Montpelier Doctor Calls For Universal Health Care
By JAN NEWPHER, City Editor
Friday August 22, 2003
LYNDONVILLE VT- The ever-rising cost of health care is fast becoming a common topic of conversation as the baby boomer generation ages. Participating in the conversation are people advocating what they believe are solutions.
One suggestion is adopting a single-payer universal health-care system administered by the government, a system used by many other countries including Canada.
An advocate of this solution is Dr. Deborah Richter, a Montpelier family practitioner who at one time served as president of Physicians For A National Health Plan and is now a representative of Vermont Health Care For All, a Montpelier-based tax-deductible, nonpartisan organization providing information and news about health care.
Richter, co-author of “Heath Care From A Different Perspective,” a March 2003 position paper, spoke to the Lyndonville Rotary Club Wednesday at the First Congregational Church in Lyndonville. She came armed with facts and figures supporting her position for a universal health-care system.
She told the Rotarians she got her start in learning about health care in the inner city of Buffalo, N.Y., where many people had no health coverage at all. It is “a real atrocity,” not having health care, she said.
One thing we are doing wrong is looking at coverage rather than at services provided, she said. Vermont is a good state to look at coverage because it reflects pretty closely the national experience.
Citing information from a summary of the Lewin Group’s 2001 analysis of health care in Vermont, a study commissioned by the state, Richter said more than 70 percent of our health-care dollars is spent on health-care infrastructure which in Vermont consists of 14 hospitals, 44 nursing homes, 1,300 physicians, 10,000 nurses, 17,000 health-care workers and more. The structure is there whether we use it or not and its cost is fixed – 84 percent for hospitals for example, and 70 percent overall.
Eighty percent of Vermont’s population at any one single time uses only 15 percent of the available health care, while a major share of the heath care is used by only 10 percent of the population, many over the age of 65.
Since health services have such high fixed costs, she said, it makes sense to tailor the size of the infrastructure to what is actually needed. These actual needs should be determined and paid for collectively – by the whole population of Vermont.
For example, 7 percent of Vermonters have diabetes and 25 percent have high blood pressure. Services right now expand to meet the need and when people cannot pay, costs are shifted onto people who can pay – the hospitals raise their rates to cover their losses. But rates cannot be raised forever, she pointed out. We should pay for health care like we pay for roads – with everyone shouldering the cost because everyone benefits.
Trying to get the marketplace to lower costs, by bringing in more insurance companies to compete with each other just won’t work, she said. Health care is not a commodity. Insurance companies understandably want to insure only the healthy, but how do we pay for the people who are sick? Health care for a premature baby can cost as much as $500,000. Under universal health care everyone pays for that baby and no one is turned away.
Some universal health-care systems are better than others and the people under those systems collectively determine what they will and will not pay for, Richter said. For example, in England, people over the age of 65 needing dialysis are not covered. That may not be what we would want in Vermont.
Vermont can shape its own system. Some procedures would not be accepted. For example, bone marrow transplants in the treatment of breast cancer did not prove effective. We may not want to cover circumcision and cochlear implants for hearing, Richter said. People may object to these decisions and they will be debated, and decided upon collectively.
Rationing of services would eventually have to be done to contain costs, Richter’s paper states. The Lewin Group Report indicates chiropractic services would be covered when referred by a physician. Preventive dental care and eye exams would be covered but not orthodontia, eyeglasses and private hospital rooms.
But health care in effect is rationed now – by affordability and decisions made by the insurance companies about what they will and will not cover.
Administrative costs currently account for 24 percent of the health care dollar. Much of this money can be redirected toward patient care if the wasteful duplication by a multiplicity of insurance companies is eliminated. The Lewin Report indicates a single risk pool of 600,000 people for Vermont would save more than $100 million in the first year.
Medicaid and Medicare payments from the federal government can be redirected into one fund and the costs would be further subsidized by a 5.8 percent payroll tax paid by employers and a 2.9 percent payroll tax on employees. There also would be a co-payment by users of $10 for most services.
Costs would be controlled by a global budget determined by a committee of skilled professionals, Richter said. She was not in favor of a co-payment by users, but if it meant the adoption of a universal health-care system she would accept it.
The two other co-authors of Richter’s paper are nurse practitioner Marilyn Rothwell and Terry Doran.
Dr. Richter and Vermont Health Care For All can be contacted through its Web site at www.vthca.org, or at 802-224-9037.