Comments Submitted to Health Care Reform Commission About Design Consultant

Today the policy committee for the Healthcare is a Human Right campaign submitted the following comments to the Healthcare Reform Commission for the members' consideration as they choose the consultant to design Vermont's new healthcare system:

1. Thank you for serving on Vermont's healthcare reform commission. As you know, Act 128 requires you to recommend one or more consultants to design a new healthcare system for Vermont. This work is of historical importance, and Vermonters are relying on you to choose wisely.

2. Vermonters have a dream. We dream of a Vermont where everyone gets the healthcare they need. In our dream, healthcare is woven into our communities and financed fairly and sustainably. In the healthcare future we see, healthcare administration is transparent and accountable to people, and people participate in the design and management of the system. We know you share our dream, because you incorporated these principles into Act 128.

3. Before you make your choice of a consultant to design Vermont's new healthcare system, we wish to remind you of the human-rights principles upon which Act 128 is based.

Universality is the principle that human rights must be afforded to everyone, without exception. It is by virtue of being human, alone, that every person is entitled to human rights.

Equity is the principle that every person is entitled to the same ability to enjoy human rights. Healthcare resources and services must be distributed and accessed according to people’s needs, not according to payment, privilege or any other factor. Disparities and discrimination in healthcare must be eliminated, as must any barriers resulting from policies or practices.

Accountability is the principle that mechanisms must exist to enable enforcement of human rights. It is not enough merely to recognize human rights. There must be means of holding the government accountable for failing to meet human rights standards.

Transparency is the principle that government must be open with regard to information and decision-making processes. People must be able to know how public institutions needed to protect human rights are managed and run.

Participation is the principle that government must engage people and support their participation in decisions about how their human rights are ensured.

In other words:
Every person is entitled to comprehensive, quality healthcare.
Systemic barriers must not prevent people from accessing necessary healthcare.
The cost of financing the healthcare system must be shared fairly.
The healthcare system must be transparent in design, efficient in operation and accountable to the people it serves.
As a human right, a healthcare system that satisfies these principles is the responsibility of government to ensure.

4. We urge you to keep these principles in mind as you choose a consultant. Be sure you are confident that the consultant you choose is capable of and willing to design a healthcare system that both satisfies and embodies the principles and goals of Act 128.

5. We also urge you to respect conscientiously Act 128's requirement that the consultant "have demonstrated experience in designing health care systems that have expanded coverage and contained costs." This requirement mandates not just experience designing a healthcare system in the abstract — as a study or academic exercise — but experience designing a system that has been successfully implemented. It is not a theoretical but an actual system that the law requires of the consultant, a system which has actually expanded coverage and contained costs.

6. Please note that the original evaluation criteria that the Commission published on its web site ( use the word "expertise" instead of "experience" in the initial, mandatory criterion. This substitution significantly misrepresents (by misquoting) the actual requirement of Act 128. You must use the experience standard called for in Act 128, not an "expertise" standard, in deciding whether this mandatory criterion is satisfied, when you evaluate each candidate.

Thanks for your attention.

David Kreindler, for the Healthcare Is a Human Right Campaign
Vermont Workers' Center