We Testify on the Senate Health Care Reform "Outline"

I testified on behalf of the campaign today based on the following testimony prepared by the policy committee.

Vermont Workers' Center's Healthcare is a Human Right Campaign
Senate Health & Welfare Committee Testimony February 18, 2010

I want to start by thanking this committee for taking seriously the need for significant and radical health care reform. We applaud your efforts and remain willing to help you in any way we can. And thank you for the opportunity to speak to you today.

As you know from our earlier testimony before you, the Healthcare is a Human Right Campaign evaluates legislation by applying the human-rights principles of universality, equity, accountability, transparency and participation. We defined these principles in our earlier testimony, which can be used as a resource to help you apply the principles.

The Health Care Reform bill draft outline offers just an outline and a list of options. For that reason it is difficult to comment without knowing the details of specific proposals. Nevertheless, we offer the following comments, to point out significant areas of omission and to offer a different focus.

The draft outline promises much less than the people of Vermont need and much less than the legislature can do this year. In approaching reform, we must treat healthcare as a human right, not merely as a expensive commodity.

Any action taken this year must be a step in the direction of comprehensive reform and not just a stop gap measure. In converting our non-system of healthcare into a true system, we must use an approach that is comprehensive, not merely dealing with containing costs. Universality, equity and the other goals of our efforts cannot be viewed simply as possible side effects but must be treated as goals that are addressed directly.

While attempting to control healthcare costs is undoubtedly a necessary step in achieving an equitable and universal healthcare system, in attempting to control costs, we must look at all cost drivers. Targeting providers and payers alone is insufficient. Comprehensive reform must take into account suppliers of drugs and medical equipment as well as patients themselves.

Any healthcare reform bill that hopes to really get at the costs and alleviate the existing problems with our system must have as a primary goal the provision of healthcare to everyone. We do not believe this goal can be separated from the reform this committee works on. For example, one item on the outline calls for a report on how much money needs to be raised, how it would be raised, and how this would impact existing payers. Wouldn't it be necessary to first determine who would be included and what types of healthcare would be provided? As you know, the HcisHR campaign calls for a comprehensive benefit package for all Vermonters and equity in the provision of care. In addition, we call for equity in the healthcare financing system. These goals should be the basis for the questions to be answered in this report.

While we understand that healthcare systems can be complex, there have been a number of studies to date that provide much if not all of the information needed to assess costs. The Thorpe study and the Lewin Group study are two studies commissioned specifically for this legislature. The Healthcare is a Human Right campaign urges you to design and implement a system in legislation this year. We should provide our goals and values to the designers or architects; we must not merely ask them for more proposals.

The first steps in implementing healthcare as a human right could include consolidating all State of Vermont run or paid for programs including VHAP, Medicaid, Dr. Dynasaur and, Catamount.

Perpetuation of the insurance model for providing healthcare will only perpetuate existing cost and access problems. The House Healthcare Committee just received a draft report on Catamount administrative costs that shows per member per month administrative costs that are approximately 3 to 4 times the administrative costs for the Medicaid program. Government run healthcare programs are preferable not only because they are much more cost-effective, leaving more funding for actual healthcare, but also because they are accountable to the people they serve, which insurance companies are not.

Accountability would be provided through regional planning systems the outline proposes. As with eliminating or minimizing administrative costs, good healthcare planning can free up funding to provide more care for people.

We believe any group or process coming out of this bill should include consumer and labor representatives. Section I.a. includes regulators, hospitals, providers and insurance plans in finding cost savings, but not consumers and workers. Likewise, the panel overseeing the process to determine a financing plan should include consumers and workers. Any process that seeks to achieve true accountability will need to include consumers and workers.

In conclusion, we believe this outline needs more to provide meaningful healthcare reform – reform that recognizes and implements the human right to healthcare. We refer you to the testimony given to this committee and the House Healthcare Committee on January 29, 2010. We welcome any opportunity to address specific proposals as this committee continues to work on this bill and remain willing to provide you any information or support you need to make healthcare a human right in Vermont.

We'll offer again the set of questions, from our earlier testimony, that we use to guide our human rights analysis of any bill, and which we urge you to use as you evaluate your work on this committee bill.

Thank you.

QUESTIONS for evaluating a healthcare bill by human rights standards:

• Does the system provide healthcare to all? Or are some groups of people excluded, as if they are not entitled to a human right?

• Does the system provide equal access to comprehensive healthcare services? Or does it separate people into different tiers of access or coverage, thus producing inequities, increasing administrative costs and weakening the system itself?

• Does the system treat healthcare as a public good? Or does the system treat healthcare as a source of profit for powerful vested interests?

• Does the system eliminate barriers to use of needed healthcare services? Or do “co-payments” and other out-of pocket costs discourage people from accessing the care that they need?

• Is the system financed equitably? Or do people pay for healthcare based on conditions that are unrelated to their ability to pay, such as age, health status, gender or employment status?

• Does the system use money effectively and efficiently? Or do numerous “payers” with numerous administrative systems introduce unnecessary costs that add nothing to the quality of the healthcare provided?

• Does the system allocate resources equitably, according to health needs? Or are some communities better served than others?

• Does the system improve the quality of healthcare, by rewarding providers who utilize best practices and provide excellent outcomes? Or does the system simply pay providers for performing medical procedures?

• Does the system enable meaningful community participation? Or are decisions made far from the people affected by the decisions that are made?

• Is the system accountable to the people it serves? Or is it complex, mysterious and impervious to influence?