Issue Position: Health Care and Housing

Issue Position

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% 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 US 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.

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