Primary care bill a good start

May 03, 2018

The Times Argus

A recent letter in The Times Argus by Frank Mazur points out a new bill in Congress that would allow physicians to provide pro bono health care to 20 patients in return for them agreeing to accept Medicaid patients and to allow them a tax write-off for so doing. This really hit me the wrong way. I fully believe, like the Vermont legislators who passed Act 48 a few years ago, that health care is, indeed, a right, not a privilege only for those who can afford it.
Another item quoted in Common Dreams reports on a recent poll done by the Washington Post-Kaiser Family Foundation states that 51 percent of all Americans support single payer health care and 76 percent of all Democrats support it, a figure close to the numbers of those who supported Obamacare.

We live and we learn.

One of the most important reasons we are paying more for health care now in Vermont and elsewhere is because so many folks who are either uninsured or under-insured are waiting too long to get help with very treatable conditions and end up in the ER and usually expensively hospitalized and dying prematurely when it is far too late for any lifestyle changes or preventive measures to help. If you are looking at whether to go to work in pain in order to put food on the table for your family or to go to a doctor that you cannot afford — either because of a huge deductible or no insurance at all — your answer is usually quite clear.

You go on working and hope that you will feel better tomorrow. Many patients also bypass primary care physicians and go straight to a specialist instead, also increasing costs. As a result, there is evidence that primary care doctors are either retiring or leaving Vermont in droves.

The Vermont Senate recently passed a bill, S.53, which would provide yet another “study” of how to make primary care more affordable. Many who have followed the process of this bill, including many state senators who reluctantly signed on to this “watered down” version of what once was an excellent bill as it came out of the Senate Health & Welfare Committee, would like to see the bill as it originally left Health & Welfare, nominally funded for a utilization study only of publicly funded Universal Primary Care (UPC). Yes, it is only a start but without this start, we will be drifting even further away from Act 48’s original mission.

Yes, there currently is a plan underway to supposedly lower health care costs by paying for care not according to procedures but rather by a per person payment. The chances of this actually lowering costs is somewhat debatable. My personal perspective is that there is a push to utilize personnel other than M.D.s, that is nurses and EMTs, to fill the gap and by providing community support services instead. This is all to the good, but I doubt many people covered by health insurance want their premiums to cover things other than top notch health care services provided by highly trained professionals. Community services need to be covered under other programs.

While S.53 would require minimal funding during its first year of a feasibility study to plan for implementation in 2022, it is a real step in the right direction. There are many intermediate steps which must be taken to get to a place where every Vermonter, regardless of their insurance or lack thereof, could have free primary care coverage that is publicly funded, taxpayer funded, in whatever way that is decided by the intermediate steps taken during the preceding years, which is well spelled out in the original S.53 bill as it left Health & Welfare.

It is my hope, and that of many other consumer advocates, that the House Health Committee will implement and support full passage of this bill with enough funding to start a process that will lead us to a cost saving and effective universal primary care program for all Vermonters. It is taking a first bite out of fully implementing the original Act 48, while not becoming overly costly and thus a nonstarter like the previous attempt under Gov. Peter Shumlin. People will still need to have other forms of insurance, private, Medicare or Medicaid, to pay for hospitalizations, procedures and specialized services not considered preventive.

Mary Alice Bisbee is a retired hospital and nursing home social worker, sixth generation Vermonter and longtime advocate for single payer health care.