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Health care dilemma

01/06/04 12:00AM By Dick Mallary
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(Host) The cost of health care will be a major item on the legislative agenda this session. Commentator Dick Mallary offers an analysis of the problem.


(Mallary) A little over four years ago, I completed my term as a trustee of an important health care institution. Before departing, I delivered a message to the medical staff concerning the challenges they faced. Among my comments to them was the following:

"...the challenges we face continue and some of them seem to be getting worse.

The public is complaining about health care cost increases, health insurance cost increases, pharmaceutical cost increases, a perceived change in the relationship between the physician and patient and anecdotes of denial or limitation of care by insurance companies or managed care institutions. The public has been persuaded that they have a "right" to unlimited health care services and that the burden of paying for it belongs to someone else. The public wants unlimited access to the ultimate in care and it doesn't want to pay for it.

Worst of all, the politicians don't want to tell the public the truth about the true cost of such a demand.

And, with all the best of intentions, Vermont has exacerbated the problem.

We have spread the cost of health insurance evenly to everyone by mandating that insurers use community rating, forcing many of the young and healthy to abandon coverage.

We have vastly increased the eligibility for Medicaid so that many are abandoning private insurance coverage to gain Medicaid coverage.

We have severely underfunded Medicaid and Medicare so that the true costs of these programs are shifted to insurers and private pay patients.

We have added numbers of mandated coverages to insurance along with strict regulatory burdens, thus also driving up the costs of coverage.

We have made it a severe financial challenge to deliver health care in Vermont and, similarly, we have made it difficult to remain solvent while delivering health care insurance.

As long as the political sector can promise what the public wants and expects and shift the burden of paying for it to others, we will continue in this precarious situation."

Four years have passed since I delivered that message. I'm now on another health care institution board, and the situation has not improved - perhaps it is worse.

The healthcare delivery and payment system, as it is now configured, will not solve the problem.

In response to its invitation for solutions, I offered to the recent Vermont commission on health care what I called a "Limited Entitlement Approach". It proposed a basic health care program that would guarantee every person a no-frills, cost-effective program of essential health care services at a cost they can afford. But, any services beyond that basic program would be their own responsibility. Apparently, the commission, reflecting public sentiment, was not ready to accept the concept that there should be limits to what we can guarantee. Until we do, the United States will continue to have the most expensive system of health care in the world with the best of care for some and precarious access to care for many.

This is Dick Mallary in Brookfield.

Dick Mallary has served extensively in state government and is a former U.S. Congressman from Vermont. He spoke from our studio in Norwich.
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