Julie Wasserman: The questions that matter in health care reform

This commentary is by Julie Wasserman, MPH, of Burlington, a health policy consultant working independently. She worked for Vermont state government for over 25 years, including division director of policy and planning for the Department of Aging and Disabilities, and legislative staff to the Senate Health and Welfare Committee. She participated in Vermont’s three-year state innovation models initiative, the precursor to the all-payer model.

The debate over Vermont’s current health care reform effort needs to be reframed. While it is easy to focus on growth rates, quality metrics and payment mechanisms to determine whether Vermont’s reforms are working, we will ultimately miss the mark if we do not address the questions that matter. 

Policymakers, regulators and state officials should be asking these questions and tackling these fundamental concerns:

  • Can average Vermonters afford health insurance?
  • Can average Vermonters afford their co-pays and deductibles?
  • Can older Vermonters afford their medications?
  • Do Vermonters delay care due to the cost?
  • Is primary care readily accessible?
  • Can Vermonters get the care they need?
  • How long must Vermonters wait to receive care or see a specialist, even for urgent needs? (The Seven Days publisher thinks the wait is far too long, as do others.)
  • Can the causes of any reductions in health care spending be identified? If so, can they be maximized?
  • What portion of school budget increases are attributable to the rising cost of health care?
  • How can we account for the notable uptick in “actual growth” starting in 2018 when the all-payer accountable care organization model began? (See graph below.)
Chart by Kevin Mullin, chair, Green Mountain Care Board 
Health care reform efforts ‘probably’ have been successful.”

Until we can answer these questions in a positive way, and ensure we are actually helping Vermonters, we cannot claim that our health care reform efforts are successful. These are the measures that matter.


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