in Washington to pass the American Health Care Act (AHCA). From what we can glean from the most recent media reports and Congressional Budget Office analysis of the House bill, the Senate proposal — concocted by an all-male group of senators without any public hearings — will reverse key protections gained under the Affordable Care Act, roll back the Medicaid expansion, reduce federal Medicaid funding by roughly 25 percent and result in nearly 23 million Americans losing coverage. If President Trump wins passage of his budget, another $600 billion will be cut from Medicaid over the next 10 years. If the AHCA is passed by the GOP Congress and signed by the president, thousands of Vermonters will lose coverage.
Medicaid is the program that funds the majority of long-term nursing home care for older adults, pays for nearly half of all births and covers most of the medical services for people with disabilities. In Vermont, Medicaid covers 206,000 residents, including 49 percent of Vermont children. Faced with the federal cuts, our state would need to raise an additional $2 billion over the next 10 years to maintain our current levels of health coverage. If our state can’t make up for this federal shortfall, tens of thousands of Vermonters risk losing access to care. Funding for mental health services, which Smith points out are already inadequate, as well as addiction treatment to address our opiate epidemic would be slashed.
Building a real health care system may seem like a monumental task. Yet, while it may not be easy (largely because it involves dismantling many of the perverse incentives and structures created by a for-profit health care industry), in Vermont, we are well-positioned to get this construction job underway. Although given short shrift in Smith’s analysis, we already have a blueprint; we already have the foundation laid. We have Act 48 — a current law in Vermont — which commits us to equitably and publicly financed universal health care.
Vermonters will continue to face lack of access, poor health outcomes, and rising health care costs until we build a true “system” in which health care is available to all people as a fundamental human right and public good.
While Smith correctly states that most of our elected leaders have not articulated a clear vision for our health care future, Vermonters have long known what they need and want in a health care system. They knew it when they supported the 2011 passage of Act 48 in overwhelming numbers, and they still know it today as they continue to demand health care as a human right for all.
And for many of these Vermonters patience is not just “beginning to wane.” Instead, and with tragic consequences, time has already run out. Lack of insurance, underinsurance, high premiums, co-payments, deductibles, and drug prices have already compromised, and for some prematurely ended, the lives of Vermonters. As a nurse working with a largely Medicaid and Medicare population living in subsidized housing, I have seen patients eschew needed preventative care or symptomatic and curative treatments because of inability to pay or as a result of limited access to underfunded, short-staffed services, especially in home care and mental health. As a health care organizer, I have heard countless similar stories.
These stories will only multiply if the Republicans at the federal level succeed in passing their version of the GOP House’s American Health Care Act, which Mitch McConnell promises to do before the end of this month.
Vermonters don’t have any more patience and, with the Republican assault on health care at the federal level coupled with the problems in our state Smith articulates, we can no longer afford to wait for reform. Instead, the time is now for Gov. Phil Scott and all our elected officials to publicly and meaningfully take a stand against the Republican Congress’ disastrous plan and start building the system laid out in Act 48.
No Vermonter — no human being — should ever have to forgo the health care they need, when and where they need it. We can do better, and we have the popular mandate and legislation to do so. It’s the responsibility of Gov. Scott and the Statehouse to join us and, if they choose not too, then it’s our responsibility in 2018 to vote in new leadership who will.