1. What does care look like in Addison county now?
Addison County is ranked one of the healthiest counties in Vermont. In 2020, 6% of people under the age of 65 did not have health insurance. This is a greater percentage than Vermont as a whole (5%), but a lower percentage than the overall U.S. (10%).
The ratio of people per primary care physician is 860:1 (reported for 2020) and the ratio for dental physicians is 1960:1 (reported for 2021). For mental health providers, that ratio is 300:1 (reported for 2022).
This is especially of note because 15% of adults in Addison county reported experiencing poor mental health for 14 or more of the last 30 days in 2020. Additionally, 1,657 hospital stays per 100,000 people enrolled in Medicare might have been prevented by outpatient treatment. This indicates that preventative care is lacking, and could be essential in ensuring better overall health and less pressure on the small, local hospital, Porter Medical Center. Interestingly, although Addison County is one of the healthiest, 28% of adults age 18 or older had a high body mass index, which is considered obese. In all, these healthcare stats indicate that Addison County has significant room for improvement in overall health and preventative care.
Looking at child care in Addison county, between the years of 2017 and 2021, 16% of children lived in a single parent household.
The average household spent 27% of its income on child care for two children.
In public schools, 29% of children were eligible for free and reduced lunch in 2021, indicating that they come from a low-income household. In the face of these statistics, it is clear that child care is likely not feasible for many households in Addison county, or bears a significant burden when it is necessary, given its high cost.
All of these statistics were taken from a report published by County Health Rankings & Roadmaps, sponsored by the University of Wisconsin Population Health Institute.
https://www.countyhealthrankings.org/explore-health-rankings/vermont/addison?year=2023.
2. Why is universal healthcare essential?
According to the United Nations reports on the Sustainable Development Goals, “ the global proportion of the population with out-of-pocket health spending exceeding 10 percent of their household budget was on the rise [before the COVID-19 pandemic], exceeding 13 per cent. With the combined health and economic impacts of the pandemic, people are likely to face greater financial constraints on access to care and among those paying out of pocket for health, financial hardship is likely to worsen further, particularly among already disadvantaged populations” (Sustainable Development Goals). In the face of this threat of increasing inequalities, it is essential that healthcare does not become a resource that is only feasible for some people.
3. Conceptual ideas for solutions
- Reclaim Public Services
Healthcare and childcare should become public services that are accessible to all regardless of income. For many countries, this is already a reality. According to Hudson’s Global Residence Index, all but 43 countries in the world offer free or universal healthcare to at least 90% of citizens (International Citizens Insurance, 2023). The United States is the only industrialized country in the world without universal healthcare for all citizens. With our current economy and governance in the U.S., care is generally privatized. This system benefits the wealthy at the expense of the poor, and creates serious disadvantages for lower-income families and individuals. As the Santiago Declaration for Public Services puts so well, “the commercialization and privatization of public services and the commodification of all aspects of life have driven growing inequalities and entrenched power disparities, giving prominence to profit and corruption over people’s rights and ecological and social well-being,” (Santiago Declaration for Public Services, 2023). Looking toward a new future which addresses the polycrisis we find ourselves in, it will be essential to provide more public services to minimize the gaps caused by income inequality.
- Rights-based Economy
Proponents for a rights-based economy point out that the current economy relies on humans to function, which means that there is not a healthy economy without a healthy population. In transitioning to an economy which revolves around human rights, “ it is essential that we offer free healthcare to all,” (Donald, 2021). We can do so by reclaiming public services and turning healthcare into a resource accessible to all regardless of income.
- Health Equity
The Health Equity Tracker is an organization and movement fighting for health equity. Health equity “exists when all people, regardless of race, sex, sexual orientation, disability, socio-economic status, geographic location, or other societal constructs have fair and just access, opportunity, and resources to achieve their highest potential for health.”.
The political determinants of health involve the systematic process of structuring relationships, distributing resources, and administering power, operating simultaneously in ways that mutually reinforce or influence one another to shape opportunities that either advance health equity or exacerbate health inequities.
The social determinants of health are the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Childcare reform
In many countries, there is universal affordable childcare through subsidies, extensive prekindergarten programs, and paid family leave.
