In reflecting back on this week of discussing Vermont's attempt at inventing a new health care system, a few voices resonate:

Nancy Turnbull, Harvard School of Public Health:
"It's a very big and bold ambitious proposal of a kind that's never been tried in the United States before.... to actually cut the connection between employment and health insurance."

Tom Huebner, CEO or Rutland Regional:
"The central problem is matching what we want from our health care system with what we can afford. We want everything, it seems like, but we don't want to pay for it."

Dr. Keith Michl:
"It going to be a difficult trick and I'm skeptical about whether our little state can pull it off."

In working on this series, we saw themes emerging across interviews, and research and listener comments. Cost are rising, for a variety of reasons. Those states that have attempted new ways of delivering care haven't met their goals, because they can get a handle on costs. Doctors can envision ways to deliver more effective care, but payment systems make those changes difficult to implement. Medicaid and Medicare extend access to health care to a lot of people who otherwise would be uninsured, but those programs also shortchange the system but not paying full price for services. Primary care and prevention strategies are desirable, but not well-funded. And heavy doses of blame have been levied on insurance companies, and on patients whose lifestyles lead to expensive health care demands.

In today's broadcast, Steve Kappel, who teaches health care policy at the University of Vermont, put it this way:

"Primarily the whole financing conversation is, what do we owe each other? Do we have obligations to other people in the realm of health, or should a financing system be built around simple self-protection."

The different perspectives on how Vermonters can best meet these obligations to their neighbors and their families form the basis of the debate over reshaping health care.
In Vermont, the Legislature is wrestling with this issue, with the introduction of an insurance exchange and health care board to oversee it, and in the future with a decision looming about whether to pursue a single-payer system within the state. VPR will continue following these developments in the months and years ahead.

PS: Kudos go to two listeners who have paid attention so closely that they wrote to make this request: stop saying "preventative"! They prefer "preventive" instead. We've used both words interchangeably and notice that other news organizations do, too. But after hearing from a listener on this question, we consulted the AP Style Guide which suggests "preventive" is correct. At least we solved one health care problem this week.