Rutland Herald: I moved to Vermont more than 15 years ago to practice medicine and to engage in an educational, and ultimately political effort to achieve universal, publicly funded health care in one small state. The prospect of such reform happening at the federal level had always seemed very dim. The prospect just got dimmer in Vermont, but I am not giving up.
I am a primary-care physician. I help my patients to the extent I can, but there is little I can do when someone can’t afford their prescriptions or their surgery or their specialty care. Long ago, I realized I could not be true to my calling and merely witness health care injustice; I also had to be an agent for change. Thankfully I found many people in Vermont who believed as I did.
One of those people was Peter Shumlin. He had co-sponsored one of the first single-payer bills to be considered in the Legislature, and he was intensely interested, as I was, in figuring out the nuts and bolts of moving from our complex, wasteful and unfair nonsystem to something more akin to the successful health care programs in developed countries around the world.
Without Gov. Shumlin’s bold leadership I am sure we would not have passed Act 48 — the landmark 2011 legislation that laid the framework for Green Mountain Care. The only missing pieces were the benefit package, the financing mechanism, and a federal waiver, all to be put in place for a 2017 launch date.
Now, we are facing a political reality that makes passage of a financing package all but impossible in the near term. The governor and his team made a valiant attempt to devise something that legislators would approve, but in the end, I think they realized that even their best efforts would not create the political will to shift so much money from insurance premiums and out-of-pocket expenses to public revenue.
When I heard the governor’s announcement that for the time being he was pulling the plug on single payer, I was disappointed, but I was not surprised. For the past few years, I’ve watched a growing torrent of narrow-minded, cynical and misinformed attacks on the single-payer concept, and I’ve been dismayed to hear so many mean-spirited attacks on the governor’s character and motives.
Therefore, I do not fault Shumlin for his decision as much as I fault the vested interests that fought so hard against the idea that providing health care to all people is worthy of public finance. These vested interests include institutions with a commercial interest in health care, out-of-state PAC money and large businesses too miserly to provide decent health care to their employees or to pay a tax for that purpose.
Also at fault is our apathy as voters, our disengagement from meaningful political discourse, and our lack of appetite for change, even when change is sorely needed. I must also mention the media, which in its zeal to hold the governor accountable, often seemed to be adding to the drumbeat of the doubters.
Single payer is not dead. The injustice and dysfunction of our present system will not go away, and only with a commitment, at a societal level, to take care of people’s health care needs as a public good, will we become a community of humans that truly cares about each other and that shares the burdens of doing so.
But commitment without follow through is not sufficient. There have been too many health care platitudes and resolves through the decades that have amounted to nothing. Please, let us not put Act 48 in that category. There may be sectors of the health care landscape that can be publicly financed and made universal one by one, so that we build toward our goal more gradually. I hope that in the coming weeks, we will have fruitful discussions about this idea and others.
As a physician, I know that it is not enough to diagnose an ailment; I must also map a course of treatment; and then see to it that the treatment is implemented. As a Vermont health-reform advocate, I think we have an accurate diagnosis of what is wrong. I think we have a good treatment plan in Act 48, but the implementation is still not clear.
Thus, we are stymied, but not defeated. We have met an obstacle, but we are not dissuaded from working over a longer time frame. I remain convinced that we can have universal health care, maintain quality and control costs, but to do all three, we must have public financing. That is my conviction, and I feel morally compelled, as a physician and person of conscience, to continue acting on my conviction to the best of my ability.
Deborah Richter is a practicing family physician who resides in Montpelier.