“This is not reformism and being incremental in the Obamacare vein by any stretch of the imagination because it is a change in our current system of looking at health care as a private commodity. Instead, these bills would establish health care as a public good and for everyone, regardless of age, income, job status or any other life circumstance.” — Ellen Oxfeld of Vermont Healthcare for All
Last week in the column it was mentioned that there were bills in the Vermont House and Senate that would provide for all of our primary care. I wrote: “Another incremental proposal includes H.207/S.88 which creates publically financed primary care to all Vermonters. According to Vermont Healthcare for All we could finance this for very little. Spokesperson for the group, Dr. Deb Richter, puts the cost at around “$160 million.” If this were to be paid for totally with a payroll tax it would roughly be double what the governor is asking for at 1.4 percent. However, if all of our primary care were covered by this state program, what do you think would happen to our insurance costs?” I’ve known Deb Richter for a long time, so I wasn’t surprised when she expressed her displeasure with my analysis. She wrote: “I gotta tell ya, I was very disturbed by this piece you wrote. Everyone is entitled to their opinion of course, but you ignored some basic facts in your analysis. It might have helped if you had simply asked one of us involved in the push for universal primary care what would happen to premiums under our plan. It turns out we have a law in Vermont that mandates premiums to reflect the level of risk. Under the universal publicly funded primary care program, private insurance would no longer have to cover primary care. Therefore, premium rates would have to go down by law. I was surprise to read your implication that they would go up.”
If anything, I was implying that rates would go down. If all of our primary care like routine visits for physicals, stopping in with a cold that just won’t quit, or that nagging backache; I have to believe that taking this basic care out of the hands of insurance companies would lower our rates, and what’s more, by making primary care a basic right would go a long way to making us all healthier and further lowering overall costs.
I also heard from Deb’s colleague Ellen Oxfeld who urged me to more fully explore the proposal. She wrote, “All studies show that free primary care at point of access is the single most important health care measure that can be taken for improving overall population health and right now, with almost 1/3 of all Vermonters underinsured, there are many who delay going to their primary care doctor which can result in a less serious condition becoming much more threatening as it is ignored.” Along with her critique of my column she sent along some materials in support of her arguments.
Perhaps the most compelling point in support of these bills is the fact that, though this is an incremental step, it does move us towards the goal of Act 48 of a universal publically funded healthcare system. For Governor Shumlin to simply say that we can’t move forward because of the cost is just wrong. The truth is that the longer we wait on reform the more it will cost. Like I mentioned last week, the governor wants to raise money with a 0.7 percent payroll tax to increase payments to doctors who treat Medicaid patients. His argument is that this will stop the “cost shift” to those of us with private insurance. While there is no guarantee that the governor’s proposal will lower our insurance payments, there is no doubt that H.207/S.88 will substantial lower our insurance cost by perhaps 10 percent.
According to the talking points, “Of Vermonters who went to the doctor once in the previous 12 months, most (61.6 percent) did not visit a specialist at all.” So if these visits were covered by the state primary care program it would take a huge bite out of our insurance premiums. Another concern is that we may be faced with a shortage of primary care physicians. By having a program where practitioners are paid per patient instead of per visit we would be making a significant investment in primary care. That first in the nation investment would be a huge draw for doctors to set up practice in Vermont.
While I understand what the administration is trying to do with Medicaid, and the boatload of federal money we could leverage, I think there needs to be something promised for the rest of us. Perhaps by linking both proposals we would see something less than a 2 percent payroll tax while creating universal access to primary care, and solve the so-called Medicaid cost shift. That would be a worthy investment in our public health. Contact your State Representatives and Senators through the Sergeant at Arms at 802-828-2228 to voice your support, and for more info check out: vermontforsinglepayer.org. I hope in some small way this clears up the murky waters.
Contact Kurt Staudter at staudter@sover.net