(The bill referred to in this OpEd is listed as H59, it is actually H156).
By Cheryl Mitchell
In the past few years, we have heard, with growing alarm, the concern that changing demographics in Vermont will soon spell disaster. The Chamber of Commerce, our legislators, our school boards, our businesses, all warn the current workforce crisis will get worse. The steady decline in the number of young children is making the cost per capita of our education system untenable. We don’t have enough people to take care of our elders, our youngest, or those in need of mental and physical health care.
It is considered an affordability crisis. We hear variously that income and property taxes are too high, the cost of housing and utilities is too high, the cost of food is too high, the cost of health care is too high. So often, when we talk about complicated and challenging situations, someone will say: “Well it’s no silver bullet but …” and proffer a potential solution such as offering people a $10,000 bonus to move here or marketing Vermont as a great place to live and work.
I’m very appreciative of the current focus on affordable housing. From close to 50 years of working on housing issues with individuals, clergy groups, mobile home park residents, non-profit and community action groups, I know first-hand how life-changing it is to have a safe and stable place to live. If that is a home or condo of your own, it is a wonderful way to help families build an asset base and a strong attachment to a local community.
Increasing the number of units to meet the perceived demand is a wonderful goal. It will also take time, money, and expertise to reach. Creative ways to address downtown and village center zoning, convert large single-family homes into multi-family homes, encourage construction of auxiliary dwelling units, promote shared living settings, all hold hope that we can retain the beauty of our rural environment and still make room for more people to live in dignity.
But this will not happen overnight. As a mother, Quaker, and gardener, I don’t really like the metaphor of trying to solve a problem by “shooting it with a silver bullet.” I have come instead to believe that silver seeds are more productive, more useful, and easier to implement.
One silver seed I’m considering right now is universal, publicly financed, primary care. It is the kind of massive, sweeping and totally sensible idea that public education was when it was first conceived and gradually implemented. In fact, implementing universal primary care might go a long way to improving public education, which has been hamstrung in recent years by huge increases in health insurance premiums. Similarly, it would benefit our local economy, as self-employed persons and small business owners would be spared the increasingly untenable cost of insurance. It might even become part of the elusive lure attracting young families to Vermont.
Having our own primary care doctor, dentist, and even therapist would be beneficial to people of all ages and all income levels. It is more likely that we would take a wellness approach to our physical and mental health if we knew that regular check- ups would not bankrupt us with huge out-of- pocket co-pays.
Initially, there would be some readjustment to caseloads as more people have access to care. However, eliminating extensive paperwork required by insurance companies would also make Vermont a more desirable place for new practitioners. New practitioners would help offset the initial influx of new patients.
Ideally, this will also allow for the kind of deep, unhurried relationships people yearn for in their health care interactions. A long term, dependable relationship between patient and provider is likely to reduce stress for both parties.
We would no longer need to create a huge bureaucracy to determine eligibility, since everyone would be eligible. Decisions about care would be made by patients, their providers and their families, with little intervention by the so-called gate keepers whose current job appears to be denying or delaying care. If we all had primary care, the huge health disparities based on race and income would gradually diminish.
We know from the Covid experience that Vermonters can shift practice within weeks if they see the value of doing so. Shifting from a hospital-dominated to a patient-focused health care system could potentially happen quickly. Excess money in the health care industry currently used for redundant administrative purposes could facilitate this transition. A thorough review — beyond what the auditor has already provided — of how funds are currently used would be useful. But we don’t need to wait for results of yet another study to sprout this seed.
Paradoxically, two contradictory bills are moving through the Vermont legislature this year: S-211, which appears designed to weaken the ability of the Green Mountain Care Board to control hospital costs, and H-59, which creates the beginnings of a universal primary care system. I’ll be working on the latter, because I believe that planting the silver seed of universal primary care will attract new families to Vermont, improve our overall health, decrease stress on public education and grow us into more economically vibrant communities. Contact your representatives to advocate for H-59 and universal primary care.
Cheryl Mitchell is president of Treleven, a retreat and learning program located on her family’s sheep farm in Addison County. She does freelance consulting on issues related to children, families, social policy and farm to community work. She can be reached at cheryl.w.mitchell@gmail.com.