For a quarter century, beginning in 1998, Vermont has been the recipient of a $962 million “gift” it had no reason to expect. It was a gift that had the potential to change the health care culture of Vermont, to perhaps orient it more toward a culture of health, not sickness.
But it has not been properly used, and its misuse continues.
The “gift” is the 1998 tobacco trust fund settlement. Vermont was one of the key states involved in the class action suit against the tobacco companies and the roughly $38 million a year was to be used in Vermont to compensate for the health care costs caused by tobacco.
There is no other example of an industry that is legally obligated to send each state funds to compensate for the damages caused by its product. And, obviously, it’s not petty cash. The settlement will result in $24 billion to the states this year alone.
The problem is that the settlement did not stipulate how states would be able to use the money, which has worked to the advantage of the tobacco companies. Most states have used the money for everything but tobacco cessation efforts, which the tobacco companies must applaud.
Vermont has conducted itself more honorably than most. We haven’t built bridges with the money, but we haven’t used it to promote healthier lifestyles for Vermonters. The lion’s share of it has been used to fund the state’s portion of its Medicaid program (34 percent).
A pittance has been used to fund the smoking cessation programs Vermont needs to reduce tobacco use.
In fact, the raid on the tobacco fund has left the cupboard bare.
Beginning in 2017, Vermont will get less settlement money each year. The problem is that the Legislature “overappropriates” what it assumes will be coming to the state annually. This means the fund is in the red for the coming year, which makes it doubly difficult for the fund to ever regain its footing. We’re always making up in one year what was overspent in the year prior.
The reason for our circumstance is that the skill to find different sources of untapped revenue has a higher priority than the skill to figure out how to use the tobacco settlement money to achieve its intended cause. The Legislature (and the governor) score more political points by using the trust fund’s $34 million to plug budget holes than by using it to curb smoking or to pursue healthy lifestyle initiatives.
But that’s the proverbial penny-wise-pound-foolish thought. It’s been proved time and time again that for every dollar invested in smoking cessation that five dollars is saved in actual health care costs.
In Vermont, as in every other state, we have a health care system that is almost entirely focused on sickness, and not on wellness. If we’re truly interested in reducing health care costs, then we can’t proceed without also addressing the need for prevention. Health care costs are a direct reflection of usage. If it’s used less, it will cost less.
James Fries, a research professor at the Stanford University School of Medicine, has long made the argument that the “compression of morbidity” is what holds the greatest potential for long-term reduced costs. What he argues is that if we can figure out how to delay the onset of chronic illness, the “compression” of what eventually spells our demise will be shortened. Instead of using the health care system to manage our chronic illnesses for 20 years, that might be cut to 10 years, or five.
As Mr. Fries argues, our obesity levels work against that need. So does smoking. So does a lack of exercise. He notes the data that showed over a 21-year study of those who exercise versus those who do not, the group that exercised developed disabilities 16 years later than the group that did not exercise.
Think about that. If, as a society, we were able to delay the onset of chronic illnesses for even half that time — eight years — the health care savings would dwarf anything considered by the bureaucrats as a “savings.”
But, as a state, we don’t really try. (And we’re better than most.) This is why it’s tragic to reallocate the trust fund money away from tobacco cessation or any other program that actually deals with the issue, which is the need to live healthier lifestyles.
Emerson Lynn, St. Albans Messenger