Heath care effort must proceed

December 17, 2014

Addison Independent: In the wake of the upcoming legislative session, and anticipation over the release of a financing package for a single-payer health care system in Vermont, many have asked why we need a publicly financed health care system in the first place. They wonder why we passed Act 48 in 2011, and ask if there might not be another why to get to universal health care — such as 100 percent enrollment in private insurance. In short, why do we need a publicly financed plan and why did the Legislature pass Act 48?

It’s important to understand that since the early 1990s, Vermont has tried everything else, from reforms during the Howard Dean administration to the federally mandated private health insurance exchange of the Affordable Care Act. But, no system based on private insurance can do what a publicly financed system can when it comes to seamless coverage and control of administrative costs. Even if we had 100 percent enrollment in private health insurance (amongst those not eligible for federal public programs), we would still face issues that cannot be solved by it.

One of these unsolvable problems in a private health insurance system is high rates of underinsurance. For instance, in 2012, 160,000 Vermonters were underinsured, and given that the bronze plan is the most affordable on the exchange, we can expect high rates of underinsurance to continue in a private health insurance-based system. In short, private health insurance does not always equal health care. Underinsured people often don’t get the care they need because they cannot afford it. This results in many people forgoing needed care until emergency situations erupt and care can no longer be put off, at which point, not only do they face more serious health situations, but mountains of unpayable bills. ?

A second problem with private insurance is that it can never be seamless. People’s life circumstances change due to changes in income, job, marital status or sudden inability to pay a premium. Under a private insurance system, anyone experiencing a change can experience gaps in coverage — these can be dangerous to health and finances. In a publicly financed system, however, everyone will be covered by virtue of Vermont residence. There is no one caught between the cracks because their life circumstances changed and they lost their private coverage even for a short while.

Thirdly, our present system is very regressively and inequitably financed. Two people with the same income can pay vastly different amounts for health care, and they can also have very different plans — as I pointed out above, many Vermonters are technically covered, but they are underinsured.

So, let’s go ahead and follow through on Act 48. Creating a publicly financed single-payer system can create an administratively less complex (and therefore more economically efficient) health care system. Equally important, it will not leave people stuck between the gaps and cracks in coverage. Raising the funds publicly rather than through private premiums ensures that all Vermonters will have the security of knowing they are covered by Green Mountain Care. Vermonters will no longer have to worry that job loss, divorce, or even the insurance company losing their checkwill result in inability to get care when it is needed, or bankruptcy because the coverage was inadequate.

It’s true that the Legislature will have to take a serious look at any financing package with which they are presented. But, I would hope they will review the package in the spirit of Act 48. That is, Act 48 has already determined that we need a publicly financed health care plan, and it creates a roadmap for getting there. Now is the time to carefully consider ways to make the financing of this plan equitable and fair for all Vermonters. If we give up on Act 48, and the idea of health care as a public good, we will remain saddled with the same old inefficient non-system that caused the Legislature to pass Act 48 in the first place.

We need to remember that a private insurance system can never be truly universal.

Ellen Oxfeld
Middlebury