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26 Jan2018

Ad­vo­cates press for uni­ver­sal pri­mary care

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By Mike Fa­her, VT­Dig­ger.org

If state leg­is­la­tors needed a cheer­ing sec­tion for en­act­ing uni­ver­sal pri­mary health care, they got one Tues­day night.

Dur­ing a pub­lic hear­ing jointly hosted by the House Health Care and Sen­ate Health and Wel­fare com­mit­tees, more than 50 peo­ple ex­pressed sup­port for a pub­licly funded health plan that would pro­vide pri­mary care for all.

The fi­nanc­ing and ad­min­is­tra­tive de­tails of such a plan have yet to be worked out. But law­mak­ers said the sto­ries they heard dur­ing two and a half hours of tes­ti­mony re­in­forced the need for a more ac­ces­si­ble pri­mary care sys­tem.

“Hear­ing peo­ple’s sto­ries is, in my view, one of the most pow­er­ful mo­ti­va­tors for every­one, re­gard­less of what your po­lit­i­cal per­sua­sion is,” said Rep. Bill Lip­pert, D-Hi­nes­burg and House Health Care Com­mit­tee chair­man.

The mem­ory of past health care re­form fail­ures hung over Tues­day’s hear­ing in the crowded House cham­ber.

Sev­eral speak­ers ex­pressed bit­ter dis­ap­point­ment over the lack of fol­low-through on Act 48, the 2011 law that laid a foun­da­tion for uni­ver­sal health care, and for­mer Gov. Pe­ter Shum­lin’s 2014 de­ci­sion to drop pur­suit of sin­gle-payer health care.

“We have had var­i­ous im­pulses to­ward get­ting health care for all Ver­mon­ters,” said Mar­jorie Power of Mont­pe­lier. “Every sin­gle time we have choked. There’s al­ways some ex­cuse.”

Power said it’s be­come clear that “we can­not, with a two-year Leg­is­la­ture and (gov­er­nor), do it all in one bite. It will just be choke, choke, choke.”

“Here we are with the pos­si­bil­ity of tak­ing a ma­jor first step,” she added.

She was re­fer­ring to a plan, es­poused in S.53 and H.248, to es­tab­lish a pub­licly funded sys­tem that would “en­sure that all Ver­mon­ters have ac­cess to pri­mary health care with­out fac­ing fi­nan­cial bar­ri­ers that would dis­cour­age them from seek­ing nec­es­sary care.”

Both bills were in­tro­duced early in the 2017 ses­sion. At Tues­day’s hear­ing, there was strong sup­port for that leg­is­la­tion to move for­ward.

Pa­tri­cia Reid of Ad­di­son said she re­ceives vi­tal care from her pri­mary care doc­tor. But she also de­scribed her­self as “un­der­in­sured,” mean­ing, “I do not ac­cess care when I need it due to fi­nan­cial bar­ri­ers.”

By en­act­ing uni­ver­sal pri­mary care, “we would cre­ate sta­bil­ity that would take away the un­fair ques­tions that I and many peo­ple like me have to ask,” Reid said.

Kaiya An­drews of Wa­ter­bury – wear­ing the red Ver­mont Work­ers’ Cen­ter T-shirt that was com­mon at Tues­day’s hear­ing – said she is a dis­abled par­ent who has been un­able to find a doc­tor who will treat her.

“We need to have uni­ver­sal health care for all hu­mankind, not just the ones that are easy to fix,” An­drews said.

Ellen Schwartz of Brat­tle­boro said she has good in­sur­ance, and it has al­lowed her to re­ceive prompt, con­sis­tent treat­ment of re­cur­ring skin can­cer.

“This is great for me,” Schwartz said. “It’s how our health care sys­tem should work – but not just for me. It should work like that for every­body.”

“Our hu­man­ity should be the sole qual­i­fier for ac­cess to health care in­clud­ing, but not lim­ited to, pri­mary care,” she added. “It is sim­ply un­ac­cept­able that some­one like me wins the health care lot­tery while oth­ers suf­fer or even die.”

Dr. Al­lan Ram­say, a for­mer Green Moun­tain Care Board mem­ber who serves as med­ical di­rec­tor of the Peo­ple’s Health and Well­ness Clinic in Barre, said many of the pa­tients he sees suf­fer from “un­di­ag­nosed and un­man­aged” con­di­tions “due to lack of in­sur­ance or ac­cess to ba­sic health ser­vices.”

“The sim­ple and log­i­cal truth is that we do not ex­pect our car in­sur­ance to pay for the gas we need to run it,” Ram­say said. “We should not have to rely on in­sur­ance to pro­vide the pri­mary care that we all need to stay healthy.”

There was ex­ten­sive tes­ti­mony not only about the need for bet­ter pri­mary care, but also about the ben­e­fits.

The pend­ing leg­is­la­tion says uni­ver­sal pri­mary care would “re­duce sys­temwide spend­ing,” in part be­cause “bet­ter ac­cess to pri­mary care re­duces the need for emer­gency room vis­its and hos­pi­tal ad­mis­sions.”

Ten­zin Chophel, a crit­i­cal care and car­di­ol­ogy nurse at the Uni­ver­sity of Ver­mont Med­ical Cen­ter, said “pri­mary care is life-sav­ing.”

Too of­ten, when Chophel en­coun­ters a pa­tient at the hos­pi­tal, “what they tell me is that they haven’t seen a doc­tor in years, decades, ever.”

Dr. Sue Deppe, a Colch­ester psy­chi­a­trist who also was rep­re­sent­ing the Ver­mont Psy­chi­atric As­so­ci­a­tion, told law­mak­ers that “un­treated men­tal ill­ness, sub­stance abuse and un­treated med­ical (con­di­tions) take an enor­mous toll on so­ci­ety. And you see it in bud­gets.”

“Uni­ver­sal pri­mary care is in­ex­pen­sive,” Deppe said. “The pay­off is enor­mous.”

Deppe would get no ar­gu­ment from Sen. Claire Ayer, D-Ad­di­son and chair­woman of Sen­ate Health and Wel­fare.

“I think we’ve proved that it’s valu­able,” Ayer said. “We just have to fig­ure out how to stand it up in a way that makes sense, and that we can man­age.”

The key ques­tions for uni­ver­sal pri­mary care, Ayer said, are ad­min­is­tra­tion and fi­nanc­ing. Nei­ther bill spec­i­fies a fi­nanc­ing mech­a­nism for uni­ver­sal pri­mary care.

Ayer down­played the sig­nif­i­cance of po­ten­tially levy­ing new taxes to pay for the pro­gram. “I think it’s more like an in­vest­ment rather than a new tax,” she said.

Lip­pert could­n’t haz­ard a guess on how far ei­ther uni­ver­sal pri­mary care bill will ad­vance be­fore the cur­rent leg­isla­tive bi­en­nium ends.

“I know that, over time, change can hap­pen. It re­quires a vi­sion and per­sis­tence,” Lip­pert said af­ter Tues­day’s hear­ing. “I re­main hope­ful that we can find our way to health care for all in Ver­mont. What we can achieve this year, we’ll have to see.”

Source: bartonchronicle.com

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