A few weeks ago, at the annual Strolling of the Heifers Parade in Brattleboro, I had a chance to chat with Governor Peter Shumlin (only in Vermont!) about the state's plans to model universal health care. "It has to happen at the state level," he said. "That's the only way." I think he's right, and I'm happy to live in the state that is trying to become the first one in the country to provide publicly funded health care for all.
The Vermont plan, which may not go into effect before 2017, is called the Patient Protection and Affordable Care Act. It was signed into law by Gov. Shumlin on May 26th. Recognizing the challenges that lie ahead, he said he was "launching the first single-payer heath care system in America to do in Vermont what has taken too long -- have a health care system that "treats health care as a right and not a privilege."
Future challenges include securing waivers from the federal government so that Vermont could use its exchange in place of the government-run system being proposed by health care reform at the federal level. Decisions will have to be made about whom the state would pay for its public financed health care system, and what benefits would be covered. The biggest devil is in the details: How much will the plan cost and how will it be paid for?
Still, supporters are strongly behind the plan. Foremost among them is Dr. Deb Richter, a primary care physician who moved to Vermont from New York State in order to work tirelessly for a single-payer health care system where it actually had a chance of happening.
"We're going to hear all kinds of scare stories," she told legislators, advocates and reporters when the bill was signed. Then she reminded them that "every other industrialized country is doing what we are trying to do. And they do it for far less money, they live longer and they get better quality health care."
That same point is made by T.R. Reid in his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Reid starts with a key question: Do we have a moral obligation to provide medical care for everyone who needs it; i.e., is health a human right?
Every other industrialized nation adheres to that notion. And they make good on their obligation without forfeiting free market values or individual choice, and without resorting to "big government" or "socialism."
Reid, a Washington Post correspondent, set out to learn how so many other countries do a better job than we do with longevity, infant survival, and recovery from major diseases without going broke. He visited five countries which each have a model of comprehensive, financially sustainable health care and the lessons he learned are formidable and simple.
Reid was able to put to rest several myths. The first is that "it's all socialized medicine out there." The fact is that "most wealthy countries rely on private sector mechanisms to provide and/or pay for health care." Another myth is that rationed care means long waiting lists and limited choice. Not so in most countries. Nor is it true that universal health care programs are run by bloated bureaucracies. In fact, we have the most complex system and the highest administrative costs in the world -- and we still rank well below other countries for important health indicators.
That brings us back, of course, to Reid's -- and Richter's -- moral question: In the world's richest nation, "why do we tolerate a health care system that leads to large numbers of avoidable deaths and bankruptcies among our fellow citizens?"
Vermont doesn't want to tolerate that any longer. That's why in the fall a five-member board will be appointed to set up Green Mountain Care, as the state's system will be called. Among the board's tasks will be to set up a payment system, to examine cost-cutting measures, and to generally oversee the development of a single-payer heath care system in Vermont. As they move forward, they will build an exchange in accordance with federal law and will regulate insurance companies within that exchange.
"This is not the top of the mountain," Dr. Richter has said, "but it's the first time anyone has headed up the mountain. No other place in the country has gotten this far."
I'm not much of a hiker, but I'm sticking with her. After all, Vermont has a tendency to lead in matters of conscience. We were the first to abolish slavery and the first to sanction civil unions. We're problem solvers and people with good sense. That's why we're going to show the rest of the country that a single payer system of health care is the way to go. That makes me wicked proud.