DUMMERSTON, Vt. — The prevailing philosophy of conservatives — that government is the problem and the free market is the solution for every ill — consistently bumps up against the reality that this philosophy rarely works as designed.
Here in Vermont, we are about to launch a program called Catamount Health, a program designed to provide coverage to the roughly 10 percent of working Vermonters who cannot afford health insurance. The state will subsidize the cost of the policy on a sliding scale for those making 300 percent of the federal poverty level — currently $62,000 for a family of four.
It's not a perfect solution to the problem of the uninsured in Vermont, but it is a good start toward the goal of universal health coverage. But that is something that the Bush administration does not want to see. Conservative orthodoxy holds that health insurance is not a right. It is a commodity that is no different from other goods and services. If you can afford it, great. If you can't, too bad. Government should not be in the insurance business, or any other business.
Given this line of thinking, the Bush administration seems to be going out its way to sabotage the efforts of Vermont and other states to expand health insurance initiatives such as Catamount. The White House is doing this unilaterally, without consulting Congress or the states.
A key part of the funding for Catamount was the waiver that Vermont obtained from the federal government to be able to apply Medicaid money toward the program. But the Bush administration objects to the idea that families with incomes at 300 percent of the poverty level should be eligible for insurance subsidies, and will not pay for coverage for families at that income level.
If that happens, Vermont could lose up $18 million over the next three years — all because of a philosophy that puts the profits of insurance and pharmaceutical companies ahead of the health and welfare of the American people.
But it's not just Catamount that's getting squeezed by the Bush administration. Vermont could also lose as much as $25 million because of changes in Medicaid reimbursements to care for special needs students. That represents about 10 percent of all state and federal spending on special education in Vermont.
Vermont currently leads the nation in the percentage of its residents covered by health insurance. That's because this state realizes that when the private sector fails, it's up to the public sector to deliver the goods.
When it comes to health care, every other country in the industrialized world realizes this. Only in the United States do we have arguments over whether giving every child access to health care constitutes "socialism," and have conservative think tanks such as The Heritage Foundation call programs such as Catamount "middle-class welfare."
In the short term, Vermont's programs can survive. In the long run, the state can't afford cuts in federal funding and still keep its insurance programs functioning at the current level.
Recently, Sen. Bernard Sanders, I-Vt., introduced the State's Right to Innovate in Health Care Act. The bill would provide federal money, as well as greater flexibility in spending that money, to five states. In return, they would try out programs providing for universal health care coverage.
Vermont is not guaranteed to be one of the five states, but Sanders is hopeful that Vermont could be. Under Sanders' proposal, at least one of the five states would institute a single-payer system.
It is abundantly clear that reforms to our nation's health care system are not going to come from Washington. The status quo — a nation that spends more on health care than any other nation in the world, yet has nearly 50 million of its citizens without health insurance — is profitable and that's all that matters.
The innovation is going to come from the states. Vermont, as well as Maine and Massachusetts, have all taken significant steps toward providing health care for everyone. These are significant steps that wouldn't have happened if they sat back and waited for Washington to come up with a plan.
All this is a reminder of one of the best scenes in Michael Moore's film "Sicko" — his interview with former Labour Party leader Tony Benn.
Benn, one of the most beloved and most reviled political figures in England, was present at the creation of the social welfare programs enacted after World War II. The Labour Party envisioned "cradle to grave" protection for Britons with universal health care, insurance against sickness and unemployment, family allowances, public housing and old age pensions. Similar programs sprung up throughout Western Europe and Scandinavia after the war.
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