OpEd: Vermont should aim higher than universal primary care

Photo of Tevye Kelman at the statehouseNote: This OpEd by high school teacher and Washington resident Tevye Kelman was published in VT Digger.

While VTDigger’s coverage of the legislative hearing on health care access on Jan. 23 was laudable for bringing Vermont’s health care crisis back into the news cycle, it was disappointing to see the hearing characterized as a “cheering section for enacting universal primary care.” At the hearing, I heard resounding support for the principle that health care should be treated as a human right, but I also heard serious concerns raised about limiting our discussion to primary care coverage. As many who testified on Tuesday night noted, the proposed legislation risks being a detour, rather than a step forward, on the road towards a truly equitable and universal health care system.

Health care is a human right. This principle is supported by a strong majority of Americans, and in Vermont, it’s been state law since Act 48 was passed in 2011. It’s certainly the principle that animated Tuesday night’s massive turnout and impassioned testimony. Unfortunately, the universal primary care bills under discussion fail to live up to this principle, and risk undermining the political will needed to confront the economic interests that benefit from a system that treats health care as a commodity.

While S.53 and H.248 might reduce costs and expand coverage for many, they would still oblige people to buy insurance to cover treatment that doesn’t fall under the rubric of primary care. This could include care for severe chronic conditions, disabilities, surgery or cancer treatment, long-term intensive care, nursing home, memory care, and various other specialized procedures. In addition, the bills’ definition of “primary care” excludes dental or vision care, and it is unclear how patient prescription drug costs would be affected. Treating health care as a human right means that no Vermont resident should ever hear the words “I’m sorry, that procedure isn’t covered by your plan” or have a health care decision be determined by economic necessity. The legislation currently under consideration does not pass that test.

Some advocates who share the goal of a universal, comprehensive health care see universal primary care legislation as a pragmatic step in that direction. A more sober appraisal, however, reveals universal primary care as a tremendous reduction in political vision that may undermine, rather than accelerate, the push for more comprehensive health care reform. We have been waiting for more than six years for our elected officials to deliver on the promise of Act 48: an equitably financed, public health care system that ensures that all Vermont residents can access all needed care. Where Act 48 provides a prescription for economic transformation, budget and tax reform, and strengthening the public sector, universal primary care reduces our vision to tinkering around the edges of a broken system.

The real obstacle to full implementation of Act 48 is not cost, but our elected officials’ unwillingness to finance it by asking our state’s wealthiest to pay their fair share. Gov. Peter Shumlin’s infamous 2014 financing plan for universal health care, which was widely derided as “proof” that a single-payer system was unaffordable, was flawed and contained regressive elements that disproportionately burdened the middle class and small businesses to preserve tax breaks wealthy families and large companies. Still, even under Shumlin’s plan, nine in 10 Vermont residents would have seen lower health care costs.

With a truly equitable financing plan, like the one proposed in a 2015 study by the Vermont Workers’ Center and National Economic and Social Rights Initiative, we could implement a universal, publicly funded health care system that guarantees comprehensive care for all Vermont residents, reduces health care costs for all but the wealthiest individuals and families, and provides an economic boon to small businesses, school districts and municipalities by removing employee health care costs from their balance sheets. It’s simply not true that we can’t afford a single-payer system; the data, and the experiences of thousands of Vermonters, show that we can’t afford not to.

Last week’s hearing was just the latest evidence that, here in Vermont, we reject wholesale the idea of treating health care as a commodity, and we believe it’s immoral and unjust for private companies to generate revenue from our human tendency to get sick and require care. We can’t afford compromises that perpetuate an immoral and ineffective system that allows our bodies to be managed for profit. It would be a mistake to throw the momentum of the movement for health care justice behind legislation that seeks to merely reform, rather than transform, the status quo. Now is the time for those who are committed to health care justice to unite behind a truly transformative vision: full implementation and equitable financing of Act 48.