Health Reform Debate Must Start with Human Rights Principles

For thousands of Vermonters, health care reform is not an abstract policy debate ("Debate single-payer must start with the facts" Jan. 23). Instead, across the state, Vermonters are organizing and mobilizing because they are faced with a choice between health or suffering, dignity or abuse, sound family finances or bankruptcy, and even life or death. They pay for the failures of a market-based system with their health — physical and financial.

Because our broken health care system has led to a human rights crisis, our discussion of health care reform must be rooted in the human rights principles that guarantee all Vermonters access to care on an equal basis, independent of payment. Today this universal system of quality health care is within our reach.

By confirming its feasibility and sustainability, the report by William Hsiao underscores Vermonters’ movement for a universal health care system. Despite this encouraging development, as Vermonters who care about our neighbors, we will continue to mobilize and educate to ensure that a future health care reform bill serves all Vermonters in an equitable manner.

The Healthcare is a Human Right campaign has developed a set of human rights questions to enable Vermonters to review Hsiao’s options and the governor’s upcoming proposals. These questions are based on the principles of Act 128 which launched the reform process. This law committed the state to recognizing health care as a public good and establish a health system that is universal, equitable, accountable, transparent and participatory. Under Act 128, Hsiao’s report had to follow those principles and translate them into practical reform options.

Unfortunately, Hsiao’s proposed health reforms do not meet all the human rights standards outlined in Act 128. According to the principle of equity, for example, no Vermonter should face financial barriers to getting needed care. Yet Hsiao’s proposal, which continues co-pays and other types of fees for receiving treatment, places an unequal financial burden on the sick versus the healthy. Why discourage people from getting needed care? Why shift costs to those who fall ill?

Or take the principle of accountability. Hsiao’s report does not describe how to make the health system accountable to all Vermonters. Instead, the report proposes to outsource and subcontract key elements of the system, despite overwhelming evidence that this reduces transparency and limits oversight. Surely Vermont does not want to embark on health reform only to return to a situation where a private company (possibly the same one Vermonters are complaining about now) can deny us access to care.

Both equitable financing that protects vulnerable Vermonters and accountability must be highlighted in current discussions over reform; these issues cannot be left to future debates. At the very least, we should agree that everyone should contribute according to their abilities, through progressive taxation, and that wealthier people, including those with investment incomes, should do so in line with their means. Moreover, all Vermonters should be given a voice in their own health system.

Without postponing reform for another year, Gov. Shumlin must move beyond the shortcomings of Hsiao’s proposal and prepare a bill that treats health care as a public good and meets the principles of universality, equity, accountability, transparency and participation. A bare-bones bill filled with empty promises and nods to the misguided federal reform measures is not worth the hard work of Vermonters who have built a movement for universal, equitable health care. Hsiao confirmed that a different, more cost-effective system is possible; now we need to make sure that this would be the kind of system worth having, and worth fighting for.

Peg Franzen lives in Montpelier and is the president of the Vermonter Workers’ Center, which coordinates the Healthcare Is A Human Right Campaign.