As the country squabbles about the best health care system for the nation, a number of Vermonters have been pushing for guaranteed primary care for everyone in the state.
But a number of questions remain to be answered, such as what primary care means and how it will be funded.
In 2015, two bills proposing publicly financed primary care were introduced in the Vermont House and Senate with tri-partisan support. A study found that for $48 more per Vermonter each year, every Vermonter could visit a primary care physician without deductibles or copays.
However, legislators wanted more information than was available, and confusion developed over complying with the national Affordable Care Act.
In next year’s legislative session, that extra $48 dollars per Vermonter — a total of about $30 million — could stand in the way.
The Legislature keeps saying that universal primary care will be great, but “we don’t give the costs of the program until the very end, and it’s honestly a challenge. It takes me 12 sentences to get the complexities out, but only takes one from an opponent to say he wants to raise your taxes,” said Mike Fisher, a health care advocate with the nonprofit Vermont Legal Aid, said.
Richard Story of Stowe said he did not vote for Gov. Peter Shumlin when he was pushing single-payer health care because he hadn’t presented a way to pay for it.
State Rep. Sarah Copeland-Hanzas, a Democrat from Bradford, said every one of those dollars is somebody’s job, and universal primary care is a great concept — even moral — but getting approval is “like trying to bring a supertanker aircraft in for a landing without landing gear.”
The comments came at a public forum sponsored by Lamoille County Democrats in Morrisville last week, with about 40 people in attendance.
Universal access to primary care will reduce system-wide health care spending, sponsors of H.248 and S.53 say, because it would reduce emergency room visits and hospital admissions by keeping Vermonters healthier.
Primary care would cover health services provided by professionals trained to diagnose and maintain an individual’s physical or mental condition, including chronic care management, preventive care, wellness services, nursing home visits or in-home visits, and other medically necessary services to assist with daily living.
Primary care would not include dental or vision care.
“We are doing a disservice to our fellow Vermonters by the way we currently fund health care,” Copeland-Hanzas said. “Changes need to be made regardless of who’s paying, and this bill puts some meat on the bones of how we can achieve universal primary care.”
Even with universal primary care, Vermonters would need additional health insurance to cover secondary care, but what exactly does that mean?
“The pediatrician my kids go through does stitches right in her office, so they don’t need hospital care,” Copeland-Hanzas said. “Not all offices do that, so is that considered a primary or secondary service?”
Lori Jones, a Morrisville resident, thinks primary health care should cover eyeglasses.
“I’ve been wearing the same scratched glasses for two years now because I couldn’t afford a new pair,” Jones said. Glasses are necessary for her daily life, so why aren’t they covered?
“I don’t know why we have that division in health care, and we don’t treat above the neck — eye, dental or mental health,” Fisher said.
Fisher says a great deal of study has been done on health care systems around the globe, and there is tremendous evidence that other countries do a better job of covering their residents.
“And yet, look at the national scene here,” he said. “It’s a reminder that politics are not rational.”
It’s not rational to allow politics to regulate the health care system, Copeland-Hanzas said. In Vermont, the Green Mountain Care Board is meant to provide that independent voice, but the board has a lot of work ahead of it.
“We can’t just tinker with the numbers in an abstract way when there are people’s lives involved,” she said.
Walter Carpenter of Montpelier said he had to negotiate the cost of his life like a “slave on the auction block,” because hospitals try to hide the fact that they charge the uninsured patients more than those insured.
“It’s irrational, but it seems that it’s not so much about rationality as it is about profit. What stops the single-payer model from passing is fear,” Carpenter said. “Universal primary care is the first step, and we’re already paying that money.”
Stowe resident Jo Sabel Courtney said the three panelists — Copeland-Hanzas, Fisher and Dr. Anna Carey, a family doctor who practices in Cambridge — were preaching to the choir in a room full of Democrats, and they needed to make universal primary care a bipartisan conversation.
“I don’t see the state senator or Stowe rep here. Were they invited? We need to change their minds about the system,” Sabel Courtney said.