| I favor a universal health care system where all citizens
are entitled to medically necessary health care. The United
States spends more per capita on health care than
any other country in the world. We have the most expensive
health care system according to a World Health Organization
report, yet our health outcomes rank behind thirty six other
countries. Clearly there is room for improvement. We do
not need to adopt the system of any other country lock stock
and barrel, but we should not let our pride and our fear
blind us to adopting ideas that have worked well elsewhere.
We can preserve what is best about our system while making
sure that we improve public health, encourage preventive
care, and improve access and affordability. We have
the opportunity to create a "Vermont Self Reliance"
Plan.
I recognize that many people believe it will be difficult
for a small state like Vermont to solve this without leadership
from Washington, yet we must try. Health care costs are
careening out of control, and bold decisive action is needed
now.
According to BISHCA, Vermont’s recent and projected
future health care spending levels are:
1990 - $1 billion
1999 - $2 billion
2004 - $3 billion
2007 - $4 billion
The rate of growth of health care spending has far exceeded
that of real per capita income. Increases in hospital costs
and especially prescription drug costs must be confronted
and addressed, yet increasing administrative costs are perhaps
the area which pose the greatest opportunity for shifting
money from bureaucratic red tape to providing care and coverage.
By 2007 it is projected that administrative costs in Vermont
will equal or exceed the entire general fund budget for
our state - one billion dollars. While leaders have been
giving lip service to decreasing administrative costs for
years, the lack of decisive action has actually allowed
administrative costs to continue to rise. Any serious reform
proposal must include a plan to simplify the system while
improving our ability to collect and analyze data swiftly
and efficiently.
Health care spending has taken an ever growing bite of
both household income and employer payrolls. A smart reform
proposal could be a real boon to economic development in
the state. I believe that regardless of the financing system
which is chosen, we should strongly consider separating
health care from employment status. The current system penalizes
both small business and self employed individuals. As businesses
compete in international markets, domestic firms which provide
the best health care coverage to employees are at a distinct
disadvantage compared to companies based in countries with
universal health care systems.
In the past, fear of change (particularly on the part of
many of us who have enjoyed comprehensive coverage as an
employment benefit) has favored maintaining the status quo.
Yet in the current environment, all of us are at risk. Health
security is in shorter and shorter supply. From crisis comes
opportunity.
Changing our health care financing system in Vermont is
eminently possible. Our small size can be an asset. As a
state we are smaller than many large corporations. One option
to explore is to self insure as a state. More and more businesses
have chosen this option. This would be one way to harvest
the administrative savings necessary to make health care
more affordable without compromising care.
We need to begin a serious conversation as a state about
how to move forward. As your Lieutenant Governor I am committed
to listening to different ideas, helping to make sure Vermonters
understand the facts, and helping to bring people together
to agree on a plan for Vermont.
In the meantime we must preserve existing state insurance
coverage for working poor Vermonters, children, and seniors.
As a short term realistic strategy I believe we should
let small businesses and individuals buy into the state's
VHAP Program. Such an approach, properly executed, will
reduce the cost shift, and provide some immediate relief
to small businesses. The harsh premium system adopted by
the Douglas administration with the support of the Legislature
should be scrapped. Thousands of people have already lost
coverage, and more will be threatened as the program is
fully implemented. This will increase the cost shift and
jeopardize the stability of our provider community, since
it will result in the loss of income to physicians, the
mental health system, and to local pharmacies. The premium
system was never projected to save a great deal of money.
It now appears it may be more expensive to implement as
federal matching funds are lost and administrative costs
increase.
We clearly cannot afford to keep expanding coverage without
making structural reforms. Prescription drug costs and hospital
costs are both rising at unsustainable rates. Choices are
being made for us about how our health care dollars will
be spent. Often times these choices are not discussed in
the public arena, but they should be.
While offering people more choice of insurance companies
may sound appealing, let's remember that costs were rising
every bit as fast ten years ago when we had many more insurance
companies. At that time, many of them spent only a fraction
of the premium dollars they collected on actually paying
for health care services. Before Vermont’s insurance
reforms were enacted, some companies wrote and promoted
policies ensuring only specific body parts and diseases,
and some companies were paying only 15 cents out of every
dollar collected from premiums for health care costs.
More insurance companies will do nothing to bring health
care costs under control. Although a fancy appealing name,
"participant directed care," has been to the latest
scheme, it really amounts to turning us all lose to fend
for ourselves in negotiations with pharmaceutical companies,
insurance companies, and medical providers. It’s not
an even match, and costs will continue to escalate as more
people become uninsured, and there are less of us left paying
for health insurance. The overall costs of the system will
still need to be paid; thus the vicious cycle will continue
with one difference: employers will have frozen their contribution
to paying for care, and more costs will be shifted to a
decreasing number of individuals.
Current proposals to allow companies to charge older sicker
people more will do nothing to bring costs under control,
We do not need to pit young healthy people and older sicker
people against each other. Everyone deserves affordable
health care. We should settle for nothing less.
back to main Issues page |
|
