Blog#147- 2/13/23
CAN THE BEAST OF HEALTH CARE REFORM BE REVIVED?
By Richard Davis
It would be inspiring if Vermont was once again a national leader in health care reform efforts. When Peter Shumlin was Governor in the 2010’s reform activism was at a high point and the possibility of Vermont becoming the first state to implement a single payer system seemed real. When his administration ran the numbers, after costly studies were done, Shumlin decided that it was not politically feasible to move ahead and health care reform died in Vermont.
There is a bill now in the Vermont legislature that aims to revive some of those reform efforts. H.156 states, “The purpose of this act is to initiate the incremental implementation of Green Mountain Care by starting to provide comprehensive, affordable, high quality, publicly financed health care for all Vermonters in accordance with the principles established in 2011 Acts and Resolves No. 48. The act gradually expands the benefits available through Green Mountain Care over 10 years, beginning with publicly financed primary care in the first year, adding preventive dental and vision care in the second year, and adding the remaining health care services according to a schedule recommended by the Green Mountain Care Board’s Universal Health Care Advisory Group.”
It is a far-reaching bill that would transform health care in Vermont and point the way for the rest of the country. I would like to champion the bill because it is the right thing to do, but in the world of politics this bill is D.O.A.
There has not been enough grassroots activism on health care issues to make it appear that H.156 embodies the will of the majority of Vermonters. That does not mean that the principles in the bill are not widely accepted by a majority of Vermont citizens, because when polls are done a majority want the kind of reform in H.156.
The problem is that politicians in the Vermont House and Senate, as well as the Governor, have not put health care reform near the top of their lists of pressing issues to be dealt with. This has been the case for most of the time that Shumlin has been out of office. Politicians who understand Vermont’s health care reform history respect the need for change, but when it comes time to act they do not do much because they have already decided that this kind of reform cannot happen on the state level.
And then there is the elephant in the room. How much will H.156 cost? I have not seen any cost projections for this proposal but it is clear that the price tag would make most politicians gun-shy. It is clear that there would need to be new taxes and that there would be high initial costs for implementation.
Politicians need to see the numbers and they need to see what those numbers mean for the Vermont economy, for Vermont businesses including health care and for individuals. Without those kind of concrete facts nothing can move forward.
There is nothing new here. All of the studies done in the past to quantify and justify large-scale health care reform, such as the Lewin and Hsiao reports, make it clear that reform implementation will be fiscally painful for a short time but that the investment will lower health care costs for everyone while improving the access to health care and the quality of people’s lives.
It is easy for politicians to sign on to H.156 but I suspect that most of them will be unable to convince a majority of their colleagues to move ahead and establish Green Mountain Care. Shumlin couldn’t make the numbers work and it seems that those numbers have only reached higher levels over the years.
H.156 is the right thing to do, but politics is not fueled by good intentions. It is rare for political bodies to be comprehensively proactive, something that H.156 requires. Perhaps cutting off a few smaller pieces of the bill so that the numbers are more palatable would revive the beast that has been sleeping since Shumlin left office.
