Editor’s note: This commentary is by Ted Cody, MD, a retired physician and hospitalist who formerly worked at Springfield Hospital.
As someone who has practiced both primary care and hospital medicine in this state for more than 30 years, I have to disagree with lieutenant governor candidate Meg Hansen’s commentary.
The health care landscape in Vermont must look very different from the clinical front lines than it does from her libertarian think tank. As much as I’d like to, I can’t blame OneCare, nor the Green Mountain Care Board, for our state’s shortage of hospital beds in the face of COVID-19. Every other state in the country is scrambling for pandemic hospital capacity, to say nothing of PPE, as desperately as is Vermont.
Bed numbers in Vermont are limited by the economy, not by government regulations. We have an uneven distribution of hospital beds because we ration according to people’s ability to afford care, not by excessive regulation. Rural communities are barely able to afford the limited hospital capacity they have, witness the bankruptcy of Springfield Hospital and the red ink at over half of the small hospitals in Vermont. Lacking large numbers of employed, insured workers, small hospitals would long ago have disappeared without government assistance from the federal “Critical Access Hospital” designation, to say nothing of Medicare and Medicaid. Though they might lack the income to support their local hospital, towns still need a place to get care. Raw libertarian economics make no more sense distributing health care than it would for allotting fire departments. We need more state and national support and coordination, not less.
If Hansen’s concern with Vermont’s excessive medical regulation had any truth, our bed situation would be worse than in the rest of the country. That is obviously not the case. Indeed, it is the free market idea of “just in time” efficiency that has limited our surge capacity in this pandemic. The notion that hospitals, MRIs, and surgi-centers would blossom all over Vermont if unregulated is absurd. Facilities are unsupportable in towns where people cannot afford them.
To our national shame, what our system does do is to efficiently ration health care by ability to pay. In the context of the current plague, our system has made even those families with employer health insurance think twice about seeking care — immigrants or young, uninsured families even more so. You might consider that those forced to keep working can only perpetuate COVID-19 in our communities.
Though it may smack of excessive regulation, I am thankful that government has stepped in and prevented insurance companies from charging out of pocket for SARS-COV2 testing. For once, our leaders have begun to see the value of promoting the health of all of us, as opposed to that of individuals or corporations.
While it is true that the government-regulated single payer health systems of Europe have also run out of hospital beds, citizens there will not be faced with bankruptcy when discharged from their three-week-long COVID ICU stays. We must certainly worry about that in this country and I suspect that the sick will come to love their private insurance somewhat less when they get the bills. I for one appreciate our state’s efforts at limiting the abuses of unregulated libertarianism and hope that our country as a whole will begin to see the advantage of health care for all.
