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Advocates press for universal primary care

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If state legislators needed a cheering section for enacting universal primary health care, they got one Tuesday night.

During a public hearing jointly hosted by the House Health Care and Senate Health and Welfare committees, more than 50 people expressed support for a publicly funded health plan that would provide primary care for all.

The financing and administrative details of such a plan have yet to be worked out. But lawmakers said the stories they heard during two and a half hours of testimony reinforced the need for a more accessible primary care system.

“Hearing people’s stories is, in my view, one of the most powerful motivators for everyone, regardless of what your political persuasion is,” said Rep. Bill Lippert, D-Hinesburg and House Health Care Committee chairman.

The memory of past health care reform failures hung over Tuesday’s hearing in the crowded House chamber.

Several speakers expressed bitter disappointment over the lack of follow-through on Act 48, the 2011 law that laid a foundation for universal health care, and former Gov. Peter Shumlin’s 2014 decision to drop pursuit of single-payer health care.

“We have had various impulses toward getting health care for all Vermonters,” said Marjorie Power of Montpelier. “Every single time we have choked. There’s always some excuse.”

Power said it’s become clear that “we cannot, with a two-year Legislature and (governor), do it all in one bite. It will just be choke, choke, choke.”

“Here we are with the possibility of taking a major first step,” she added.

She was referring to a plan, espoused in S.53 and H.248, to establish a publicly funded system that would “ensure that all Vermonters have access to primary health care without facing financial barriers that would discourage them from seeking necessary care.”

Both bills were introduced early in the 2017 session. At Tuesday’s hearing, there was strong support for that legislation to move forward.

Patricia Reid of Addison said she receives vital care from her primary care doctor. But she also described herself as “underinsured,” meaning, “I do not access care when I need it due to financial barriers.”

By enacting universal primary care, “we would create stability that would take away the unfair questions that I and many people like me have to ask,” Reid said.

Kaiya Andrews of Waterbury – wearing the red Vermont Workers’ Center T-shirt that was common at Tuesday’s hearing – said she is a disabled parent who has been unable to find a doctor who will treat her.

“We need to have universal health care for all humankind, not just the ones that are easy to fix,” Andrews said.

Ellen Schwartz of Brattleboro said she has good insurance, and it has allowed her to receive prompt, consistent treatment of recurring skin cancer.

“This is great for me,” Schwartz said. “It’s how our health care system should work – but not just for me. It should work like that for everybody.”

“Our humanity should be the sole qualifier for access to health care including, but not limited to, primary care,” she added. “It is simply unacceptable that someone like me wins the health care lottery while others suffer or even die.”

Dr. Allan Ramsay, a former Green Mountain Care Board member who serves as medical director of the People’s Health and Wellness Clinic in Barre, said many of the patients he sees suffer from “undiagnosed and unmanaged” conditions “due to lack of insurance or access to basic health services.”

“The simple and logical truth is that we do not expect our car insurance to pay for the gas we need to run it,” Ramsay said. “We should not have to rely on insurance to provide the primary care that we all need to stay healthy.”

There was extensive testimony not only about the need for better primary care, but also about the benefits.

The pending legislation says universal primary care would “reduce systemwide spending,” in part because “better access to primary care reduces the need for emergency room visits and hospital admissions.”

Tenzin Chophel, a critical care and cardiology nurse at the University of Vermont Medical Center, said “primary care is life-saving.”

Too often, when Chophel encounters a patient at the hospital, “what they tell me is that they haven’t seen a doctor in years, decades, ever.”

Dr. Sue Deppe, a Colchester psychiatrist who also was representing the Vermont Psychiatric Association, told lawmakers that “untreated mental illness, substance abuse and untreated medical (conditions) take an enormous toll on society. And you see it in budgets.”

“Universal primary care is inexpensive,” Deppe said. “The payoff is enormous.”

Deppe would get no argument from Sen. Claire Ayer, D-Addison and chairwoman of Senate Health and Welfare.

“I think we’ve proved that it’s valuable,” Ayer said. “We just have to figure out how to stand it up in a way that makes sense, and that we can manage.”

The key questions for universal primary care, Ayer said, are administration and financing. Neither bill specifies a financing mechanism for universal primary care.

Ayer downplayed the significance of potentially levying new taxes to pay for the program. “I think it’s more like an investment rather than a new tax,” she said.

Lippert couldn’t hazard a guess on how far either universal primary care bill will advance before the current legislative biennium ends.

“I know that, over time, change can happen. It requires a vision and persistence,” Lippert said after Tuesday’s hearing. “I remain hopeful that we can find our way to health care for all in Vermont. What we can achieve this year, we’ll have to see.”

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