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Health Care Priorities

04/19/05 12:00AM By Dick Mallary
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(HOST) As VPR commentators take a Hands-on Health Care approach to finding a cure for Vermont's Health Care ills, commentator Dick Mallary suggests that the legislature must tackle the fundamental question of how to fairly "ration" services.


(MALLARY) The single most important issue facing the Vermont legislature this year is how we provide and pay for health care. It is controversial. It is contentious. And, unfortunately, most of the players aren't dealing with the real issue.

The United States spends about 15 percent of its annual gross national product on health care - more than any country in the world - and our health results are only mediocre by world standards. Some of the excess cost is caused by administrative overhead, some by inefficiency, some by medical errors and even some by fraud. But much of the reason is that we are spending much of our money in the wrong places and on the wrong things.

The United States leads in medical research into new technologies, procedures and pharmaceuticals. Some of the new methods provide great benefits at modest cost. Others provide only marginal benefits at very high cost. And yet, the American public seems to believe that it should have convenient and low-cost access to every potentially beneficial form of health care, regardless of its cost or benefit. And our public officials echo that belief.

The time has come to talk honestly about setting priorities. Yes, rationing. We can't afford to provide every service or procedure or drug of whatever benefit to every person who demands it. Since government now pays for about half of all health care in the United States, it ought to spend its money on the health care that will do the most good for the populace. Whether we embrace a single-payer system or continue with a multi-payer system, government will have to set priorities for its spending and, to set priorities, there must be a clear and understand- able standard for what care will be provided and paid for and what care will be denied. Setting that standard requires achieving consensus on deep philosophical, religious, moral, political and economic principles and beliefs. It isn't easy, and that's probably why the politicians don't want to talk about it.

The fundamental issues that the Vermont legislature should be grappling with are two: What should be the responsibility of each person for his or her own health and health care? And, what level of health care should be guaranteed by government to every person? Only after we have answered these questions can we address the questions as to how we provide and pay for health care.

It seems to me that the Vermont legislature is getting the cart before the horse, since it is grappling with the structure of the system before it has dealt with the hard issue of setting priorities.

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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