Our brave little state took a big step forward in 2011 with the passage of Act 48, which not only would have provided universal health care but was projected to lower healthcare costs in Vermont (private and public) by $1 billion over a 10 year period. But at the last minute, then-Governor Shumlin pulled the plug on the project in 2014, and it was never financed by the Legislature.
We now have a chance to go back to that vision and think about health care not as a commodity but as a public good – like public schools, roads, and fire departments. We all benefit when everyone has access to these public assets.
H433, a bill sponsored by members of all three political parties, was introduced last year into the Vermont House, but it has yet to be voted upon. Residents throughout the state are demanding that it be brought out of the House Health Committee, where it has been stalled, and taken up by the General Assembly to actively discuss, take testimony, and vote on, this session.
H433 proposes universal, publicly-financed health care over 10 years for all Vermont residents, starting with universal primary care, mental health services, and substance use treatment as a first step. There would be no premiums, no deductibles, and no co-pays. Primary care is actually inexpensive – it represents only about 6 percent of all of our health care spending – and yet it has an enormous impact. The Oliver Wyman report of 2024, commissioned by the Green Mountain Care Board, predicted $300 million in hospital savings from expanded primary care.
As the federal government cuts federal subsidies for purchasing insurance on the healthcare exchange (“Vermont Health Connect”) and as the cost of insurance premiums rise, Vermonters have been forced to drop their healthcare plans. Of those who are privately insured, almost half of Vermonters under 65 years old are underinsured, with high deductibles and copays. This leads people to avoid primary care because it’s just too expensive. The problem is, when they get sick, their only recourse is to go to the E.R., where the cost of care is 10 times higher than in the primary care office.
That expense is passed on to employers in the form of higher premiums – 60 to 80 percent increases over the past six years. Rising healthcare premiums are a major factor behind our rising education costs and corresponding increases in property taxes. And more than 1 in 10 Vermonters have become bankrupt due to medical debt.
Only a publicly financed system, which acknowledges that having access to health care is a societal good, can address this healthcare crisis. We have wasted time and money repeating failed models of so-called payment reforms like HMOs and ACOs, not to mention allowing corporations to make a profit as they deny care.
Making primary care a public good will reduce our premiums, since insurers are prohibited from charging for services they no longer pay for. Implementation and financing for services after the second year will be determined by the General Assembly after hearing recommendations from a universal healthcare advisory group. Let’s not forget that the recent federal tax bill provides an average annual tax cut of $57,000 per filer for the top 1 percent of income earners in Vermont (about 2,000 households, with annual income of around $500,000)! Certainly we could try to capture these federal tax breaks for the wealthy to better meet Vermonters’ needs. There are currently bills pending in our statehouse that propose modest surcharges on these wealthy Vermonters, which could be channelled to finance universal care. Huge sums are being wasted right now on the profits and administrative overhead pouring into insurance companies, as well as on the money spent by providers on billing.
Let’s send a message to our legislators to take up H433 immediately. Putney town residents, along with residents in at least six other towns in the state, will have a chance to vote on this issue at Town Meeting. But everyone can show their support by emailing or calling their legislators.