Overview:

EVERY YEAR for at least the past 20 years the total cost of health care to Vermonters has gone up steeply. In the year 2004 the total cost was $3.2 billion. In the year 2005 it was $3.5 billion. In the current year (2006) it is projected to be $3.8 billion.

Every observer with any pretense of knowledge about the state's economy and finances has said this rise in costs in unsustainable. For far too many Vermonters the costs became insupportable years ago. By now more than 1 in 10 Vermonters has no health insurance. And the number with insurance inadequate to their needs is anybody's guess - although all current guesses are in the 100,000 range, or 1 in every 6 Vermonters.

As individuals we perceive costs in the rise in our health insurance premiums or shared costs of premiums. But that's only part of the story. We also pay into the total health care costs, even if we have no health insurance at all.

This happens in a number of ways, many of which are barely visible to us. A portion of our federal and state incomes taxes pays into the total health care costs. So does a portion of our property and school taxes. We pay higher prices for consumer goods because of health care costs. We lose wage increases because of rising health care costs. We make large tax giveaways to help with health care costs. High health care costs adversely affect us all in every part of our lives and in every corner of our state's economy.

Every Vermonter in one way or another helps pay the total of health care costs each year. And yet not every Vermonter gets the health care they need and some are broken financially trying to get it.

Any answers to this quandary must confront the total of health care costs. Since everyone pays in one way or another, everyone must figure in the solution.

Reform proposals that select individuals or groups of individuals for preferential attention (coverage, less expensive insurance policies, higher payments, lower payments, mandated insurance, etc.) cannot significantly impact total of health care costs. Proposals that depend on patient choices and patient behaviors will have either minimum affect on total costs (health savings accounts, educated patient decisions, insurance coverage for those without coverage, etc.) or will require twenty to thirty years to significantly affect total costs (health prevention, streamlined chronic care, healthy lifestyles, etc.).

The vast majority of total health care costs are not generated by patients. They are generated in our health care services - hospitals, physician practices, nursing home, and other medical facilities. These are the costs we must confront. And the only sensible way is systematically.

To do this - to address total costs systematically, to ensure the continued existence and high quality of the health care services we depend upon - requires a system.

In these pages we present and entertain discussions about a universal health care system - what it is, what it could mean for Vermont, for Vermont's total health care costs, what it could mean for individual Vermonters, what we and others think about lesser fixes to the burgeoning problems of out of control health care costs.