Saturday, July 24, 2010

Vital Communities

The heart of Vermont is our communities. We live on a small scale here where being someone's neighbor really means something. We share our joy in good times and support each other during bad times.

We are fortunate to have the opportunity to live in a way that many people can only imagine. The scale in Vermont is small and personal. Even our biggest city, Burlington, is small by the standards of other states.

Sadly, I share the growing concern that our communities are in jeopardy. Increasingly, we read that boards are feuding, local politicians are resigning and seats on boards and commissions go unfilled. Some think the answer is in hiring professionals to do jobs that we have always elected our neighbors to do.

Selectboards across the state have contracted out the auditing of the town's books and now some have talked about hiring full-time treasurers rather than having an elective officer. There is talk about having county superintendents of schools. These are just a few of the initiatives that are trying to remove government a crucial step away from voters.

State requirements on communities continue to be one of the biggest problems. The Legislature has repeatedly added burdens on to local officials, through Act 60 and countless other measures, but have provided little training or support in carrying out these mandates. I think the League of Cities and Town's (VLCT) should share some of the responsibility for the decline in support for town officials. In the Legislature, I'll work to correct this and to see that local officials are asked to comment on any further proposals that will impact them.

Unfortunately, the Legislature relies too heavily on pressure groups, like VLCT, to hear how the actions it takes will impact local communities. Rather than hearing from individual communities, legislators often hear a one-size-fits-all recommendation that, in the end, fits very few communities properly. That needs to change.

As part of this, I will work to get funding for local road, bridge, and culvert maintenance restored to the local level where it rightfully belongs. The Legislature must stop the practice of underwriting the General Fund budget with highways fund money. Communities, and their local economy, run on good, well-maintained roads.

In Strengthening Local Economies I'll talk about encouraging local entrepreneurs and expanding job opportunities. Helping to grow local economies will have more than just economic benefits. Strong local economies will help us strengthen our communities.

As one example, with people traveling long distances to get to better paying jobs, many local fire departments and rescue squads suffer from manpower shortages between 8 a.m. and 4 p.m. By creating better paying jobs closer to home, we can shorten commuting distances which helps the environment, strengthens families, aids vital volunteer emergency services and which would also help re-engage people in their communities.

How important is keeping your local community vital and active?  What role should the legislature and State government play in this? Leave a comment below.

Thursday, July 1, 2010

Health Care: It's about Affordability

There has been all sorts of talk about making Vermont more affordable and about what to do about health care. For me they are intertwined, you can't talk about one without the other.

When I went to my first health care rally ten years ago (I hate writing that) someone had a sign that said,  "Make it better - not just different." I've remembered that sign as the various strategies have come up.  Up to now all we've done, by focusing on insurance companies, is make it different.

When did the discussion become about health insurance - it should be about affordable, quality health care for all.

Did you know that many people are just one accident or health care emergency away from bankruptcy? That's probably you or someone you know such as a brother, sister or neighbor. It's true, a large number of bankruptcies in this country are brought on by either large health care debt or the loss of one income in the household. Yes, I said one income. Frequently, the family still has money coming in, but just not enough. Combine the two situations, health debt plus loss of income, and you've got real problems.

I'll talk about Vermont incomes, debt and making Vermont more affordable in another posting. Right now I'll focus on health care.

As I said, for me it's about equal access to needed health care - not about providing "universal coverage." Words matter - thinking in terms of "coverage" makes this an insurance issue. When you think about it in terms of "access," it becomes a health care issue.

I think you and I both want access to the care we need - when we need it. But, we don't want to lose the house or our lifestyle getting it. We don't want adequate health care to be something only the rich can afford. If this involves insurance then let's make it better - not just different.

One approach that, I think, makes sense is declaring Vermonters one big insurance pool - excluding the Medicare and Medicaid recipients. The State then sets the rules for covering that pool - what's covered (yearly exams, preventative testing, etc.) and standardizes the reimbursements and codes . We then invite companies to put together insurance plans to cover us all.

You save a lot of money by standardizing the codes and reimbursements and the claims forms.  Hospitals and medical practices spend a lot of money and time on trying to figure out which insurance companies pay what for which procedures. Simplify it and you save a lot of money.

The proposals from the insurance companies are then reviewed and the most appropriate and affordable would become Vermont preferred providers. You would be able to choose which plan and which insurer you want to go with.

Funding This
Companies, including the State of Vermont and local governments, would pool what they now pay for health care as a base for funding this.

We, the insured, would each pay a modest premium, deductible and a co-pay on visits, all of which would cap at somewhere around $1,500 per year for individuals and $3,500 for families. With the employer contributions, this represents a multi-billion dollar market.

Other Solutions
This is just one idea; another is to learn from our neighbor to the north (Canada), take what works, improve what doesn't, discard what we don't like and have universal care. That's what I would prefer and it took one sentence to tell you about it.

What do you think? Add a comment or write me a note.