Spotlight on the Vermont Senate race 2018: Health care and housing
The six candidates for the Senate seats representing Addison County, Huntington and Buel’s Gore were asked to comment on five important issues.
Today, for the fifth issue, we asked each of them to address health care/housing with the following prompt:
Health care insurance, finding affordable housing and education are the three cost drivers in society. We’ve discussed education. As Senator what measures would you propose to help make housing and health care insurance more affordable? 350-500 words.
Marie Audet — Independent
Having access to affordable health care is an issue that touches everyone. We know — because the legislature tried and failed — that having a single payer system on our own does not work. That means that until Senator Sanders and his colleagues can successfully implement a federal “Medicare for all” program, Vermonters will have to use our creativity and collaboration to see us through.
My own experience with healthcare has been frustrating and costly, both as an individual and as a small employer. I know that a lot of Vermonters, like me, must take a wait-and-see approach when it comes to making decisions about our health. “Will I get better on my own,” we wonder. “Or should I bite the bullet and pay so this doesn’t get worse?” I now question my doctor on the need for additional tests over first trying a less expensive course with medications or lifestyle change. Some people say that no one should have to make these decisions; others say we need to take control of our own health. One promising pilot created by the legislature is the Accountable Care Organization Program. It is showing good results in treating people to keep them healthy while saving money on health care costs.
I’ve listened to many candidates, across the state, contemplate rising health care costs. Their ideas are diverse, and sometimes at odds with each other. What I can promise is to continue to become informed, work collaboratively with the smartest leaders on this subject, and do what I do best — strive to do better.
One of the biggest demands in a healthy, attractive community is safe, affordable housing close to good jobs, schools, necessities, and amenities. The good news is that most of us are in agreement on the need for affordable housing and smart growth as a part of growing strong, diversified communities. The legislature has provided several types of funding sources to support this. One area where we can do better is in permitting these projects. Currently, permitting is often a complicated, unpredictable, expensive, and protracted process. Developers and business owners often believe they are on the right track, only to later learn they are not. Predictability in permitting would help in the development of new energy efficient housing for all ages and income levels.
November 6 is just around the corner. I hope that over that past five weeks, these essays have helped you get to know each of us a little better. All six essays are available on our website: www.audetralstonvermont.com. As an Independent, my only commitment is to you, the voters. I’d love to hear from you. Don’t forget to vote!
Christopher Bray — Democrat
This question focuses on the affordability of both health care and housing, and like most challenges we face, each is connected not only to the other, but to other aspects of our lives. For instance, housing costs reflect property taxes, and property taxes reflect education costs; and education costs reflect the cost of the most inflationary element within the school budget: health care costs for faculty and staff.
Thus, we come full circle and back to a useful starting point for any deep and lasting affordability solution: reducing the costs of health care, and then ensuring that the costs of health care insurance also decline.
My principal proposal for further reducing health care costs is to explore how we can provide universal primary care, because it has the potential to drive down health care costs for the entire community by ensuring that people get to a doctor as soon as they need to — rather than avoiding the doctor’s office because of prohibitive cost-sharing charges borne by the patient — in the form of deductibles, copayments and coinsurance charges, all of which reduce the likelihood that someone in need of care will actually seek it out.
Seeking out timely health care translates into avoiding expensive hospitalizations and emergency room visits by preventing disease and treating conditions earlier. This timely care — delivered as primary care — saves everyone money, because we are all insured in “pools” of patients, such as through private insurance, the Exchange, or Medicare. When any patient in the pool seeks timely care, it reduces not only the cost for that single patient, but for everyone in the pool by reducing the premiums to operate the pool’s insurance program.
To those who say we must put off universal primary care until the federal government undertakes it, I ask them to consider that since 1989 Vermont has successfully operated a universal health care program for children and pregnant women: Dr. Dynasaur. We DO know how to run such a program in a cost-effective manner, and we can do the same again for universal primary care (UPC). Further, within our health care system, less than 6 percent of the dollars are spent on primary care, even when including outpatient mental health and substance abuse services. This is a manageable portion of our health care system.
By reducing health care premiums through this approach, we will reduce the cost of health care to everyone, including those working in our schools. By reducing that cost, we will relieve the pressure on property taxes, and therefore on housing costs.
Even so, “affordable” is a relevant term, one that is dependent on income. Improving household income is the most important step in making housing more affordable. Vermont has the highest housing vacancy rate in the country, according to the U.S. Census Bureau’s 2017 figures. This tells us that properties are available (vacant), but for many people, they are not affordable.
In sum, Vermont’s affordability issues require addressing health care as well as wages and benefits that enable our workforce to gain the capacity and stability required to own or rent a home. And our ability to do all of this requires the careful creation of prudent, cost-effective programs that deliver a broader prosperity to Vermonters.
