Reform languishes
Editorial
Times Argus (Barre-Montpelier, VT)
February 2, 2006
One of the leading advocates of health care reform has given members of the Legislature, Democrats and Republicans, a failing grade for addressing reform in a meaningful way.
Dr. Deborah Richter told a labor gathering in Barre on Sunday that plans proposed by Gov. James Douglas and by Democrats in the Legislature fail to take on the health care system as a system. Instead they are tinkering around the margins.
Richter is the co-author, along with former Human Services Secretary Cornelius Hogan, of a book called “At the Crossroads: The Future of Health Care in Vermont.” She and Hogan are leading advocates of an integrated, publicly financed health care system, and their thinking helped shape the health care debate as it got under way last year.
In her recent speech she was critical of Democratic legislators for accepting Douglas’ “reality” regarding health care. That reality is characterized mainly by a fear of new taxes. Democrats have backed away from plans for the use of broad-based taxes to pay for health care, knowing that Douglas would veto such a scheme.
Richter describes a different reality. She says that Vermonters presently pay a variety of taxes for health care — some visible, some invisible. We pay through property taxes, taxes for worker’s compensation, premiums paid by employees and employers, a higher cost of doing business, bankruptcies, and taxes that already go to government programs.
This system remains enormously costly and out of control because care remains separate from financing. Health care providers at present have little incentive for keeping people well. Insurance companies have little incentive for paying out money. Because providers and payers are separate, they work at cross-purposes.
Richter makes the point that most of what is paid out for health care is fixed costs — nurses’ salaries, hospital expenses, dialysis units. The nurse’s salary does not disappear if no one shows up at the emergency room on a given night. We pay her salary because we want her in the emergency room in case our spouse has a heart attack.
These fixed costs can be budgeted, Richter says, and doing so is the best way of containing costs. No other sector of the economy — certainly, no major business — operates without a budget. But the health care sector does.
Douglas opposes a broad-based tax, saying it would hurt the economy. Richter counters that Douglas portrays a broad-based tax for health care as a new tax. Instead, she views it as a replacement tax. It would replace a host of visible and invisible taxes that we are already paying but over which we have no control.
She says the Democrats in the Legislature have failed to come through with the studies that they promised on the financing of health care reform and its effect on the economy. She urges the Democrats to pursue these studies in order to provide a base line for discussion of meaningful reform.
The Legislature and governor have talked about a variety of constructive measures, such as improvements to the care of chronic illnesses and more sophisticated information technology. We are still waiting for information about whether broader reform would be possible. There are many questions about whether it would be, but there is no hope for progress until we have some answers.