Last week at a health care reform forum sponsored by the Vermont Citizens Campaign for Health (VCCH), Vermonters heard yet another indication that overhauling the state's health care system will not be easy.
Anya Rader Wallack, special assistant to the governor for health reform, said that H.202, the health care reform bill now in the Legislature, will control health care costs, insure every Vermonter, preserve individuals' choice of physician, reduce complexity and administrative waste, and encourage prevention and access to primary care medicine.
A five-member professional board, appointed by the governor, will have to come up cost control measures agreeable to doctors and health care consumers, as well as design a benefits package - called Green Mountain Care - that covers all Vermonters.
All of these goals sound good. But then you get to the part that has many Vermonters concerned.
Can the Green Mountain Care board, which has been designed to be independent from the Legislature, come up with a universal health care plan that is financially sustainable?
No one is saying.
What is clear is that this board will be responsible for coming up with a way to finance a single-payer plan by 2013, for coming up with a budget by 2014, and for coming up with an implementation plan by 2015.
In other words, the Legislature will not be taking on any of the tough questions about creating a new health care system for Vermont. It will be left to the Green Mountain Care board.
The theory is that taking politics out of the health care debate will ensure a better outcome. Admittedly, health care is a complex and confusing area of public policy, and anyone who tells you differently is lying. Given what we're seeing in Washington right now, taking politics out of the health care equation is a good thing.
But the talking points from opponents - that H.202 will do for health care what Act 60 did for education funding, and that the Legislature is moving too fast - amount to hogwash.
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Health care reform has been debated in Montpelier since the early 1990s. It has been conclusively established that the status quo is not working, and that a single-payer insurance system could cover more people for less money.
There are no secrets or surprises: reports to that effect have been circulating for years. All that has been lacking is the political will.
Everyone agrees on this point, though: Vermont spends about $4 billion a year on health care, and costs are rising at a rate of $1 million a day. And for those who are insured - whether through Catamount Health, the Vermont Health Access Plan, or a private insurer - the premiums, deductibles, and co-payments keep rising, and the coverage keeps shrinking.
Ralph Meima of the Marlboro College Graduate Center may have had the best insight at last Monday's forum. He lived in Sweden for 14 years and had a chance to experience that country's health care system firsthand.
Sweden has had socialized medicine in one form or another since the 19th century, and its citizens are heavily taxed to pay for it. Meima said that the biggest difference between that country and the United States is that a society in which no one has to fear falling into poverty because of health problems is a much calmer society.
The social and economic chaos that so many Americans face because they lack health insurance, or have inadequate coverage, is unknown in the rest of the industrialized world. While our Congress is trying to gut Medicare and Medicaid, Meima said, in Sweden, the only discussion is about improving the quality of health care.
That is the dialogue that needs to be restarted in our country. Are we a nation that still believes in the public good? Or are we about to descend into a future in which it truly is everyone for themselves, and if you are poor, sick, hungry, or homeless, too bad for you?
Vermont is taking a step in the right direction with H.202. But the various special interests that are fighting the single-payer model - the insurance industry, the hospital industry, and the drug companies - are lining up to kill the modest reforms that Vermont is proposing, and to prevent other states from coming up with their own reforms.
Fortunately, Vermont is different from the rest of the nation. We are a progressive state with a well-informed citizenry. Those belonging to the local grassroots groups that have been battling for health care reform for years have laid a strong foundation based on the facts, not emotional appeals. Outside groups and outside money have had little effect on public policy in this state.
We can still show the rest of the country how one little state can set up a health care system that provides universal coverage, while controlling costs and maintaining quality. We can't let up now.