Over the past two years, we have seen remarkable progress in the ongoing reformation of our health care system. Vermont has been moving in a solid and straightforward direction in the reform of how we deliver health care to the whole of our population for the past twenty years. We have recently grown our Blueprint for Health, which allows for a more holistic provision of care within the confines of our present insurance-driven system. Across the state, smaller medical centers are returning to the practices of the past — the kind of care we think of when we think of the old rural family doctors — more home visits, better nutritional care, better hospice care, a stated policy to keep people in their homes as long as possible, better office visits and, as importantly, the means to pay for it through pay schedules that encourage providers to prevent illness rather than react to it under an emergency basis.
In conjunction with the federal Affordable Care Act, Vermont is also building the required health care exchange, where patients and businesses can shop for the right insurance plan for themselves and their business in a transparent way. No surprises when you receive your benefit book from your provider. The exchange will allow Vermont to draw down tens of millions of health care dollars and tax benefits that will finally begin to provide some relief from the rising costs of insurance premiums. This exchange, which may also include a state-run option, brings us closer to our dream–a universal health care system.
This dream is real, and Vermont is as close as any other state to achieving it. But it won’t be easy. A universal health care system is the most compassionate way of providing health care to our people, and I think that it is a privilege. To be the only first world country without a universal system is, frankly, embarrassing. (I choose to call it a “universal” system rather than “single payer,” but others will not. In this argument, the terms are interchangeable, but I think the difference is important. When we have universal access to health care, there will be different payers–the individual or family, Medicare, Medicaid, and what have you.) But we will not get there overnight, even though a substantial part of our population already participates in a form of universal coverage, whether it be Dr. Dynasaur, Tricare, Medicare or VHAP. We know how to do it, and we know how it can work, and we are striving to make it affordable and available to everyone.
I strongly support our efforts to make universal coverage happen in Vermont. If it can happen anywhere in a way that is honest and efficient, it is here. I am proud of the efforts made so far, and I know full well that we have many miles to go before we get there. I approach this endeavor with my eyes wide open, and as I have said publicly again and again, if we cannot figure out a way to provide excellent services better than we do now for a lesser cost, we cannot change the system we are working with now. I believe we can, and I believe we will have a difficult time convincing customers, clients, patients, providers and payers that it is the right way to go. But our hard work will either make it happen, or it will show that it can’t, and no one should regret that or feel bad for trying.
(Update, July 6, 2012: The Supreme Court, in what was widely viewed as a surprise, upheld the Affordable Care Act in full. They also ruled on how Medicaid funds can and cannot be used by the federal government as an enticement or, more precisely, a stick to help implement the ACA. At this time, we do not expect these rulings to affect our efforts negatively.)