Good news came Friday in Montpelier when Gov. James Douglas agreed to consider an increase in taxes to help pay for changes in the stateâ€™s health care system. Though he conceded that it took him out of his â€œcomfort zoneâ€? on taxation, Douglas approved the notion of adding a 60-cent tax on a pack of cigarettes â€” driving state taxes from $1.19 to roughly $1.79.
Good for the governor. Just the notion of raising taxes to accomplish a public good was a needed concession to move things forward and offer an element of hope in future legislative discussions.
The governor, however, still insists that the final draft on the health care plan must include his employer-sponsored insurance plan, which requires employees who qualify for their companyâ€™s health insurance plan to opt for that plan rather than the stateâ€™s plan. While such a requirement would drive up costs to businesses, itâ€™s a fair point and one that Democrats can easily support.
Democrats, meanwhile, are now arguing for a provision that would require every Vermont resident to have health insurance and, perhaps, to adopt an annual â€œemployerâ€™s premiumâ€? of $200 to $400 per worker for businesses that do not offer health care insurance to their employees. Though Massachusetts just adopted a similar plan, thatâ€™s too punitive for Vermont, Douglas said, creating yet another point of contention.
So where are we in this debate? With much of the Houseâ€™s plan already conceded and with much remaining to be resolved, Vermonters can legitimately ask: Even if approved, how significant will the reforms be? One analysis is that weâ€™re taking a baby step toward universal coverage that may be better than nothing, while others may argue that the current direction would make matters worse.
Vermont Business Roundtable argued the latter in a letter to Sen. Jim Leddy, Chairman of the Senate Health and Welfare Committee, last week and brought up some valid concerns:
â€œThe Roundtable has very serious concerns that this bill and its various amendments being considered will by design: a) worsen the current cost shift burden; b) deliberately place additional costs onto the shoulders of those paying for health care benefits, and c) place further strains on the health care delivery system.â€?
The notion of doing more harm through legislation than good will be ardently rejected by the measuresâ€™ proponents, of course, but the Roundtableâ€™s point is a timely reminder that not all proposals â€” particularly those disemboweled in the legislative process â€” improve matters.
The Roundtable, which represents 115 businesses in Vermont, has long sought changes that would simultaneously reduce the rate of health care inflation while also improving Vermontersâ€™ health. To accomplish those twin goals, the Roundtable has endorsed measures that include:
â€¢ Building upon the current multi-payer, employer-based system of health care to ensure competition.
â€¢ Focusing on chronic care initiatives to improve patientsâ€™ quality of care.
â€¢ Investing in health information technology to lower costs and improve the accuracy and quality of services.
â€¢ Supporting an individual mandate to enroll every Vermonter into the health care system.
It is apparent that the Roundtable is not a proponent of radical reform and has a business-driven agenda. Nonetheless, their caution at this point in the debate is worth serious reflection.
To punctuate their concerns, the Roundtable reminded legislators that Vermontâ€™s system was in relatively good shape with far fewer uninsured than most other states, and that legislators should resist the temptation to over-promise benefits.
â€œThe Roundtable has â€¦ previously articulated its concerns that proposals must not jeopardize the fiscal stability of the state by over-promising and under-funding reform efforts, or by creating an entitlement mentality among Vermonters that cannot be realistically supported â€¦ The Roundtable strongly urges the committee to remember that Vermont is fortunate to start out with a very good health care system. We encourage lawmakers to stay focused on those provisions that are both affordable and effective in reducing the cost shift and that make all Vermonters healthier.â€?
As with the doctorâ€™s hippocratic oath: legislatorsâ€™ first concern in these matters is to â€œdo no harm.â€?
Angelo S. Lynn