Vermont and the Art of the Possible
There are many volunteer and professional groups in Vermont commissioned to study options for solving various civic and social problems, from runoff pollution in Lake Champlain to prison overcrowding and the healthcare crisis. The greatest gift these commissions could give Vermonters would be to both quantify the problem and clarify the elements over which Vermont actually has control.
Coalition 21 was convened by The Vermont Business Roundtable under the Leadership of Stephan Morse, President of the Windham Foundation. This brings together a diverse group of stakeholders and healthcare policy professionals to address solutions to Vermont’s healthcare challenges.
It will be important to note that Vermont has done better than almost any state in the union in caring for its citizens and that we are at or near the top of the charts for many healthcare benchmarks. Yet 10% of Vermonters still have no coverage.
Vermont is both revered and ridiculed for its humane approach to social issues. Ironically, this deep tradition of community caring predated the Democratic and Progressive revolutions in Vermont and was a matter of policy in the work of early Republicans like Flanders, Aiken and Davis. Vermont has a deep and enduring tradition of caring for its own. Vermonters, for the most part, clearly believe that healthcare coverage and access for all is a worthwhile benchmark.
This can present the danger of overreaching. We must remind ourselves constantly of the art of the possible. We do not want to follow Tennessee, having to unwind a healthcare vision we cannot afford. Vermont is quite often The Little Engine that Could, but we must be mindful of our limits. We are a micro-economy within a giant economy whose guiding values we do not always share. We cannot afford to go it alone and pioneer in healthcare reform, bucking the current laissez-faire attitude in Washington.
Our innovative effort to import drugs from Canada is an example. The FTC, apparently owned now by the industry it regulates, will not allow it. A Vermont healthcare insurer noted recently that their payments for pharmaceuticals now exceed those for primary care, a bizarre conundrum that indicates the degree to which the pharmaceutical industry is out of control. Pharmaceuticals are one of the fastest rising cost items in healthcare budgets, especially now that their manufacturers are allowed to bypass medical professionals, spending billions to market new symptoms and branded drugs directly to consumers. Nor will they be required to negotiate with the government for quantity discounts. Not for lack of trying, Vermont will have little effect here, as the current administration in Washington seems to favor Pharma interests over the urgent concerns of the States, who are foundering under unregulated pharmaceutical cost escalations.
We ourselves are a principle driver in healthcare cost escalation. We simply use more. For those with coverage, there is very little connection to cost. Looking ahead, consumers we will be asked to share more cost and responsibility with government and employers. Less time will be spent in hospitals. Less expensive treatments will be deployed and patients will be enlisted in their own care and prevention.
Having said this, Vermont enjoys a tradition of caring for its own and excels in innovation scaled to the art of the possible. There are better ways. They are not always sweeping. We can lead the nation on healthcare issues, not by sweeping new programs to with universal coverage, but with small scale innovation. We must be careful not to gut the innovation that thrives under the radar. Our own UVM College of Medicine has over 1100 clinical trials underway with Fletcher Allen. There are many community-scale successes already: Addison County Parent Child Center, Chittenden County United Way’s efforts to focus the community on larger healthcare issues, service coordination, access and prevention, well child programs, The Business Roundtable’s Born To Read Program, The Governor’s Highway Safety Program, VNA’s Father and Children Together and countless other state and community programs that incrementally enhance our communities and our well being.
We must stay focused on the art of the possible and continue to make incremental progress until the goals of the States are better aligned with those of the federation they comprise.
Bill Schubart
6:23:31 AM 
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