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The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Schubart: Health Care Change

Vermont has committed to meeting the standards imposed by the new federal healthcare law and also to pioneer a single-payer system by 2017.

And while few would debate the need for change, the environment in which we set out to accomplish it is fraught with political controversy, misinformation and fear.

Nationally, a dysfunctional hybrid of for-profit and not-for-profit health services precludes secure coverage options, affordable care, or consistently reliable health outcomes - raising the thorny question of whether a national commitment to universal and affordable healthcare access can ever be affordably reconciled with the profit motive and free market capitalism. But Vermont has a primarily not-for-profit system and a good chance to create a high-functioning system based on community needs.

The Green Mountain Care Board is the regulatory apparatus for creating healthcare system change in Vermont. They’ll need to use creative destruction in order to design a cost-effective statewide network of tertiary care hospitals, community hospitals, clinics, and sole practitioners to deliver this new “right” to 620,000 dispersed Vermonters. They’ll need to close down or re-purpose current service providers that are redundant or not cost-efficient, while still meeting the healthcare needs of the given market. They’ll need to shift a competitive delivery culture to a collaborative one while still preserving functional business models.

They’ll also need the will and authority to amend the guild mentality of medical education, to further expand the quantity and spectrum of healthcare professionals - from nurses, nurse-practitioners, and EMTs, to primary care practitioners, and specialists, even as it affects their compensation. Perhaps UVM’s Colleges of Medicine and Nursing will lead by increasing enrollment.

And resources must also be allocated to help us understand how best to use a redesigned healthcare network, how to take charge of our own health and avoid unnecessary expense and illness. We’ll need to invest preemptively in wellness education from pre-school through secondary, specifically as it relates to addictions, sexuality, nutrition, and personal safety.

We will need t he foresight to understand and address the interplay among our legal, social and financial investments in public education, economic justice, addiction recovery, incarceration, and mental and physical health. These investments cannot be viewed in isolation.

If the Green Mountain Care Board has the wisdom and courage to address these issues and the cooperation of Vermonters to understand the complexities of changing our health care system for the better, great things can happen. And, as the nation plays catch up with countries that have long experience with national healthcare, it should be possible to learn from their experience and avoid the pitfalls that some of these larger questions raise.

But it’s a challenge to explain change of this magnitude in a way that’s both accessible and meaningful. Even professionals and business leaders struggle to understand the full impact – and Vermonters have little time or inclination to fully absorb the dazzling complexity of legal and regulatory reform. So, they sensibly ask, “What does this mean for me and my family?”

Bill Schubart lives and writes in Hinesburg. His latest book is Lila & Theron.
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