Peter Briggs — Republican
As government has gotten more involved with health care the expense has only increased. Just as with education, I advocate for more choice and less government intrusion. Under the current system as much as 70 percent of what we spend on health care is administrative and clerical — due to ever increasing government oversight and mandates. Doctors and their staff today spend too much time entering one of 87,000 billing codes on their computers after each patient visit so that government employees can track and analyze procedures and costs.
The University of Vermont Medical Center is acquiring hospitals and clinics at an alarming rate, eliminating competition. If organizations such as surgery centers were allowed, instead of being denied, routine procedures could be administered for a fraction of the cost.
Americans and Vermonters are leery of monopolies for good reason — competition is discouraged and consumers have fewer choices. Right now we have only two coverage providers in the state — Blue Cross Blue Shield and MVP. Health insurance should be available across state lines. We should also encourage health savings accounts so that customers can shop for lower price services rather then not worry about it because “the government will pay”.
Individual responsibility must be encouraged — in all areas of life. Two diseases — diabetes and heart disease — are responsible for more than half of the health care expense in this country. They are the direct result of poor lifestyle choices. Eating less and getting more exercise costs nothing. But if the government takes care of you, instead of you taking care of yourself, there is less incentive to take control of your own health. Patients must be incentivized to lead more healthy lifestyles.
One of the ways to reduce housing costs is to allow other options than the $50,000 mound systems that are currently an expensive piece of rural homes. It used to be that the excavation contractor did a perc test and the local health officer issued a septic permit for a conventional gravity fed in-ground system. Those systems are working fine today in the vast majority of homes in Vermont.
Now however, state certified technicians must be paid to design very costly mound systems with special sand trucked long distances and requiring electric pumps instead of gravity. I advocate for giving the responsibility for single family septic designs back to the towns. We farmers have a saying, “if it ain’t broke, don’t fix it”.
But the primary driver of the home affordability problem in Vermont is not the cost of new housing, which is a function of the cost of land and the square foot costs of building. It is the fact that too many Vermonters lack the skills to earn what is needed to afford a home and therefore must rely on federal and state assistance. The solution requires cooperation between schools and the business sector to identify the skills that need to be taught in our schools, not the least of which are basic skills that are lacking in too many high school graduates.
Archie Flower — Libertarian
“It is much more important to kill bad bills than to pass good ones.” – President Calvin Coolidge
The question of making health care insurance more affordable is something of a misdirection. It presupposes an acceptance of the underlying assumptions of our current deeply flawed system. Of course we want affordable health insurance, but insurance is not care — and conflating them is a precarious distortion of reality. The current health care system has suffered from decades of interference in the market — prices are obfuscated behind a byzantine insurance calculation, and thus the market reacts neither quickly nor effectively.
The housing market has likewise seen regulations creep up over decades. Building codes are a good foundation to ensure the safety and sustainability of our houses and public spaces, but these can best be handled by the free market. It seems to me that housing is a superbly solved problem on a technological level; we have an abundance of choices of materials to build with, systems to heat and cool with, everything we need to make a house and make it a home. But development is mired in so many regulations such that we see prices inevitably go up because supply is artificially limited.
The solution to both of these is to cut regulations, cut spending, and cut taxes. Montpelier is addicted to micro-management and centralization of control. We don’t need Montpelier telling us how to live our lives, and we don’t want Montpelier as surrogate parents. It’s empirically proven again and again that allowing competition and allowing market forces to work will bring higher quality goods and services in greater supply at ever lowering prices. What most people fail to realize is that we do not currently have a free market system, and so capitalism gets the blame for our economic woes. Instead, what we currently have is corporatism — a system which favors the largest corporations at the expense of not only smaller businesses but also the workers and consumers.
At all levels, government’s role is one of service to the People. Its only rightful authority is twofold: first as a steward of commonly held lands and property; it has the role of ensuring just access to these resources open to all. Secondly, government has the same authority we each do of third party defense; defensive action on behalf of someone whose rights are (in imminent danger of) being violated. Everything else is an usurpation of authority, a presumption of rule rather than service. We can see, then, the wisdom of President Coolidge when he says bad bills are more important to stop, as these are invariably bills which overstep governmental authority.
As this is the final guest essay we’ve been asked to write as candidates I’d like to end by saying thank you to the Addison Independent for this space, my fellow candidates for sharing their thoughts, and thank everyone who is reading these — please think carefully about your choices and be sure to get to the polls this Nov. 6.
Ruth Hardy — Democrat
According to a recent statewide survey, 47 percent of respondents cited the expense of housing or healthcare as the item that creates the most financial stress in their lives. I would work to expand access to affordable housing and healthcare, and provide Vermonters livable wages that can support these basic necessities.
