A publicly financed universal health care system (single payer) removes health insurers as the “middleman,” reduces administrative complexity and paperwork costs, and by removing barriers to health care, gets us to the doctor earlier, when our conditions are less serious.
Although Gov. Shumlin pressed the pause button on single payer in 2014, it is worth asking if we can still make progress toward the goal of health care as a public good originally enacted in Act 48 (passed by the Legislature is 2011). Can we get there through incremental steps rather than in one giant leap?
Many ideas have been put forward, but even incremental steps, if they are to take us in the direction of a universal public system, must have two key ingredients: they must enable universal access and create a public good. Fortunately, there is good news on that front. At the end of the last session the Legislature mandated an official study of the cost of financing a universal primary care system and the results are now in.
Why universal primary care? First, primary care is that crucial first-contact health care service that most of us use most of the time in our interactions with the health care system, and it keeps us healthy by diagnosing problems early. Public health studies show that a system of universal primary care is the single most important measure that can be taken to improve public health in a given population. Primary care services include those provided by internists, pediatricians, specialists in family medicine, gynecology, nurse practitioners, and even those who provide mental health and substance abuse services.
Primary care for all is also relatively inexpensive. While it occupies a critical place in any first rate public health system, it comprises only a small portion of total system costs – less than 6 percent of health care costs in Vermont, for instance. The recently completed study results show us that for just a little more than we spend now (about $48 more per Vermonter per year), we can make primary care a public service for all Vermonters, with no out or pocket costs. This is a critical step because according to the state’s 2014 survey of the privately insured, nearly 1/3 of all privately insured Vermont residents under age 65 are underinsured, and we all know that high out of pocket costs often deter people from seeking timely care.
Financing primary care as a public good will reduce the costs of private health insurance for all Vermonters, since private insurers will no longer be paying for those services (and therefore cannot charge for them). With a publicly financed primary care system we will also save money in the long run, because universal primary care catches problems early, before they are serious and more costly.
As important as saving on long-run costs and eliminating out of pocket costs might be, equally important is the fact that public health studies confirm that in case after case, widely accessible primary care is the single most important step that can be taken in improving public health. Guaranteed primary care for all has been linked to longer life expectancies, fewer emergency room visits and hospitalizations, and lower rates of mortality.
If we want to break down barriers to health care, improve public health, and contain costs, a universal publicly financed primary care system is a crucial first step. There is something in this for every one of us, as we would all benefit from a universal primary care system. Providers would also be positively impacted as a publicly financed primary care will simplify the administrative complexities under which they currently operate, and such a system will attract badly needed primary care providers to our state.
The Legislature would be well advised to take the results of the recently completed study seriously and to consider how to move forward with a universal primary care system. Two bills presently in the House and Senate (S.88 and H.207) propose steps to create such a system, and they deserve our support.
Ellen Oxfeld lives in Middlebury