Health care for Vermonters

Posted Friday, February 3, 2017 2:57 pm

At the present time, the health care exchange in Vermont is called Vermont Health Connect. It is a version of the federal Affordable Care Act commonly known as Obamacare.

Many say it is not working very well. Many say that the entire national program called Obamacare is not working very well.

So how did we get here and why is it not working very well? Let's take a look at how this has evolved and talk about some of what Obamacare in Vermont is or is not all about.

It all started about eight years ago when there was a whole team of people in the U.S. Congress, including Bernie Sanders, who wanted to introduce a new health care system that would replace the for-profit health insurance system that was in effect at the time. We need a more effective (read: more health access and better outcomes) and less expensive (affordable) health care system. It was to be similar to the systems that most other civilized countries in the world are using. When first suggested it was to be modeled on our present United States Medicare system. It was referred to as Medicare For All. Did we ever get Medicare For All? No we did not.

The legislative process that ensued was to turn the original Medicare For All idea on its head. In the end the congressional back-and-forth debate ended up right back where it started — the original for-profit insurance system that we started with. It did make a few important improvements in the original for-profit system, imposed some limited restrictions on insurance companies and their denial of claims, and provided health insurance for about 20 million people. Essentially, however, it stayed the same, using our health as a commodity for corporate profit.

The insurance companies, pharmaceutical companies and hospitals were so strongly opposed to a Medicare For All system that they spent millions and millions of dollars to defeat it and they succeeded. The result was to put the whole system back into the hands of the insurance companies and that's where it stands right now today; Obamacare.

Let's take a look at how health care in the hands of insurance companies works. Those of us who can afford it pay insurance premiums to a private company that has thousands of customers the more the better. In terms of business strategy the basic premise is to try to enroll as many payers as possible and then endeavor to pay as few claims as possible. That is the requirement built into the profit-making system.

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People are saying, look, it's like any other business. The more business competitors there are, the cheaper it's going to be. And it's true that for consumable products like baked goods. For example, if I'm across the street from another baker and their bread is selling for a dollar a loaf, I might try to sell mine at 95 cents a loaf because I'll have more people come in and I'll sell more loaves and make more money even when charging less for the bread. So that's the normal competitive system.

The argument is that if we have more insurance companies in our health care system and we bring more across state lines for instance, it will be cheaper. NO! That is not the way it works for health care. Competition does not cause costs to go down in the for-profit health care business world. The more competitors there are, the lower the risk pool per each gets fewer and that causes less profit for each business.

Health insurance companies are a very unusual hybrid kind of capitalist business in our economy. Their business model is not selling bread or automobiles, tangible products that are sold in exchange for money. Let's say an insurance company has 50,000 customers. Many of those customers require medical care from doctors, hospitals and other health care providers, while other payers require little or no care at all. So out of that 50,000 people, there are going to be some people who need a lot of care and the company must pay out a lot of money for their care, but others will require no care at all. That is where the profit comes from and that is why the insurance companies need to have many, many customers. That is why the normal competitive principle does not work in our health care business. Only the very large companies without competition can survive because they need a large risk pool to harvest payers who do not need their services.

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We do not see Medicare prices going up every year like we see insurance premiums going up every year. That's because the Medicare system does not have to make a profit but the insurance system does need to make a profit.

Let's not make the mistake of thinking that our premium payments will go down any time soon under the present for-profit system. As long as there are insurance companies calling the shots, where profits are the priority, that will inevitably lead to higher costs for users.

If Obamacare does not seem to be working it is because it treats our health as a product to be bought and sold for profit. This is why the discussion in Washington is so hard to understand. The legislators seldom acknowledge the dichotomy between the human right of health care for all vs. a commodity to be sold for profit.

The Affordable Health Care Act (Obamacare) and the Vermont version, Vermont Health Connect, is now and always has been a profit-making enterprise. People are now demanding to do away with it. But the question is what do we replace it with?

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The answer is already at our fingertips here in Vermont. In fact it is a law that is presently on the books. That is the universal health care law titled "Act 48, Green Mountain Care" (GMC). This law states that in must be in place in 2017 and that it will be a single payer system that covers all Vermonters.

"The law required Vermont's Executive Branch to develop a plan for financing and operating Green Mountain Care a publicly financed coverage program for all Vermonters." The governor did submit a report but said it was not the right time for Act 48 to be implemented and it would not work.

There is reason to believe, that now under the present conditions the governor was wrong.

So we are urging that now in the state of Vermont it's time to take another look at Act 48 a law that is still a law on the books and is designated to be in place in 2017.

Let's instruct our legislators to take another look at the present Act 48 law and see if they can use it to get us out of this mess known as Obamacare and replace it with the health care law that is cheaper, more inclusive and is already the law in Vermont.

This commentary is by Mary Gerisch and Bob Howe, whose radio program, "Health Law Trends," airs on WBTN AM. This is an edited transcript of one of their weekly shows titled " Health Care for Vermonters." broadcast in December. It first appeared on VTDigger.