Our current system in the U.S. has three main issues (Gould et al. 2017):
- Lack of resources for parents to stay home with very young children
- Lack of access to affordable early care and education
- Low and uneven quality of early child care and education options
In order to address these issues, policy reform should be the first priority. According to the report by Gould et al., there are certain principles that policy proposals should address in order to actually create a more just system.
| Family leave should be: – Available to all with parental responsibilities, not just mothers – Of sufficient duration (no less than three months [Gault et al. 2014]) – Accompanied by adequate wage replacement (approaching 100 percent for the lowest-wage workers) |
| Child care costs should: – Be capped at a manageable share of family income – Be affordable for low- and middle-income families, relieving the cost burden equitably across incomes |
4. Local organizations working on the issue
Health Services Available in Middlebury
- Dr. Dynasaur – healthcare insurance for children, teens up to age 18, and pregnant women, who meet income qualifications. Apply online at VermontHealthConnect.gov.
- Vermont Medicaid – a government health insurance program for eligible seniors 65 or older, people who are blind or disabled, children, pregnant women and parents.
- Mental Health and Emergency Services – provides 24-hour emergency services to individuals experiencing a mental health crisis, such as depression, acute anxiety, suicidal or homicidal thinking or behavior, family problems, increased symptoms or onset of symptoms of mental illness, and alcohol or drug emergencies.
Vermont’s Health Care Advocate HelpLine
They can:
- tell you what free and lower-cost programs you may be eligible for
- help you apply for and get free and lower-cost health coverage
- find out what your health plan covers
- provide advice about how to solve billing problems and make complaints
- work for fair treatment and affordable health services for everyone
The Office of the Health Care Advocate is not an insurance company and is not part of the Vermont state government. It is a special project within Vermont Legal Aid, an independent non-profit law firm.
United Way of Addison County: Promoting Health
Missions:
- Increasing access to quality healthcare for under-and uninsured people
- Providing clothing, equipment, and experiences to children living in poverty that allows them to get outside all year long to play with their classmates and friends
- Working toward the elimination of physical, sexual, and emotional violence through direct service, education, and social change
- Investing in substance use disorder prevention, treatment, and recovery
https://unitedwayaddisoncounty.org/promoting-health
Health services locations in/near Middlebury
- Porter Medical Center – Middlebury – 24-hour emergency services, comprehensive medical care, inpatient and rehabilitation care, a network of physicians and a nursing home.
- Open Door Clinic – a free health clinic for uninsured and under-insured adults in Addison County, located in the Porter Medical Center. Clinic is by appointment only.
- Mountain Health Center – Bristol – a community health center providing access to primary care, dental care, and mental health services. A sliding fee scale guarantees health care to everyone regardless of ability to pay. Certified Application Counselors are also on-site to help people apply for healthcare on Vermont Health Connect
- Counseling Service of Addison County (CSAC)
Vermont Senate just passed new child care bill on March 30, 2023
What does this mean?
- Legislation that would increase child care subsidies by more than $120 million a year.
- A new payroll tax to support the biggest increase in child care funding in state history.
- It would improve quality by increasing compensation for early childhood educators.
- By substantially increasing state aid to the parents of young children, according to Hardy, Vermont will simultaneously improve affordability for parents and boost revenues to the home- and community-based centers that provide care.
- The legislation also includes a universal paid leave program that would allow new parents to take up to 12 weeks of work to bond with a newborn.
Countries With Free or Universal Healthcare. International Citizens Insurance. 2023.
Donald, Kate. Spotlight on Sustainable Development 2021 (Global Civil Society Report on the 2030 Agenda and the SDGs): A rights-based economy. In critical times, a roadmap for action. (Pp. 81-84)
Gould, Elise, Austin, Lea J.E., and Whitebook, Marcy. What does good child care reform look like? Economic Policy Institute. March 29, 2017.
Gault, Barbara, Heidi Hartmann, Ariane Hegewisch, Jessica Milli, and Lindsey Rechlin. 2014. Paid Parental Leave in the United States: What the Data Tell Us about Access, Usage, and Economic and Health Benefits. Institute for Women’s Policy Research.
Progress Towards Sustainable Development Goals- Report of the Secretary-General. Sustainable Development Goals. United Nations Department of Economic and Social Affairs.
https://sdgs.un.org/goals/goal3
Santiago Declaration for Public Services. January 26, 2023.