Commentary

Jessica Early: Vermont health care lacks a system

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.


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  • Robert Ronald Holland

    Ms. early has certainly penned a fine commentary. Her diagnosis is sound. I would differ with her implied treatment. When you frame the argument at the system level you imply that a legislative change of the system, for example to a single payor system, is the cure. We tried that and it failed. The editorial board of the New England Journal of Medicine placed the responsibility for the failure in the hands of Governor Shumlin. I would disagree with them. I think such a massive change in essentially 1/5 of the US (or Vermont’s) economy is impossible to pull off. (Try turning the Titantic to miss the iceberg.) Rather than a revolution in the health care system, we must think about an evolution in health care decision making. If we can incrementally move in the direction of decisions that are focused on the patient and crafted to provide effective, efficient, timely and safe health care, then over the course of a decade or two we end up in at a far different place than where we are headed. Of course with our cultural impatience and “day trader” approach to public policy such a strategy requires consistent leadership. Look around – do you see any competent health care leadership?

  • Jerry Kilcourse

    Dental care is health care….it should not be considered as an afterthought or a separate category.

  • Craig Powers

    “We have the popular mandate and legislation to do so…”.

    Been there…done that! Single payer/publicly funded health care at the State level, was proven to be completely financially unsustainable in VT during the Shumlin administration. Still, organizations like Rights & Democracy and the Vermont Worker’s Center demand that we go down that road without offering ANY solutions that make it affordable, except for their core constituents.

    • walter carpenter

      “Single payer/publicly funded health care at the State level, was proven to be completely financially unsustainable in VT during the Shumlin administration.”

      I respectfully disagree as I think the expense of it was estimated to be greater by Shumlin than it really was for purposes other than single-payer.

  • Keith Stern

    When a hospital administrator makes hundreds of thousands more than the governor of a state there is a problem. Both have a staff behind them and a board (legislature.) It is just one piece of a puzzle that needs to be solved.

  • walter carpenter

    “Vermont taxpayers cannot afford this.”

    We are already paying more than a single-payer plan would cost @ some 6 billion a year or close to it and we still have thousands of uninsured or underinsured. This is without the atrocious deductibles factored in. If you substituted a single-payer system that did not have to deal with private insurance admin costs, the huge CEO salaries, the deductibles gone, and so on we could afford it easily enough.

  • walter carpenter

    “Learn not to expect or want the impossible.”

    Having lived in a single-payer nation before, where every citizen was covered through a national health plan that they paid into, I fail to see why preventing the premature deaths of 45,000 of our citizens because of lack of access to health care due to no insurance and high costs is impossible.

  • rosemariejackowski

    TEETH is a new book, just published. Every legislator in Vermont needs to read it. We need dental care for all. We need to change dental care from just a business to an essential part of health care.

    Please see

    http://www.truthdig.com/arts_culture/item/teeth_20170616

  • Jerry Kilcourse

    Yes Ellen…Universal Primary Care makes so much sense on so many levels at at a tiny fraction of our overall heath care costs, it should be a no brainer! Any opposition to this bill, redefines the old cliche. “penny wise and pound foolish.”

    i.e. one example; Too many of us use the emergency room as a substitute family doctor.

  • rosemariejackowski

    We need transparency in the system. Why is Dr Conroy’s annual compensation being kept secret? She is CEO of Dartmouth Hitchcock.
    If too much money is spent on administration, there is too little left for direct patient care.

  • JohnGreenberg

    No, it’s about .01%, assuming a population of 350 million.

    One is too many.

  • JohnGreenberg

    What does utopia have to do with your poor arithmetic?

    As to your other contention, it’s false: “Uninsurance is associated with mortality. The strength of that
    association appears similar to that from a study that evaluated data
    from the mid-1980s, despite changes in medical therapeutics and the
    demography of the uninsured since that time. … Numerous investigators have found an association between uninsurance and death” The authors were concerned that these studies were based on old data, so they re-examined the issue. In doing so, they controlled for “race/ethnicity, income, education, self- and physician-rated health
    status, body mass index, leisure exercise, smoking, and regular alcohol
    use.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775760/

    Facts matter.

    • Edward Letourneau

      Face facts: we are not going to nationalize heath care in the US and make it non-profit — and that is what is needed for the cradle to grave care that are wishing for. And frankly, why should others be paying the bill for people that abuse themselves? Now, there is care for people medical problems that are beyond their control, but your personal wellness is up to you. If you die early because you smoke, drink, use drugs, jump off cliffs, stick you had in fan blades to see if you can stop them, etc. the bill ought to belong to you. Not other people.

      And here in Vermont, we have 1/3 of the population on free medical care and the Congress is saying enough. When the state starts sending you the bill in higher taxes to pay for them, you will have a different view of what they ought to be entitled to.

  • Edward Letourneau

    Those countries run non-profit heath care systems. It is socialized medicine. And before you object, face facts: One we are not going to nationalize heath care in the US, and two, “The problem with socialism is that you eventually run out of other people’s money.” – Margaret Thatcher