The housing shortage in Vermont most impacts individuals in crisis, families with low or modest incomes, individuals with long-term care needs, and the elderly. As a result, there is a growing homeless population, and people who need assistance often go without vital services because of a lack of stable housing. In addition, our prison system incarcerates people who would be better, and more affordably, served through community-based supportive housing programs.
In order to address the growing housing crisis, I would:
1) Target investments toward transitional, supportive housing for individuals and families in crisis who need intensive services such as substance use counseling and medical care; domestic violence protection; and mental health stabilization.
2) Expand development of affordable supportive housing units to serve individuals who are in need of long-term or permanent services, such as disability support, eldercare, and assisted-living.
3) Incentivize development and renovation of moderate-sized homes close to town centers for young professionals and families, or retired Vermonters seeking to downsize housing and expenses.
4) Support organizations already working on expanding affordable housing, such as Addison County Community Trust, WomenSafe, John Graham Shelter, and Charter House.
5) Secure funding through publicly financed bonds and loans; savings in corrections and social services; federal, state and local funds; and private sources.
My experiences working at the Open Door Clinic and Planned Parenthood underscored the reality that people still do not have adequate access to affordable healthcare. And, during many conversations with voters, concerns about healthcare have come up more than any other issue.
I support enacting publicly-financed universal primary care so we all can go to the doctor when we need basic and preventative care, including mental health, substance use, and dental care services. The current Dr. Dynasaur program, which provides health services to children from families with low incomes, could serve as a model for such a program. Having all Vermonters participate would enhance health equity, reduce risk, and enable continued work on cost containment.
Local public and private budgets already fund such care, so investments at the state level would allow savings in these budgets. Further, savings could be had through reductions in costly emergency and specialized care necessitated by lack of access to primary care.
Moving beyond primary care, I support efforts to form a coalition with other states working on progressive healthcare reform to create a broader universal care program. This would create strength in numbers and buoy Vermont’s ability to advance healthcare access, particularly because progress at the federal level appears unlikely in the near future.
Healthcare reform is complicated, and recent efforts have produced skepticism among many policymakers. However, like with housing, we must work to ease the financial, physical, and emotional stress many Vermonters experience when they need healthcare.
Paul Ralston — Independent
Good housing — affordable, energy-efficient, conveniently located homes — is still the cornerstone of the “American Dream.” Supply is tight in Chittenden County, and any shortage there puts price pressure in nearby rural communities like Addison and Franklin County. The inventory of homes on the market is good, but prices are higher, and after-sale energy upgrades can add significantly to buyers’ costs. Rental vacancy rates are very low.
Home ownership has become more expensive (mortgage, taxes, insurance), interest rates are starting to climb, and energy costs still make up a larger part of people’s household budgets. First-time home buyers are struggling with higher down payment requirements.
“A good job close to home” is the phrase I coined to encapsulate what all of us strive for. Housing must be seen in context with employment — can the jobs sustain home ownership? Is it necessary to make a time-consuming, expensive commute? Can folks live and work in the same community?
Vermont does a good job with a variety of programs for housing. The Vermont Housing and Conservation Board is a professional organization that works collaboratively with local housing agencies to overcome barriers to affordable housing development. A recent $30 million VHCB bond will help underwrite capital costs to lower the initial cost of new projects. The funds are administered by Vermont Housing Finance Agency, another great Vermont organization that creatively uses public/private partnerships and tax credits to encourage and support home ownership and homebuilding. Several agencies in Addison County participate in housing — from the worst-case scenario of homelessness, to development of rental properties and affordable homes. All these initiatives deserve continued public support and funding.
I believe a good home, close to a good job, with adequate public transportation and robust telecommunications are inseparable parts of sustaining vibrant, affordable communities.
I believe Vermont has a good health care system. What we all struggle with is the cost of health insurance and access to health care providers. What we all want is a more affordable and more reliable structure.
When I served in the Vermont House, state government pursued a plan for a “single payer” health system. I supported that effort, but Vermont was not able to create a plan that would work just in our state. We realized some benefits, but we were unable to fulfill the promises.
A federal solution would be best, but Congress continues to frustrate and disappoint. In Vermont, the options are limited. We have discouraged most insurers, so we are in a difficult position to resist large annual increases from Blue Cross/Blue Shield. Vermonters could allocate more tax revenue to health care programs — existing ones like Medicaid and Dr. Dynasaur, and/or new proposals like “universal primary care.” The question is one of funding. Like my position on housing, I favor making health care more affordable — controlling costs where we can, and prioritizing funds to the most cost-effective programs that bridge the gap of affordability. Doing so will require funding decisions that may be difficult for ordinary taxpayers.
Thank you to our readers for taking the time to learn more about the candidates for public office. Click here to read more in the series. Decide who will best represent you and your community, then vote. Polls will be open on Nov. 6 until 7 p.m.; early voting ballots can instead by cast by going to your town clerk’s office to get a ballot.