Vermont Can Lead the Way

This op-ed from the Vermont Workers’ Center appeared in the weekend editon of the Times-Argus and Rutland Herald


We do things differently in Vermont. Rarely has there been a week that showed so clearly how independent Vermonters are from national politicking.

As federal lawmakers moved toward repealing President Obama’s health reform law, Vermont took a step toward a different and much better system.

Instead of turning back the clock and limiting people’s access to care, Vermonters may get a universal system that works for everyone. If we do, we mainly owe it to our own tenacity and our unwavering commitment to take care of each other. But we also owe it to Dr. William Hsiao, a renowned health economist from Harvard University, who presented us with three thoughtful proposals for fixing Vermont’s broken health care system.

Dr. Hsiao and his team recommend a system that provides health insurance to every Vermonter, with all receiving a common benefits package. Payments to doctors and hospitals would be channeled through a single pipe, as Dr. Hsiao puts it, to cut costs and eliminate waste. In his estimates, such a system would achieve both universal coverage and cost savings in the order of $1.2 billion by 2019.

Given that tens of thousands of Vermonters currently cannot get the care they need, and that many have been bankrupted by high health care costs, Hsiao’s proposals deserve immediate attention and urgent action by our Legislature. So how should our representatives weigh the options outlined in Dr. Hsiao’s report?

To answer that, it’s worth recalling how we got this far. Dr. Hsiao’s team was hired last summer after Vermont passed the Universal Access to Health Care law (Act 128), which commits the state to develop a health care system that meets the principles of universality, equity, transparency, accountability and participation, and that treats health care as a public good.

It is no coincidence that these are the exact same human rights principles that have guided Vermont’s large grass-roots movement, the Healthcare Is a Human Right Campaign, started by the Vermont Workers’ Center in 2008. Without this bottom-up pressure to realize the human right to health care in Vermont, we would not be discussing Dr. Hsiao’s options for a human rights-based system. It took many thousands of Vermonters demanding that we stop treating health care as a commodity bought and sold in the market that persuaded the Legislature to pass Act 128.

This resulted in securing the state’s commitment, under Act 128, to make health care a public good, like fire services, that belongs to all of us.

Now the ball is in the Legislature’s court again. Our representatives must assess how Dr. Hsiao’s proposals meet the principles of Act 128. For example, would the system eliminate financial barriers to getting needed health care? Or would people still be burdened with high out-of-pocket costs and deductibles? Will the costs of the new system be shared fairly and equitably? Or will those with lower incomes pay a higher share? Would Vermonters be able to hold the system accountable for meeting their health needs? Or would there be middlemen operating out of the public eye? Would the system treat health care as a public good, or would access and services be arbitrarily restricted by market forces?

These are the types of questions we need to ask if we want to get health care right this time. The Healthcare Is a Human Right Campaign has developed a guide (“Detailed Human Rights Standards for Healthcare Systems”) to help Vermonters assess how Dr. Hsiao’s plans meet the principles of universality, equity, transparency, accountability, and participation.

As we start asking these questions, it is encouraging to hear Dr. Hsiao’s promise of a health care system that can include everyone and provide the same benefits to all. The human right to health care means that every person must get the care they need, independent of payment or any other factors. Vermont should adopt a system that makes this a reality. There is overwhelming evidence that the strongest vehicle for making care fully accessible and accountable is a publicly financed and publicly administered system, in which the people have the say, not private companies. Vermont’s lawmakers should keep this in mind as they discuss the way forward.

And forward we must go. Let’s recall that last year we heard plenty of politicians’ excuses for not doing anything to tackle our health care crisis. Mostly they claimed not knowing how to reform health care and how to develop a better system. That’s why the Human Right to Healthcare Campaign started with basic human rights principles to guide the process of change. And that’s why Vermont then hired Dr. Hsiao to develop detailed plans.

The current system is unjust and unsustainable. This week Dr. Hsiao has shown how we can change it in as little as three to four years. But our legislators need to do their part. Now is the time to act. We are Vermonters. We can lead the way.

Peg Franzen is the president of the Vermont Workers’ Center, which coordinates the Healthcare Is A Human Right Campaign.