BRATTLEBORO — At the Vermont Citizens Campaign for Health's recent annual meeting, two members of Dr. William Hsiao's team presented early findings gleaned from interviews with professionals, elected officials, and advocacy groups involved with health care in Vermont.
Ashley Fox, Ph.D., and Nathan Blanchet, a Ph.D. candidate at Harvard, said Vermont is in a unique position to remain a health care reform “trailblazer.”
They cautioned that this wouldn't prove easy and would require, above all, a sense of unity among elected officials, businesses, residents, and advocacy groups.
Unity, said Blanchet, may not be easy in a state with a population of - as one Vermonter described them - “socialist libertarians,” who support working together as a co-operative community while wanting to be left alone, independent, and free to do as they please.
Fox and Blanchet interviewed 70 people representing hospitals, health care providers, legislators, business owners, and health care advocates in August and September.
According to Fox, an Agency for Health Care Research and Quality Fellow at Yale University, she and Blanchet tried to balance interviews between those pro-health care reform and those who are wary of such measures.
This year, the Legislature passed Act 128, which deals with health care financing and universal access. Lawmakers charged Dr. William Hsiao, a professor of economics at Harvard University, and his team to develop three plans to provide universal health care to Vermonters.
According to Act 128, of the three plans suggested by Dr. Hsiao, who helped design Taiwan's health care system, one had to be a government administered single-payer option, another had to be a public option and the third plan one of Dr. Hsiao's own design.
Fox said she and Blanchet reviewed Vermont's 1994 attempt to enact universal access to health care. At that time, the legislature was close to passing reform legislation but, in the end, lawmakers did not succeed in enacting any large-scale changes.
“The past shapes the present in a profound way,” Fox said.
Fox outlined some factors that contributed to the legislation's failure, including the absence of a clear funding method, too many proposed plans, the Burlington Free Press “misrepresenting” a cost increase, and opposition from small, grassroots business groups.
Blanchet said the state faced opportunities, constraints, and concerns moving forward on reform in the present era.
He said having Democrats in control of the legislative and executive branches of government will provide one opportunity.
“We'd be in a different game if Brian Dubie had won the election - not sure what that game would be,” said Blanchet.
Other opportunities include Governor-elect Peter Shumlin's appointments of cabinet members with health care reform experience and the progress made in the “art and science” of successful health care reform, and in developing new systems.
Constraints included fallout from the recession, limits placed on states' powers by the new federal health care bill, and no explicit allowances for waivers from the federal Employee Retirement Income Security Act (ERISA), which sets minimum standards for pensions and health care in private industry.
Blanchet called the biggest threat Vermonters' diversity of interests.
Vermonters would need to unify their health care coverage and benefits goals to ensure successful future reforms, he said.
A unification of plans could prove an interesting feat in a state with a “patchwork” of benefit plans and delivery systems, and a population with easy access to its elected officials, said Blanchet.
Kate Kanelstein, an organizer with the Vermont Workers' Center, said Vermont is at an “exciting” point with health care reform.
“But we're up against pretty big challenges,” said Kanelstein. “The opponents have a lot of power and a lot of money. But we have a lot of us.”
Dr. Hsiao and his team will present their findings to the Legislature in mid-January. The public and legislators will have a chance to comment on the proposed health care plans. Then, the team will review and present the revised plans later next year.