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Context and Perspective

August 4, 2012

reptomstevens

One of the more interesting aspects of serving, be it in the legislature or on local governmental boards, is the need to rely on the context of a discussion, point of view or an argument, as well as the perspective of the person presenting it. Too often political conversation, or discussions about what should be done, don’t progress much beyond our initial biases because we, as advocates for our position, don’t see a benefit in giving ground or acknowledging there may be a common ground based on debate and compromise.

Take, for instance, our current discussion about health care or, more precisely, the cost of providing health care. Over the past 12 years, the amount of money we spend on personal health care has grown over 200%, and this increase is represented in our health insurance premiums, if we have employer-sponsored health care benefits or if we need to pay premiums for our state-sponsored health care. There are several arguments that are at play and unsustainable increases in cost is merely the latest and most visceral: how can we afford to keep our family covered if our costs go up X% every year and my salary doesn’t grow? Health care costs are not the only payment for a commodity that have risen astronomically–home heating with oil and propane have risen nearly 300% since 2000, as has gasoline. College tuitions have, at the least, doubled. Salaries for most Vermonters have remained static during the same time.

Finances aside, what other elements of health care matter? Historically (and I mean ALL of American History), our country has avoided moving its whole population to a universal health care system. From the time of the Revolution and the Civil War and the Industrial Revolution, there have been a number of attempts to install a health care delivery and payment system where everyone qualifies and everyone pays. In the past, our American Exceptionalism and our ingrained beliefs that everyone can earn what they deserve have allowed for what is now a capitalistic and Darwinian attitude toward health care. We seem to say, with our status quo, that if you can’t find a job that provides decent health care benefits, then that is your fault and you have chosen the consequences. Others, those who are suffering the consequences of a lack of health care insurance, are leading a fight to make health care a human right, something that we should all have access to no matter our financial or employment status.

Which aspect you support depends on your perspective, and how you support your view depends on your contextual knowledge. Would your attitude change if providing health care to all would reduce statewide costs, but might cost you more? Or if providing health care to all would cost significantly more, rather than less? Is it about money or fairness? Would your stance change if you knew how many Vermonters already have access to universal health care through Medicare, Medicaid, Dr. Dynasaur, VHAP or TriCare? Finally, if you have employer-based health care, how quickly would your perspective or context change if you were laid off tomorrow and you find that the difficulties in retaining health care coverage are something that shouldn’t happen?

From there, can anyone grasp the institutional context? Will doctors really flee Vermont because their need to be compensated at a higher rate overtakes their Hippocratic Oath? Will expensive malpractice insurance and education be subsidized so a doctor’s overhead is lessened? Or will a shortage of doctors exist because we will, all of a sudden, need more to take care of the presently uncovered individuals and, like schools, we want to retain a low doctor to patient ratio? And won’t this shortage and the desire to provide care to all lead to rationing? And what about the high price of pharmaceuticals?

Finally, there needs to be a quick nod to the existing insurance companies and their desire for profit and, in the words of some, a free market. Isn’t their desire for a profit just a way to justify rationing care? Aren’t their “premiums” just a “tax”?

We are the last first world country on the earth to institute universal health care. Many folks are appalled by this, and many think it is perfectly fine.

From this, those of us who are tasked with legislating these changes, or not, must weigh all of the persectives and contexts before we make decisions. Our need, no matter what our political leanings, should be to be able to take the black and white arguments we receive from advocates and lobbyists and turn them into something grey that actually works in this time and place.

It is said that a good compromise makes no one happy. Regardless of the issue–health care, education, property taxes, income taxes–this maxim is mostly true. When we are asked to consider common sense, I can assure you we are presented with several different versions of it from folks with different perspectives, different values and, yes, different contexts. From this list of ingredients, we try to make something palatable. That’s our job.

One of the benefits of serving in the legislature is that we have access to all of these stories and it is a privilege to listen to them. I may not agree with the arguments put forward, and you may not agree with mine, if they are in opposition. But the discussion is what is important and in what we like to call “the People’s House,” it is a necessary ingredient for our deliberations.

Always feel free to share your perspective and your opinion with us, and if there is an discussion and argument you would like to engage us in, please have it and please teach us what you know. The more we know, the better decisions we can make.

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