Avery Book: What COVID-19 teaches us about Vermont's health care reform effort

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We are poor and working-class Vermont residents who are struggling amidst the COVID-19 pandemic. Many of us have lost our jobs, while others are forced to work as essential workers, putting our lives on the line to serve our communities and earn a living.

It is from this perspective that we receive the news that Vermont's health care reform effort, led by OneCare Vermont, will be temporarily suspended. We believe it's a good moment to step back and ask, "What has this reform effort done for us?"

Our health care system is in a major crisis, with a number of hospitals facing the prospect of closure at a time when hospital care is desperately needed. By putting the All-Payer model on hold, the state hopes to triage cash to failing hospitals by relieving them from financial risk and dues payments to OneCare.

How are we to interpret this move, other than concluding that OneCare Vermont is an additional bureaucracy that threatens to make this public health crisis even worse?

Stepping back, however, it's not that surprising. Now in its ninth year of operation, OneCare Vermont — a private company founded by Dartmouth-Hitchcock and UVM Health Network that now controls the majority of Vermont's health care — has failed to address the actual problems facing our communities.

Premiums, co-pays, and deductibles continue to rise at alarming rates. Low-income people and those of us in rural regions are increasingly unable to access or afford the care we need, while primary care and home and community based services are starved of investment. Even in the midst of a workforce shortage, thousands of home and health care workers struggle to get by on less than $15 an hour.

Taken together, we're left with only one reasonable conclusion: The All-Payer model, and its flagship company OneCare Vermont, wasn't designed for us.

Guiding this model is a vision of privatized health care that preserves the inequitable health insurance system while closing down hospitals that don't turn a profit — i.e. those that serve poorer and more rural parts of Vermont. Meanwhile, big businesses and the wealthy are let off the hook from paying their fair share of taxes to fund public goods like health care.

The politics of privatization and public-sector austerity are directly responsible for our country's dubious position as the world epicenter of the COVID-19 pandemic. Treating a health care system as if it's a business is no way to guarantee public health.

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It doesn't have to be this way. We can come out of this crisis with a health care system that meets the needs of all of us by returning to the foundation laid with Vermont's 2011 universal health care law, Act 48. Act 48 promised to provide a universal, unified health care system that treats health care as a public good and a human right.

As our hospitals face the prospect of bankruptcy and thousands of newly unemployed people join the ranks of those who rely on Medicaid, we're calling on you to:

- Immediately expand Medicaid to cover everyone, regardless of income, immigration status, or any other factor, while fast-tracking the implementation of public financing to fulfill the promise of a universal health care system.

- Keep our hospitals open by establishing a new public authority that assumes ownership and direction of all 14 hospitals, operating them in the public good.

- Cancel the All-Payer ACO Model Agreement and decommission OneCare Vermont, transferring its assets, along with the responsibility of managing payment reform, to the state.

- Make direct investments in primary care and home and community based services to shore up these systems and enable them to thrive over the long term.

- Raise wages for all home and health care workers to a livable wage, and follow the recommendations of Vermont's unionized nurses and health professionals to secure personal protective equipment for essential workers.

For those of us who lived in poverty before the crisis, going back to "normal" once the lockdown is lifted is not an option. Faced with a deep recession, Vermont's COVID-19 response must be guided by the needs of the poor and working class, with the aim of bringing about a more just and democratic society.

Avery Book is president of the Vermont Workers' Center and a resident of Thetford.


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