What the “Hsiao” Designs Mean For Vermont

What the “Hsiao” Designs Mean For Vermont

When we launched the Healthcare Is a Human Right Campaign in 2008, our goal was to “change what is politically possible” in healthcare reform through grassroots organizing. A variety of groups and individuals had been making a very persuasive argument for Vermont to move to a universal healthcare system that decoupled healthcare insurance from employment and had single-payer public financing. But last year, as our grassroots organizing helped push the need for universal healthcare onto the front burner of the legislature, we realized that while the concept of having a single-payer universal healthcare system is pretty simple, how to get there from where we are now was not perfectly clear. The mix of market-based healthcare insurance and a variety of taxpayer supported programs added up to a mess that would be difficult to navigate a way out of, and there was no real road map of exactly how that navigating could be done. It was clear we needed that road map, and that was the goal with S.88 (which became Act 128 — see our Synopsis at http://www.workerscenter.org/act128).

We also realized that to really have healthcare be treated as a basic right — as a public good for all — we needed to have a much more comprehensive design than just how the system would pay healthcare providers. In talking with Vermonters, it became clear to us that there is a lot more about our healthcare system that needs to be fixed, so we need a comprehensive plan instead of continuing the losing battle of piecemeal, patchwork fixes. This is why to us the principles in Act 128 are so important. We need to make sure that the new healthcare system we put in place truly does work for everyone, so we need guidelines to keep it on track (see our Detailed Human Rights Standards for Healthcare Systems at http://www.workerscenter.org/assessment ).

I have learned, working on this campaign for the last three years, that most everyone agrees that we should have a universal healthcare system. I’ve talked to thousands of Vermonters, and I would say less than 1% of people think otherwise. But a lot of people I’ve spoken to have very good questions of how exactly it will work. How will we pay for it? How will it affect me and my family? That’s one of the most exciting things about when Dr. Hsiao’s team releases the designs: we will start getting the answers to those questions.

It is also important to emphasize how extraordinary it is that Vermonters have Dr. Hsiao developing these designs. To have one of the most respected healthcare systems experts in the world is really amazing (check out his Harvard profile: http://www.hsph.harvard.edu/faculty/william-hsiao/) , and we didn’t just get him. A whole team of his colleagues from Harvard University, MIT and Yale, along with local, Vermont healthcare experts, has been working incredibly hard on this project. We know that what they will give us will go far beyond financing; it will really get at how we can switch from a system that treats healthcare as a service commodity to one that treats healthcare as a public good, and it will enable us to move towards a healthcare system that provides the best quality care to every Vermonter without all of the frustration and waste of our current “system”. The designs will help answer questions about how to best deliver healthcare services to Vermonters and how to best be able to afford those services.

I should say that we expect not to agree with everything that Dr. Hsiao’s team recommends. Parts of his recommendations were based on dozens of “stakeholder” meetings in which he was trying to determine what was the most “politically feasible” path for Vermont to move towards universal healthcare. We know the Hsiao team talked with a number of groups who are strong proponents of preserving the elements of the healthcare system that currently make people a lot of money, like the Chamber of Commerce and healthcare industry executives. We know that while increasing numbers of businesses want to see the cost of providing healthcare taken off the backs of employers, many large corporations see their employees’ desperate need to have healthcare insurance benefits for their families as an effective tool for employee retention. We know that health insurance companies don’t want to go the way of buggy whip makers and are going to do whatever they can to justify their continued existence. So we believe we will need to push to demonstrate that it is “politically feasible” to create a healthcare system that is truly in the interest of ordinary Vermonters and is as courageous in staying focused on the healthcare needs of Vermonters as we can get it to be.

The designs we will have of how exactly Vermont can move towards having a real universal healthcare system are not only a benefit for Vermonters. We are hearing from more and more people around the country who are looking at us to be a model of how universal healthcare is possible on a state level. Vermont has an opportunity, this year, to lead the country. Together, we have set a powerful example of how people can define the political agenda and redefine the role of government as needing to meet the basic needs of our communities. It’s not going to be easy, but I so much look forward to working with you to make it happen!