Rutland Herald
The voters lead
March 3, 2005
Vermont voters sent a clear message on Town Meeting Day that they are ready for the Legislature to take a serious look at the establishment of a system of universal health care coverage.
Twenty-one of 23 towns voting on the measure approved a nonbinding resolution calling for action leading toward universal care. The margins were often overwhelming. In Springfield the vote was 1,318 to 395. In Montpelier it was 1,433 to 792. Only Stockbridge and Bennington rejected the measure.
These results do not represent a scientific sampling of public opinion. Rather they are an expression of an emerging political consensus that the present health care system is caught in a hopeless cycle of higher costs and declining care. Something has to be done.
This consensus is shaped by a new awareness: that it is a mistake to view health care as a business.
The problem of how to think about health care is examined in an insightful article in the latest New Republic magazine. Arnold S.Relman, a professor emeritus of medicine at Harvard, examines the ways that market economics make the health care system worse, rather than better and shows that new proposals applying market principles to health care are doomed to failure.
Relman cites an earlier analysis of the health care system to show several ways that the ordinary rules of market economics do not apply to health care. First, the demand for health care is seldom a matter of consumer choice; it is driven by illness or injury. Second, the supply of services comes not in response to buyers, the way the supply of automobiles does. It comes from the judgments of physicians about the needs of patients. Doctors differ from car salesmen in that they are supposed to put the interest of the customer above the need for profit.
Third, the supply of health care providers is limited by the costly process of entering the field. Fourth, prices are usually insensitive to market forces. Fifth, there is a virtual absence of price competition.
During the past decade there have been efforts to subject the health care system to market forces, but they have only made things worse. For one thing, competitive pressures put doctors in a contradictory position. They are supposed to be looking out for the patient, not trying to cut a good deal for themselves. Hospitals are supposed to be serving populations, not trying to market ever more expensive services. Insurance companies that are free to shun some patients create large populations of uninsurable people, usually the ones who need services the most.
Vermonters have seen these things happen. In the past four years the number of uninsured Vermonters has jumped by about 50 percent. A system that provides coverage in helter-skelter fashion to some people but not others puts an insupportable burden on those who do have coverage and worsens the health prospects of those who don’t.
The Vermont Legislature ought to hear the message from Vermont’s voters about universal care and consider the lessons ontained in Relman’s article. Health care is a service, not a product. It is delivered by a system that ought to be supported fairly by the broad base of Vermont’s citizens, who in turn ought to receive dependable, affordable health care. That is the direction the Legislature appears to be heading, and the voters are beginning to show that they approve.