We need health care for Vermont
Toolbox
By Dr. Stuart E. Williams - Published: November 10, 2008
I am a family physician who has lived and been in practice in central Vermont for 28 years. I am proud to be a part of a network of professionals and nonprofit facilities that provide excellent health-care services to Vermonters. In fact, in 2007, Vermont was rated the healthiest state in the United States and our health-care spending per capita is among the lowest in the nation, due in part to efficient use of resources.
Vermont also has made significant progress toward assuring health-care services to its citizens through expanded Medicaid eligibility, Doctor Dynasaur, and the new Catamount Health Plan.
But we are still facing a health care crisis, which only worsens as our economy melts down and many working families cannot afford the health care they need. Ten percent of Vermonters still lack health insurance, and many thousands more have limited coverage or high deductibles that inhibit access to medical services or expose them to bankruptcy.
It's not just adults who are victims of this crisis: The number of uninsured children in Vermont, according to the Census Bureau, rose between 2005 and 2007 from 5.3 percent to 9.4 percent. Even with subsidized health care programs, premiums are often too high for low-income Vermonters. This results in delayed preventive and secondary treatments, often with tragic outcomes.
In my practice, I place a strong emphasis on preventive health and early identification and control of medical conditions. People who are uninsured or have high deductibles often put off or forego preventive services because of out-of-pocket expenses.
I know and have treated some of these people. One, a middle-aged store clerk, had high cholesterol and a strong family history of heart disease, but could not afford regular blood tests or the effective medication I recommended to control cholesterol. This patient suffered a heart attack and required bypass surgery, which might have been prevented with early treatment of high cholesterol. Another patient is a logger who did not qualify for Medicaid and could not afford a screening colonoscopy. He came in with advanced colon cancer that could have been prevented by early detection of a pre-malignant polyp. A young electrician with insulin-dependent diabetes was unable pay for an evaluation by an ophthalmologist that might have identified the retinopathy that ultimately led to a hemorrhage and loss of vision in one eye.
I had seen these patients at a time when early screening or treatment would likely have made a beneficial difference in their medical outcomes, and the only barrier to these preventive services was financial. If these patients had been in a lower income bracket, they would have received services through Medicaid. But, unfortunately, they were low- to moderate-wage earners who made too much to be eligible for Medicaid and too little to afford the high premiums or deductibles of private insurance plans.
Is it not time that Vermonters agree that health care is a public good and should be a personal right? Just as we have committed to providing equal education opportunity to our children, we should commit to universal and affordable access to health care for all.
We can accelerate the achievement of that goal by immediately expanding access to Catamount Health for all Vermonters, including the under-insured and small businesses. This will require lowering the plan's current premiums, which, though publicly subsidized, are still too expensive for many. In addition, we should eliminate its troublesome waiting period for eligibility and ban the exclusion of pre-existing conditions.
In respect to our state's health care system as a whole, if the administrative costs of health-care financing could be reduced to the level of Medicare (just 3 cents on every dollar compared to 15 cents by private insurance companies), the savings would be sufficient to pay for coverage for all uninsured Vermonters. This reform can be accomplished by establishing a unified, publicly funded financing system for health care, modeled after Medicare. In addition to lowering administrative overhead, such a financing system would reduce administrative costs to hospitals and providers by simplifying billing and referral procedures. This would not change how health services are delivered. Vermonters could still choose their own doctors. What it would do, finally, is give all Vermonters equal access to affordable health care.
There are many obstacles that can interfere with people receiving appropriate health care services, but affordability, in a nation as wealthy as ours, should not be one of them.
42