Ways of seeing: Time is right for big policy strides

Like so many of us, I am grateful that the school districts have decided to delay irreparable decisions until the end of the summer. There are many people now working hard to craft a path through the huge challenges. Just as we are beginning to see light at the end of the COVID tunnel, so win-win solutions are beginning to emerge for our children and schools.
The shifting Federal landscape means that these four easy changes could be implemented simultaneously:
•  Remove the burden of health care from employers
•  Permit and encourage pre-school parity
•  Assure nurturing care from pregnancy through pre-school
•  Incentivize towns and school districts to work together
Now is the perfect time to remove the burden of health insurance from our school districts and also dramatically improve equity and health for all people in Vermont.
I often think of health care coverage, as it currently exists, as a baloney sandwich. The bottom layer of bread is rich, nutritious, and baked from locally grown ingredients. This is Children’s Medicaid, better known in Vermont as Dr. Dynasaur, which provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. This program is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, developmental, and specialty services.
For the purposes of our sandwich, this comprehensive coverage is excellent. However, it only covers half the children in Vermont. Imagine eating an egg salad sandwich with half the bottom layer of bread missing. Pretty soon most of the filling would be on the floor.
A simple fix would be to immediately remove the income restrictions — the current limit is 317% of poverty — and enroll all children under the age of 21. Although that might sound expensive, the cost of Medicaid is actually minimal for healthy children.
As of October 2019, Medicaid also covered one in four adults between the ages of 19 and 64, five in eight nursing home residents, two in five individuals with disabilities, and one in five Medicare recipients. The big expense for Medicaid is actually adult care, and many of the chronic conditions for elders have their seeds in adverse childhood experiences. Better care for all kids will mean better health for adults.
The top layer of bread in our health care sandwich is Medicare, a wonderful support for all qualifying people age 65 and older. Although we think of it as free, most recipients are paying a monthly premium that is taken directly from their Social Security Benefit. We can think of Medicare as the Wonder Bread of health care: it is ubiquitous and allows many people to have access to hospital and primary care. But the old Wonder Bread slogan “Helps build strong bodies 12 ways” is not that appropriate.
We all know about the dreaded donut hole in Medicare coverage. Anyone who watches television or reads magazines is bombarded by advertising for Medicare Advantage plans. These promise to provide many of the missing ingredients (dental care, hearing and vision care, prescription coverage, preventive care …). Certainly incorporating those into the basic program would reduce confusion, duplication, and front office expense for providers who have to bill multiple insurance companies. 
The filling of our health care sandwich — a variety of health insurance programs, provided by a variety of payers (including employers) for a variety of working adults — can be thought of as baloney. That product has some inherent nutrition, but other choices would be far healthier. A more apt analogy might be a game of Mr. Potato Head gone wrong. For those too young to know this game: a plastic shell looking more or less like an Idaho potato comes with a variety of body parts — eyes, ears, mouth — and accessories that can be snapped into the shell. You take turns acquiring pieces based on luck of the draw. The winner is the one coming closest to something that looks like a real face.
In these unprecedented times, we are beginning to realize that mental, physical, social, and emotional health are all interrelated. We have learned dramatically that the health of whole communities depends on the health of each person. The moment has come for a shift to wellness for all. As we move in that direction, we can:
•  Extend Dr. Dynasaur/Medicaid to all children who are not currently covered. (2021)
•  Add the missing ingredients to Medicare (2022)
•  Begin increasing the age limit for Medicaid and dropping the age limit for Medicare by five years each year.
In five years everyone will be covered by one of those programs. Employers will be free of the burden of health insurance, and we will be closer to addressing the equity gap.
This is certainly not going to solve all of the problems our school districts are facing, but it will be a significant start.
Cheryl Mitchell is president of Treleven, a retreat and learning program located on her family’s sheep farm in Addison County. She does freelance consulting on issues related to children, families, social policy and farm to community work. She can be reached at [email protected].

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