Rutland Herald Editorial: "Douglas, do no harm"
Vermont can make significant progress on health care next year as long as Gov. James Douglas allows efforts initiated this year to move forward. In 2011, he will no longer be governor, and it would be a serious disappointment if he were to cast his shadow forward into next year by vetoing the health care bill passed by the Legislature this year.
The health care bill that emerged from the Legislature calls for a study to develop new health care options in Vermont to extend access, control cost and improve quality. Douglas has suggested that another study of health care would be a waste of money, but that would be true only if the health care system was working.
It's not working. Costs continue to escalate, creating enormous burdens on household budgets and on businesses. The state has made progress in providing options for people, such as Catamount Health and programs to cover children's health. But the combination of high cost and lack of access still stands in the way of good health for too many people.
If Douglas signs the health care bill, or at least allows it to become law, Vermont would launch a new study to outline at least three possible reform options, including a single-payer system and some sort of public option for health care. One of the world's leading experts on health care reform testified before the Legislature this year and is a leading candidate to become the consultant hired by the state to develop these options.
He is William Hsiao, an economics professor at Harvard's Department of Health Policy and Management. He is a world leader in the study of health care systems and the reforms needed to expand access and contain costs. He has helped the governments of Taiwan, Mexico, Cyprus, Colombia, China and Sweden to improve their systems.
Passivity is always an option. The passage of federal health care legislation means that, gradually, greater access will be available as people are required to buy coverage and insurers are no longer allowed to deny it.
But the cost-containment mechanisms in the federal law will be slow to take effect, and mandating that people buy insurance does not solve the problem of high insurance costs. The federal system will create subsidies to help people afford coverage, but Americans will be saddled with the same system, dominated by insurance companies and a costly fee-for-service payment system, until more fundamental reform occurs.
That's why there is still a role for states to do the pioneering work of developing more efficient and effective systems. It is likely that the Obama administration, even after passage of the new health care law, would welcome experimentation by the states to take reform even further. It would be a complicated endeavor for a state to develop its own single-payer system, or the kind of public option that advocates were pushing for the federal system, but cooperation from the federal government could help make it happen.
The success of the Legislature in passing its health care bill this year is due in large part to the extraordinary grass-roots campaign spearheaded by the Vermont Workers' Center. This year the "Health Care Is a Human Right" campaign coordinated by the center became the kind of effective effort at grass-roots organizing and political activism we have seen before with the campaign for marriage equality. The campaign created a mandate that legislators employed to take a step closer to comprehensive health care reform.
Like the campaign for marriage equality, the health care campaign put a human face on injustice. The injustice in this instance occurs when a wealthy nation organizes its health care system in a way so perverse that millions of people suffer from lack of adequate care.
The campaign has created momentum on health care not seen before. Previously, health care has been the arena for policy experts, government officials, insurers and others familiar with a topic so arcane and complex that inaction becomes easy. The "Health Care Is a Human Right" campaign introduced the human element by putting forward a simple proposition about justice. When the injustice of the present system is established in people's minds, inaction becomes more difficult.
As he leaves office, Douglas must not put himself in the way of this momentum. Vermont can become a laboratory for progress on health care that will serve as a model to the nation. Douglas ought to let it happen.
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