As reported in a recent VtDigger article published by the Valley News (“UVM professor finds link between lobbyists, rising health care costs”; Oct. 25), Dr. Alex Garlick has provided a number of positive recommendations for addressing the current health care cost crisis in Vermont, including a strong Green Mountain Care Board, expanding housing options for health care providers and limiting the impact of lobbyists.

However, I strongly disagree with his suggestion to increase the number of clinics and hospitals, with the intent of increasing competition among providers and prompting them to reduce fees in order to gain business. There are two major problems with a market-based approach to health care in Vermont.

First is the matter of scale that Dr. Garlick mentions. Even in Chittenden County, Vermont is simply too small to support multiple facilities competing against each other, except in limited areas such as urgent care, ambulatory surgery and imaging. In fact, we have the opposite problem, with birthing centers and other services closing due to low volume.

Even more fundamentally, health care does not conform to a supply-and-demand model. In our debates over the Affordable Care Act, Medicare and Medicaid, we have differences about how far coverage should extend, but there is near-universal agreement that we have an ethical duty to provide necessary health care to those who need it, not just those who can afford to pay the going rate. By its very nature, this commitment draws us away from free market principles and toward governmental fiscal and regulatory involvement in the health care system.

Also, when their health and their very lives are at stake, most people do not spend time shopping around for the best deal. Instead, they prioritize timeliness, quality of care and locality. Those who can do so purchase health insurance and let the insurance company deal with the cost. Those who don’t have health insurance tend to ignore the cost when they decide they have to access health care services.

Given these dynamics, increasing the number of providers in Vermont would not generate vibrant competition, but rather lead to increased expenses and lower revenue per provider.
If health care billing was understandable and transparent, there would probably be some uptick in consumers seeking out cost information before committing to treatment.

More significantly, the cost of the billing process itself could be substantially reduced for both providers and insurance companies. For example, bundled payments per procedure would be far simpler and clearer than the current fee-for-service model that bills individually for many aspects of treatment. Billing rates could also be made consistent across providers through state regulated rates rather than through individual negotiations between providers and insurers.

These are just some of the ways the health care system can streamline nonclinical elements instead of relying on market principals to contain health care costs. Ultimately, we stand to gain more through collaboration than competition or consolidation.

Gus Meyer is a licensed psychologist and former member of the Gifford Health Care Board of Directors.