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Editorial: Viable community hospitals are also a right, not a privilege

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Posted on June 16, 2011 |
By Angelo S. Lynn



Supporters of Vermont’s successful push for health care reform this past legislative session championed the single-payer system toward universal care based on the belief that “health care is a right, not a privilege.” In a similar vein, Gov. Peter Shumlin and our legislative leaders must embrace the notion that “strong community hospitals are also a right, and not a privilege for the state’s largest and wealthiest communities.”

We are all losers if, in the process of providing universal health care, we end up stripping our smaller hospitals of vital services for the sake of economic efficiency.

As a state, we are losers if we force too many Vermonters to drive long distances to receive the daily care that is now routinely provided at community hospitals like Porter in Middlebury, and force Vermonters to drive to regional centers to visit ailing family and friends following procedures that have heretofore been provided closer to home. That priority, however, has yet to be been defined, or embraced, by current leaders.

When asked at a Middlebury fundraiser for Democrats on Tuesday night what assurances he could offer that Porter Hospital’s vitality would stay intact, House Speaker Shap Smith could only say that he didn’t foresee hospitals of Porter’s size being closed, but that the services it now offers could certainly see changes as the overall system is revamped.

What will drive the shape of the revised health care system, he said, was money. The focus, he reminded the audience of enthusiastic Democrats, was driving down the rising cost of health care so that it was sustainable. (See story on Page 1A.) But let’s not put price above the value of community.

Over the past few years we have applauded the effort to re-invent the state’s health care system. We also embrace the notion of health care as an individual right, not a privilege for the wealthy. We acknowledge that the government’s social contract to its citizens should be to provide affordable health care to all residents, and we recognize that the spiraling cost of health care increases must be curbed to be sustainable.

But in this valiant effort to create a new system, let’s be sure to keep intact that which is working well.

As Dr. Michael Kiernan, emergency room doctor and head of the medical staff at Porter, said at the meeting, local community hospitals were “a gem of social engineering… In a sense, we are owned by the communities we serve, and we answer to them. We have to … show that we are ferreting out the sources of error, infection and miscommunication. As a result, that little hospital down the road (Porter) is the safest place to be sick in this region.”

Kiernan added that he was skeptical lawmakers could devise a new system that was “better, smarter, faster, and more responsive to this community.”

And so begins the first of many battles over what this new health care system will look like.

**********

An early mistake in this battle is to delay a more detailed analysis and discussion of the numbers that made up the basis of William Hsaio’s initial study and report that helped the Legislature determine that a single-payer type system would be the best way to proceed to save the state the most money while covering all Vermonters. As currently planned, the five-member Green Mountain Health Care Board, which becomes operational this October, will use the study and other available information to create the structure of the new system.

Of the tenets currently adopted by the Legislature under H.202, the overarching premise is that implementing the single payer system will not have a negative aggregate effect on the state’s economy; that its financing will be fair, equitable and sustainable; that cost containment efforts will cut Vermont’s per-capita health care spending below the national rate; and that providers will be paid at levels sufficient to allow Vermont to recruit and retain high quality medical personnel.

It sounds wonderful, but it’s time to start putting some meat on the bones of this discussion. We’ve spent 12 months of Gov. Shumlin’s campaign and this first six months of his administration talking in platitudes about a mythical health care system that will save the state tons of money, attract new jobs, invigorate business and provide universal care. Let’s bring the numbers to bear in places like Addison County. Let’s talk about how it might affect Porter Hospital, about what services might be compromised, about what strengths we might be able to capitalize on to develop a niche part of the health care market; let’s talk about how this might make our current system stronger, sustainable, and a leader of innovative ideas, procedures and social policy and what we may have to sacrifice.

We want to believe, but we also are protective of what we have. Democrats will have to find a way to appease these constituents first and foremost, or see a groundswell of opposition to this important initiative. The best way to do that is with an honest and lengthy discussion of what a new system might entail. The sooner that happens, the less suspicion the public will have and the more support they will extend.

Angelo S. Lynn

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