We were asked to testify in the Vermont House of Representatives Committee on Healthcare today. Here is the text. Let's keep organizing!
Healthcare Is A Human Right Campaign
Testimony to House Committee on Healthcare
January 15, 2013
Thank you. My name is James Haslam, I am the Executive Director of the Vermont Workers’ Center. The VWC was started in 1998 and launched the Healthcare Is A Human Right Campaign in 2008 to change what was politically possible and establish a universal healthcare system.
As you know, it is easy to get down into the weeds of the healthcare system, and you will have to do that during the coming session. But while we have the brief opportunity right now to look clearly at the big picture, I ask that you apply a couple of paradigm shifts to the way you think about our healthcare system. What we have to do, to move forward in making a healthcare system that embodies the human rights principles established in law by Act 48, is to let go of some of the baggage that has accumulated over the more than six decades of a healthcare system based largely on employer-provided, market-based health insurance.
We understand that, in the short-term, the ACA forces private insurance onto even more of us than ever, and many folks see this transition phase as a step backward — the opposite of a healthcare system that is a public good. So all the more I urge you to look with fresh eyes at the design of our healthcare system, and to let go of those parts of the system that were installed for purposes other than caring for the health of the people of Vermont.
Specifically, we must recognize that such things as “benefit packages” and user fees (the latter couched in the insidiously nice-sounding term “cost sharing”) are the result of that old system — the system that we are working to put behind us — the system in which insurance companies maximize their profits by restricting care, leaving people to suffer and die. Just as health insurance is not healthcare, the trappings of a health insurance system are not necessary components of a healthcare system.
Finally, before I get into the details of our goals for this year, I want to urge you — as we have many times over the last four years — not to conflate means with ends. We spend a lot of money on healthcare, and there is — and will be — a lot of talk about the cost of healthcare, but the goal of our healthcare system is not to save money; it is to protect and care for the health of the people of Vermont. Let’s keep this primary goal in mind as we crawl through — and mow down — the weeds.
Now I’m pleased to walk you through our proposals for this sessions’ healthcare agenda:
We must ensure that the transition to Green Mountain Care, our universal health care system, is based upon Act 48’s principles of universality, equity, accountability, transparency, and participation.
Act 48 sets out clear principles for the design and establishment of our new health care system.
These principles serve as guidance for the transition process as well as for the new system. The law is clear that these principles should guide decisions on both, and we encourage you to apply these principles to every decision you make.
We’ve put forward detailed standards on how these principles apply to systems development and to financing in particular. We would like to engage in a discussion on these standards as you develop measures for implementing Act 48 in its transition phase as well as its ultimate goal of universal health care.
The principles and standards will make your work easier as they offer a consistent analytical framework for weighing policy options. This is not something we are superimposing on your efforts. You drafted Act 48 with a view to enabling the monitoring and assessment of progress made toward meeting the goals of universal healthcare. We believe that all public policymaking can benefit from a focus on goals, using principles and standards that reflect the values and rights of our communities.
We call for a timely and participatory transition process that implements those principles in a decisive, meaningful and accountable manner.
We must ensure that even during the ACA-mandated exchange transition phase, our healthcare system expands the public provision of healthcare services to increase access to care, and does not take a step backward by reducing access to care through eliminating public programs.
We ask you for a commitment to ensure that nobody will suffer from a reduction in their access to healthcare because of the transition process. We must go forward, not backward. “First, do no harm” should be the very basic motivation for your actions this session.
This means all people currently served by public programs must continue to have access to care at at most the level of costs they are currently paying — which is already too high. We are currently excluding over one fourth of the people of Vermont (28% underinsured) from getting the healthcare they need. Surely we must expand access rather than reduce it.
We will not just put people’s health at risk but will endanger the entire reform process if we are not taking seriously our obligations to protect people’s health at all times. The entire process will lose credibility and falter if we do not hold true to the intent and principles of Act 48.
We call on the legislature to ensure that adequate support will be made available to everyone who is moved into the exchange. Such support must be funded equitably, not by punishing poor and working class people through “sin” taxes or by cutting other programs that serve people’s needs.
We must take action, during this session, on an equitable financing plan for Green Mountain Care.
Act 48 requires that GMC be publicly financed, with sufficient funds to ensure universal access to comprehensive and appropriate care for all, and that this financing must be shared equitably. The principle of equity is an explicit requirement in Act 48 for the design of healthcare financing, and we hope you will join us in affirming this principle in the planning and transition process.
The HCHR campaign has put forward a detailed proposal for equitable financing, and we hope you will review and discuss this with us.
The most equitable way to finance a healthcare system is through progressive taxation, which ensures that financial contributions are based on ability to pay rather than on the use of needed care or the purchase of a particular insurance product.
We encourage you to set the parameters for implementing equitable financing through progressive taxation and eliminating insurance premiums, deductibles, co-pays and co-insurance.
We must ensure that all health needs of the people of Vermont are included in the design of our universal system, and that healthcare provision is based upon a person’s individual health needs, not upon a general set of “covered benefits.”
Each of us has a right to receive the healthcare services we need, when we need them. This obviously includes dental, vision, hearing and long-term care; in essence, all care deemed medically necessary and appropriate for a patient by a doctor.
We call on you to help us move away from the notion of healthcare as a risk against which we can insure us through purchasing a defined set of benefits with insurance premiums. Rather than develop “benefits packages” that artificially restrict access to care, Vermont must use its resources in a cost-effective way that does the most good for everyone’s health. In a universal healthcare system, based on shared goals of protecting and improving the health of all Vermont residents, the insurance model becomes obsolete. As we are replacing the private insurance-based system with a public universal system, the concept of “benefits packages” loses its meaning. This paradigm shift is supported by Act 48, Vermont’s universal healthcare law, which requires access for all Vermont residents to “comprehensive,” “appropriate,” and “medically necessary health services.” Rather than paying premiums for benefits packages, we should pay taxes to share the cost of providing all needed care as a public good.
To ensure that GMC puts people’s health needs first, we must proceed from a presumption that everyone should get the medically necessary care they need. This approach reverses the premise of restricted access in an insurance-based system, where many health services are denied or restricted from the outset, and the patient then has to argue for or buy additional services. Once the system has shifted to prioritizing health needs, then the state can put regulatory processes in place to guide allocation of public resources in a way that maximizes health outcomes for the entire population.
We must ensure that our system is universal by including all Vermont residents, regardless of their immigration status, and by making certain that all workers - including those injured or fallen ill at their workplace - and are included in this system.
We encourage the legislature to commit this session to including immigrants living and working in VT in our universal system.
We also ask you to take steps toward integrating the healthcare aspect of Workers’ Comp into GMC.
Both actions are needed to ensure that we are moving to a truly universal system that leaves no one out and treats everyone equally.
In conclusion, I would just say we are delighted to work with you, this session, and to work to make politically possible what has never before been possible in this country, so that Vermont can continue to lead this country in fulfilling the human right to healthcare. Thank you.