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Health Care or Health Financing?

04/22/05 12:00AM By Ellen David Friedman
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(HOST) All this week, in our Hands-on Health Care series, VPR commentators have been considering what it may take to cure Vermont's Health Care ills. There are two competing Health Care recovery plans currently being debated in Montpelier. Yesterday, commentator John McClaughry took a critical look at the legislature's proposal. Today, commentator Ellen David Friedman wraps up our series with her thoughts about the Governor's plan.


(FREIDMAN) Governor Jim Douglas is suddenly seeming out of touch on health care reform. His plan clings to the discredited system of health insurance which covers just some of us, while many thoughtful people across the political spectrum have concluded that health insurance is actually the problem and universal health care is the solution.

It's hard for me to understand why someone would defend health insurance companies. I mean, they don't actually do anything to improve health. Their function is to manage financial risk. So they spend millions of our premium dollars in verifying coverage, in denying claims and paying hefty executive salaries. But none of those millions go to keeping us healthy. And isn't the very tenet of risk management in health care itself suspect? Risk management may work for fires and floods, but it makes no sense for the care of humans who will all age, who all are vulnerable and who will all, eventually, need some kind of health care.

Plus, the old insurance model has led us into an irrational method of linking health care to random externalities: Yes, you get it if you're really poor, but no, not if you're working poor. Yes if you are employed with a union contract, but no if you're employed where the boss can't afford it. Yes if you're under 18, but no if you're 19.

And to make matters much worse, this division into separate pools - some of us covered and some not - guarantees unstable and unstoppable cost shifts. All of us end up financially burdened, and meanwhile, who is making critical decisions about our health? Not our clinicians, but rather our insurance executives. No one would deliberately design a system like this.

But while our health financing system is an enormous problem, our health care in Vermont is quite good. Researchers tell us that Vermont's infrastructure - the clinicians who care for us and the resources they use - is actually just about the size you'd want, in order to serve all Vermonters and serve us comprehensively. But the insurance approach keeps lots of folks out and is clearly pricing more of us out every day.

Once we can differentiate between health financing and health care, we can start choosing what's important. The multi-partner task force called Coalition 21 has started by adopting principles of universal access and financing that's fair and sustainable. The bi-partisian special House Committee has started by turning those principles into the outlines of a program. We can start choosing a future where all Vermonters are served equally, where premiums disappear and where we all contribute equitably through broad-based and progressive taxes.

It's a choice between a system of health care that remains a privilege - one that already leaves more than 60,000 Vermonters out - and one that provides a common benefit of good government to be paid for and used by all.

I'm Ellen David Friedman.

Ellen David Friedman is vice chair of the Vermont Progressive Party and has been active in the labor movement for 25 years. She spoke from our studio in Montpelier.
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