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Schubart: An Ounce of Prevention

Periodically, we must relearn old lessons. A key such lesson is Franklin’s “Ounce of prevention…” adage - as relevant today as when Franklin applied it to fire prevention 250 years ago.

Vermont has reached a critical juncture. We face some daunting issues we seem unable to fix. We’re expedient and well-meaning, but our efforts to tweak our way along are in vain and are now only adding more expense.

Politics has evolved from public service into a lucrative career so there’s plenty of blame to go around, but attributing blame has become a political end in itself, defending empty ideologies and distracting us from actually fixing what’s broken.

Special ed., emergency healthcare, mental health crisis care, drug rehab, homelessness, environmental degradation, unemployment, incarceration …everywhere we see the exploding costs of remediating our failure to focus on the wellbeing of people, families, communities, the environment, and the economy.

Access to education, healthcare, housing, and economic self-sufficiency are all predicates to avoiding burgeoning downstream social costs. Yet the prospects for these stabilizing elements have deteriorated over the past thirty years. College is less affordable. There’s more insurance coverage but few can afford it. Housing is beyond the reach of many middle class families. Young adults now foresee less economic opportunity than their parents did. And we’ve distracted ourselves with vacuous ideological squabbling. Meanwhile, the severity of social malaise and government mistrust have worsened to a point where we can no longer afford work-arounds. As my car dealer once said, ‘It’ll cost you more to keep it running than to get a new one.”

Rather than join the rest of the civilized world, we tried to accommodate every interest in healthcare and are surprised that the ensuing mess isn’t working. Our access and quality remain exceptional but cost, transactional complexity, opaque accounting, for-profits interests, and the fee-for-service system continue to confound good preventative care. We have an insurance network composed of Medicare, Medicaid, ERISA, and the regulated non-profit Blue Cross, that could work as we transition away from fee-for-service to a capitated prevention model. But as long as we tolerate Pharma’s greed and accommodate commercial insurers, we’ll never control healthcare costs, which remains the single largest escalator in all our socio-economic costs.

We must refocus government investments on preventing the gathering storm ahead, and yes, it will cost more in the short term to save substantially in the future. But this “ounce of prevention…” will be well worth it.

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