Editor’s note: This commentary is by Brendan Tang, a cook living and working in Brattleboro. He is also a member of the Vermont Worker’s Center.
[O]n Tuesday some members of the Vermont Senate proposed to drastically change S.53, the bill which many hope would establish a publicly financed universal primary care system in Vermont, effectively making preventive care such as routine checkups free at the point of service.
The Appropriations Committee proposed changing the title from “An act relating to a universal, publicly financed primary care system” to “An act relating to recommendations for achieving universal coverage for primary care in Vermont,” reflecting changes proposed by the Health and Welfare Committee that would essentially change S.53 from a bill to enact universal primary care to a bill to consider universal primary care.
Most significant among the Health and Welfare Committee’s proposed changes is the removal of a mandate to draft legislation to finance the system by the first day of 2019, which is replaced by a plan to develop a “draft operational model” by that time which would outline how a universal primary care system would work. The Green Mountain Care Board would “convene, facilitate, and supervise the participation of certified accountable care organizations, Bi-State Primary Care, and other interested stakeholders” to draft this model. In other words, the only parties specifically invited to the table are the industry health care providers who have a vested interest in making sure health care stays expensive. (One of the main benefits of any “universal” coverage system is that a single payer such as the state has better negotiating powers than multiple payers — private insurance companies — competing against each other, and can therefore drive down the cost of health care. Hospital CEOs and other industry leaders have an interest in seeing universal and quasi-universal health care fail for this very reason.)
The proposed changes would also add a section which pushes the date of implementation back to 2022, three years later than the original bill’s timeline. More importantly, this section includes seven different conditions which the plan for a universal primary care system would have to meet to be implemented at all, giving the administration a wide berth to nix the project altogether. Most worrying among these conditions are the first three, which mandate that the plan “will not increase the administrative burden on primary care providers,” “will provide reimbursement amounts for primary care services that are sufficient to attract an adequate number of primary care providers to participate,” and “has appropriate financing in place to support the covered services while ensuring the continued solvency of the program.” In other words, any concern that the plan would require too much paperwork, cut into a provider’s bottom line, or strain the state budget would be enough to stop universal primary care from ever seeing the light of day.
To recap, S.53 as introduced was already an unambitious bill which would at best set the intention to establish a universal primary care system in Vermont by 2019 and require the state to draft separate legislation on how to finance it. With the proposed changes, in that same timeline we would only have a report on what such a system could look like, heavily influenced if not directly authored by those in the industry most interested in its failure, with a whole slew of escape valves to make sure it is never implemented.
Vermonters are already entitled to a publicly financed, universal, single-payer health care system — fully covering not just checkups but surgery and hospital stays among other services — by law under Act 48. Former Go. Peter Shumlin pulled the plug on implementing the system in 2013 even though the law was already passed (in fact it was the platform he campaigned on). Although universal primary care would be a strict downgrade from the universal single payer health care system to which Vermonters are already entitled, many Vermonters hope universal primary care could be a stepping stone toward single payer. Perhaps it’s a small concession to those Vermonters that the Health and Welfare Committee added an explicit reference to Act 48 in their proposed changes, stating the intent to “use universal primary care as a platform for a tiered approach to achieving universal healthcare coverage.” Yet the committee’s other proposed changes to the bill would water it down, push it back, and give it plenty of room to fail altogether. Tying the struggle for a truly universal and comprehensive single payer system to such a feeble, diluted effort at universal primary care is a distraction at best. If Tuesday’s proposed ammendments are made to S.53, then the predictable failure of that universal primary care bill can not be allowed to drag the more ambitious struggle for single payer down with it.
