At his first inaugural, Franklin D. Roosevelt made his famous remark about fear being the enemy of change. The year was 1933 and the country was in the depths of the Great Depression. Government intervention was required to save people from joblessness and starvation.
Now we are facing a similar — if less momentous — juncture in Vermont. Health care costs threaten to cripple the economy
— they push school and municipal budgets to unforeseen heights; they saddle businesses with unpredictable rate hikes; and they force unlucky Vermonters into bankruptcy. Gov. Peter Shumlin has proposed a solution — but it has been met with fear.
The first fear is the “price tag.” But a price tag connotes buying something we don’t now own. T h a t ’s no t t h e case with health care. We currently pay for it through premiums, out-o f – p o c k e t s a n d taxes. Let’s say the total amount we now spend is $5 billion a year. If we reallocate and consolidate half of this funding, leaving the other half as is, and maintain total spending at $5 billion, why does that constitute a $2.2 billion “price tag?”
When the price tag fallacy is dispelled by recitation of the facts, the fearmongers retreat to a more nuanced position. Pointing out that many people do not now receive all the health care they should, they then criticize Shumlin’s plan to insure everyone as financial imprudence. You can’t expand coverage without additional cost, they say, and then rather selfishly proclaim that it’s only the expansion that Vermont cannot afford.
However, every study done so far shows that we can insure everyone under a single-payer plan and pay no more, perhaps less (as a population) than we do now. How is that possible? In a nutshell, it has to do with the negotiating power that accrues from the merger of health care funding sources, from the ability to set binding budgets and reimbursement rates, and to reduce administrative costs of billing and insurance paperwork.
The second fear is quality. Some hospital CEOs have decried public financing as a threat to quality. “We’re definitely very on board with getting paid for performance,” said one administrator, in reference to new payment mechanisms being instituted by private accountable care organizations. But when it comes to public reimbursement that would rein in hospitals’ ability to set charges, and would expose to greater public scrutiny such things as high executive salaries, the CEOs stir up fears of substandard care.
Admittedly, going forward, we’ll make more overt choices about how much as a society we can afford in health care facilities and services. These choices will not be easy. But is it not better to make them in a public, transparent process, than to stand by and watch a spending orgy pitting hospitals against hospitals, independent physicians against hospital-owned physicians, businesses against insurance companies, and patients against providers?
Furthermore, does anyone really believe that Vermonters, through their elected representatives, would ever tolerate budget cuts so severe as to result in a second-rate health care system? Doctors and hospitals hold revered status in Vermont. The outcry would be deafening should a public financing process force the closing of clinic doors or the elimination of life-saving devices. No, the challenge will not be underfunding, but how to avoid the natural tendency to say “yes” to every increment of new expense.
The final fear, as Roosevelt said, is fear itself — “nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.” If the free market purists, the government haters, the Plan B advocates, and now the “They’ll take your Medicare away” rhetoricians, succeed in blocking public financing next year, fear will have triumphed over reason. We’ll see a prolongation of high costs and unequal access.
We must conquer fear, imbue our legislators with courage, and have faith in our ability to solve the health care conundrum. As Roosevelt declared: “We do not distrust the future of essential democracy.”
Ethan Parke is a resident of Montpelier.