The larger good
Polling shows that the news about Vermont Health Connect is trickling down slowly to Vermonters. And yet the date is approaching after which about 100,000 people are expected to use the new exchange to obtain health care coverage.
At this early stage the group most likely to be seriously embroiled in figuring out the new system includes owners or operators of small businesses who are required by law to obtain insurance through the exchange or else pay a penalty. They are the ones who will have to sift through the options provided on the Vermont Health Connect website and decide what is best for their employees and for their businesses.
The state of Vermont is trying to help. It has hired a corps of people called navigators to help consumers of health care coverage get through the maze of choices. It is a major public initiative that promises to shake up a significant sector of the economy. Accordingly, there has been much speculation about whether the state is ready for the Tuesday launch date or whether the whole thing will collapse in a morass of computer dysfunction.
Gov. Peter Shumlin and other boosters of the new system have tried to prepare the state for what they acknowledge will be bumps in the road. What might those bumps consist of?
For one thing, it is inevitable that the new slate of coverage offerings will serve different people in different ways. We can expect to hear complaints from some people that their premiums are higher or they must accept plans that are less comprehensive or more burdened by costs than their previous plans. We can expect to hear from businesses that the process of determining what is best for their employees is complicated and time-consuming.
But we can also expect to hear from people who are able to afford coverage for their first time because of the subsidies for which they qualify. Because coverage will be available even to those who are not employed, we can expect that people will feel freer to change jobs or start ventures of their own.
The success or failure of Vermont Health Connect will not hinge on the difficulties or advantages experienced by a particular individual. Change of this magnitude is inevitably disruptive, and the advantages will not accrue to people equally. We will be able to judge success only on the basis of the larger, common welfare.
We need to keep in mind that the present system also apportions advantages and disadvantages, and there is little fair about them. Many people pay high prices for insurance that is essentially worthless. Others cannot afford any coverage and yet they make too much money to qualify for public programs. Others live in fear that they will lose their coverage if they lose their jobs.
We are used to these tales of hardship because we have been living with them for so long. And in ameliorating the hardship that now exists for some, others will be required in some cases to pay a little more — or to buy insurance when they are not inclined to do so. An acceptable balance of these demands is what will signify success.
It is possible to compare the changes in store for us with the transformation Vermont experienced when education funding was reformed in 1997. The system as it existed before reform allowed enormous advantages to a few wealthy towns and left the majority of towns to struggle to pay for their children’s education. The new system brought fairness to the system so that a good education was affordable even in poor towns. Taxes went up for some people and down for others.
Critics of Obamacare and the new system of health care exchanges say it is nothing less than income redistribution. True, as charged. Taxpayers who pay to support a fire department see their income redistributed when the fire trucks roll up to their neighbor’s house to put out a fire, expending revenue for the benefit of one homeowner. We agree to redistribute our wealth in a variety of ways for the common good — whether it is to obtain good roads, effective police and fire departments or good schools. Health care is now being recognized as a public good.
It will take some months to determine how effective Vermont Health Connect is in securing the public good. Business owners may wish they didn’t have to negotiate the complexities of the Vermont Health Connect website and to make new decisions about how to cover their employees. Calculating the variables involving family income, subsidies and coverage plans will not be easy.
But they can make it work if they enter into the process with the sense that they are involved in a larger venture — a grand experiment in obtaining economic and health security, not just for themselves and their employees, but for the state as a whole. They are engaged in an attempt to make Vermont a better place for all Vermonters. It is something we can all be proud to take part in.