Published: May 5, 2011
Passage of historic health care legislation by the Vermont Legislature puts Vermont on the road to reform that could chart a new path for the nation.
Fundamental to the new plan is a concept effectively promoted by a grass-roots campaign that persistently drummed home its message: Health care is a human right.
To embrace that idea is to set in motion changes that alter profoundly the way that people receive health care. Health care becomes something to expect as a citizen — like public education or police protection — rather than something one might or might not be able to afford, like a new car or washing machine.
When one accepts the notion that health care is a human right, one’s view of the health care system as it exists today changes. It is no longer acceptable that a capricious system denies care to people because of arcane provisions in their insurance policies. It is no longer acceptable that people are allowed to go without care because they cannot afford coverage. It is no longer acceptable that health care emergencies bankrupt families whose coverage does not stretch far enough.
Some of the changes contemplated by the new law are several years away because much planning and study are yet to be done. Critics have charged that advocates for change are moving too fast because they don’t know yet how we will pay for a new system. But the new law allows time to examine those questions. The program pushed by Gov. Peter Shumlin proceeds step by step. There are many complex questions that still must be addressed — a funding source, the IBM problem — and only after satisfactory answers are found will a new system be put in place.
It is a daunting problem. The state’s health care system is already rated highly. No one wants health care at Fletcher Allen, Central Vermont Medical Center, Gifford, Dartmouth-Hitchcock or any other of the major medical centers serving the state to be compromised because budget decisions become the province of state government.
And yet the rapid escalation of costs, left unchecked, already represents a threat to the quality of care provided at those places and by providers throughout the state. As costs continue to rise the system becomes subject to the famous death spiral, whereby high costs make care increasingly unaffordable for more and more people, forcing prices ever higher and making care even more unaffordable.
Vermont is a small enough state that, one hopes, it could serve as a model for others. In a risk pool the size of Vermont, it is possible to predict with some accuracy how many heart attacks, strokes, auto accidents, births, will take place in a given year. Insurance companies make these calculations as a matter of course. Budgeting for actual needs, rather than opening an unrestrained spigot, would allow the state to impose some restraint on health care costs. The state could also save hundreds of millions of dollars in new efficiencies by reducing the paperwork required because of the helter-skelter system that exists today.
Those who do not trust government are likely to be wary of the government’s new role in managing a sector that makes up about 20 percent of the economy. Skepticism is warranted. Citizens need to oversee and critique the decisions that are made and ensure that a public system truly operates in service to the public.
But skepticism must not be an excuse for inaction. Indeed, the system today is not an acceptable alternative. It is a chaotic mixture of public and private systems, with little accountability and extreme waste. It will not fix itself. That’s why the state, behind the determined leadership of Gov. Shumlin, has decided to step in.
It is a bold experiment founded on a humane principle and seeking to look with open eyes at one of the most complex policy problems bedeviling the American economy. It is an adventure in democracy that Vermonters can be proud to be a part of.