By Ellen Oxfeld
Let’s hope Vermont is looking in the rearview mirror at the coronavirus pandemic. Have we learned anything about health care?
Most people agree that Vermont did better than most states at controlling the spread of the virus, and now, with 80% of the eligible population having received at least one dose of the vaccine, we are the national leader.
So what have we learned?
For one thing, it looks like if we make health care a public good in Vermont, available free of charge at point of service, a lot of Vermonters will avail themselves of that service and get the care they need.
Of course, nothing is truly free. Even our vaccines were not free. We pay through taxes and we want those taxes to be fair. But, once we’ve paid for the service collectively, we can reach a lot more people if the service includes them automatically — no co-pays, deductibles or means testing to make things complicated.
In the rest of our health care system, the average person is saddled not only by premiums, but high out-of-pocket costs such as deductibles and co-pays that often deter them from seeking care in the first place. This is not to mention that we have myriad different plans with different rules.
Contrastingly, in the vaccine rollout, we saw that a system that automatically includes everyone makes access so much easier. The vaccines illustrate just how efficient it is to make health care a public good.
We learned something else in the pandemic. The people who worked so hard for the health of all of us were not highly paid corporate executives, but public servants. They were people like Vermont Health Commissioner Mark Levine, whose dedication to seeing Vermonters through the difficult exigencies of this pandemic were seemingly limitless. And there were countless others whose names we do not know who worked tirelessly as well — on the front lines of health care service, or behind the lines collecting the data we needed to confront the pandemic.
These committed individuals were indefatigable in their efforts to keep Vermonters healthy. They were public servants or front-line health care workers and not highly paid corporate executives. Recently, UVM Medical Center hired a new director of strategic communications for $400,000 a year. That sounds like a director of “spin” to me. Could such a position have contributed to the health of Vermonters the way our health care workers did? That seems highly unlikely. How many more nurses could UVM hire for that amount?
The pandemic has shown us that when all Vermonters are included, and we treat health care as a right and a public good, we can achieve great results. Let’s take the next step. According to Vermont’s own state statute (enacted in Act 48): “The State of Vermont must ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters. Systemic barriers, such as cost, must not prevent people from accessing necessary health care. All Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting.”
We haven’t achieved our own stated goal enshrined in law. Even before the pandemic, almost 40% of Vermonters were uninsured or underinsured, and we know from national data that rates of un-insurance and underinsurance are even higher among the poor and racial minorities than in the general population. This adds up to health care delayed, health care denied and lives lost.
Every year there is legislation that proposes implementing Act 48, Vermont’s own roadmap to a publicly financed “universal and unified health system.” (This session it is H 276, which proposes a phased implementation of Act 48, starting with primary care and then adding other services until all health care becomes a universal public good). H 276 has 44 co-sponsors. Yet, once drafted and sponsored, universal health care bills have lately been ignored by legislative leaders or committee chairs — despite rank-and-file support.
It’s time to take this legislation off the wall, consider it and pass it. If we care about economic justice, racial justice and the health of Vermonters in general, we need to get back to our own stated goals.
Let’s learn from the pandemic and make all health care a public good. Collectively we spend $6.5 billion a year on health care in Vermont. Yet despite this price, many of us still cannot access health care due to cost. The reason is that in our byzantine current system of health care, nearly one-third of all costs go to paperwork, profits and the complexity of creating barriers to care instead of ensuring access to care. A universal publicly financed system could use resources to cover everyone instead of diverting it to such waste.
Getting this done is not a pipedream. Our legislators need to make health care a front-and-center priority when they return in January. We can’t wait for the rest of the country. We need to lead, just as we did during the pandemic, and show there is a better way. We need health care for all.
Ellen Oxfeld, of Middlebury, Vt., is a board member of Vermont Health Care for All.