by Joseph Blanchette
Local Vermont media recently lavished coverage on Vermont House Bill 202, which would establish the country’s first state-wide single-payer health system. They paid little attention, however, to a nearly identical bill, H-808, which declared “essential levels of nutrition” as a basic human right of all Vermonters, and will give state government increased control over the purchase, distribution and cost of food.
Vermont, you see, faces a crisis. Fatty foods, sweets, trans-fats, and empty-calorie foods and beverages not only waste available nutrition dollars, but often lead to serious chronic and costly conditions like diabetes and heart disease. Such food related diseases will have a devastating impact on the state’s global health care budget. According to one H-808 sponsor, “people are spending too much money on unhealthy foods at the same time others are going without. The market has failed and this craziness must stop.”
Vermont has the dual problem of high levels of obesity as well as unacceptable numbers of residents who are undernourished. Access to adequate, affordable, high-quality food isn’t shared equally by Vermonters. Many towns don’t have sufficient grocery capacity. Others have too much. Some residents must drive over thirty minutes to buy food. Grocery prices have become unacceptably high for many residents, forcing them to choose between paying for food or other household expenses. According to one legislator, “Large grocery chains and multi-nationals are more concerned about profits than putting food on kitchen tables. Once we can get the middlemen out of the picture, we can dramatically lower food costs.”
In order to reduce the administrative costs found in the current grocery system and eliminate duplicate providers, H-808 establishes an independent, five-person Nutritional Quality Board, appointed by the governor. Considered state employees, Board member responsibilities include limiting the growth of spending for food across the state, negotiating prices with providers, and planning the fair distribution of food stuffs. In addition, the Board will develop the “Essential Nutrition Diet Guidelines” for Vermonters, select healthy foods for grocery shelves, set fair prices for food products and determine Vermont’s annual Global Nutritional Budget. Commenting on Board authority, another sponsor said, “We can’t control health care costs without controlling the cost and over-consumption of food.”
H-808 is designed to meet legislative goals of improving the diet and health of the population, enhancing the consumer nutritional experience, eliminating obesity and malnutrition, and reducing the amount and cost of food consumption in Vermont to sustainable levels. To that end, in order to fund the new Vermont Nutrition Fund, the Board will work with legislators to identify progressive financing sources. When asked about the program costs, however, the lead sponsor said, “We don’t have the answers, frankly, but we’ll have really smart people figuring this out.” Because ability to pay should never interfere with a person’s right to essential nutrition, however, anyone making under $43,320 (400 percent of federal poverty level) will be exempt from contributing to the Nutrition Fund.
The Vermont Access to Nutrition Exchange (VANE) will provide the mechanism by which Vermonters will secure their Individual Nutritional Diet Card (INDC), a grocery debit card. Based on caloric intake guidelines, each resident’s card will receive an annual nutrition spending account to pay for groceries approved by the state Nutritional Quality Board (NQB). The Exchange will also coordinate the equitable distribution of grocery products statewide, enforce of the Global Nutritional Budget and oversee the Nutritional Coordinator Specialist (NCS) program. This program establishes county panels of nutritional therapists who will track individual food purchases through an electronic database, and identify residents who need nutritional counseling or grocery providers who fail to follow state product and pricing guidelines.
If you’ve read this far, I hope you’re thinking, “This is crazy!” And you’d be right. Fortunately for Vermonters, H-808 doesn’t really exist. But unfortunately, H-202 does. If you substitute the words “health care” and “medical services” for “nutrition” and “food”, you will get the gist of what Vermont politicians have in store as the “fix” for our health care system. They think empowering a small number of appointed technocrats to design, manage, and regulate Vermont’s health care system will make things better. Implementing a centralized system of control and oversight of nutrition would surely send the quality and quantity of food spiraling downward, and costs and shortages skyward. The same will happen with health care. In fact, government’s failed intrusion into health care over the past fifty years should be painfully instructive to all. Even more government control and less consumer freedom is not the answer.
(Joseph Blanchette was a Howard Dean appointee to Vermont’s Health Policy Council and the Public Oversight Commission as a labor/consumer representative. As a former Vermont-NEA Benefits Director, he also served as a fiduciary and co-manager of a non-profit health insurance purchasing trust serving public school employees. He lives in Vermont and is a board member of the Ethan Allen Institute.)