How quickly we forget. Just short of four decades ago, Vermont policymakers decided that a competitive healthcare system had not lowered healthcare costs, but was, in fact, driving costs up, as hospitals vied for more expensive technology and market share. The relationship between our thirteen community hospitals and our tertiary-care hospitals – then Fletcher Allen and Dartmouth – were tortured and riddled with expense.
We decided that a citizen-regulated monopoly would better constrain costs, regulating towards a more cost – efficient and accessible network of integrated healthcare facilities, spanning sole practitioners, community clinics, community and tertiary care hospitals. And it worked. Looking at measures of access, prevention and treatment, avoidable hospital use, costs, healthy lives and equity, the Commonwealth Fund recently ranked Vermont’s health system as the highest-performing in the country.
Governor Scott understands and supports this vision for Vermonters’ healthcare, while we now hear our progressive democratic legislative leaders railing against monopoly and championing competition as the factor that will control costs. But we already crossed that bridge many years ago, so I find it especially ironic that this rhetoric reflects current attitudes in Washington, as Republicans work to dismantle the Affordable Care Act and eliminate important protections, like those Vermont enacted thirty years ago. Vermont’s direction has been one of collaboration, not competition, and has prioritized policies that benefit all those over ones that might benefit only some.
We’re one of the last “civilized” countries in the world not to regard healthcare as a basic human right, even as Vermont has worked within its scarce means and small scale to create a healthcare system that could “act as if.” We’ve made great strides, including having among the fewest uninsured residents while being among the highest-quality, lowest-cost states in the nation.
We must stay the course – while admitting that having said that, affordability is as much an issue here as it is elsewhere in the country, and we need strong regulatory oversight to ensure continued progress on constraining costs.
But if we believe that healthcare-for-all should be a right, then we must also acknowledge that “free-market”competition in health care conflicts with the collaborative, integrated system we’re developing to provide access to quality healthcare for all Vermonters.