Bill Schubart comments at Press Release for primary care & mental health bill – Jan 26, 2023 – VT Statehouse

In healthcare policy, Vermont must reset its priorities  ̶  either fund hospitals or the healthcare of Vermonters. Yes, they are intertwined but not an either/or  choice as some hospitals would have us believe.

The hue and cry to “support our hospitals,” has up to now, driven healthcare costs far beyond the capacity of most Vermonters, insurers, or the State and severely diminished access.

The question we must ask ourselves is “how do we deliver affordable, equitable, accessible, community-based healthcare to the largest number of Vermonters?”

Hospitals are a vital part of the equation but, not in all cases, the most cost-efficient way to deliver on our goal. Their expansive goal to provide all healthcare services under one roof (primary care, urgent/emergent care, tertiary care, home health and hospice, mental health services, and now Medicare advantage insurance) better serves the expansive business vision of hospitals than the healthcare needs of Vermonters.

Instead we need a dispersed architecture of services starting in our schools and communities that moves much of our $6.4 billion annual investment in healthcare upstream to education, prevention, diagnostics, trauma-informed counselling, family-support systems, and hospital avoidance. Urgent and emergent care requiring hospitalization will escalate to the closest hospital  ̶  and, by the way, we may not need all 14 hospitals we have.

This new bill is a vital start to our goal. It begins a promising conversation that will require executive and legislative courage to enact as the headwinds of those opposing change descend on both branches of government.

I would urge the pioneers offering this legislation to also remember Dr. Berwick’s Moral Determinants of Healthcare, which address many of the deciding factors of future health such as early childhood development, education, employment, food, access to healthcare, housing, clean air, soil & water etc.. all are among the challenges Vermonters face.

New Mexico just passed a similar bill (67). Here is its mission:

“Revolutionize primary care into interprofessional, sustainable teams delivering high-quality, accessible, equitable health care across New Mexico through partnerships with patients, families, and communities.”

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