RICHFORD — U.S. Sen. Bernie Sanders, I-Vt., toured the fourth floor expansion of Northern Tier Center for Health’s (NOTCH) center in Richford Monday morning, before holding a town hall with seniors in St. Albans.
Sanders wanted to talk about health care and Social Security, while questioners brought up Pres. Donald Trump and the state of the Democratic Party.
NOTCH is an official Federally Qualified Health Center (FQHC), a community-based organizations that provide comprehensive primary and preventive care, including health, oral and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.
In 2016, NOTCH received approximately $725,000 in federal funds to add two dental care operating rooms, office space for patient accounts, care coordination and outreach teams, storage space, a meeting room and a teaching kitchen to the top floor of its location on Main Street in Richford.
“One of the areas in health care that is largely neglected in this country is dental care,” said Sanders, outside one of the new operating rooms. “Here is a small community, and Pam can tell you better than I, where the need for dental care is very significant.”
“Now matter how we expand, we seem to always keep our chairs full and there's people who need the care,” said Pam Parsons, executive director of NOTCH.
In addition to expanding dental care, NOTCH has also become involved in the treatment of opiate addiction, hiring Dr. Edward Haak to broaden their treatment program.
“So we're not just prescribing a medication, but we're helping them make a new start in their life,” said Parsons. “It is time consuming and a big dedication and I must say, he's very committed to it and we're pleased.”
Sanders asked about the extent of the epidemic locally.
“Senator, the problem is overwhelming,” Haak replied. He said when he came on board and developed a program, within two weeks, the program filled to capacity at 100 patients. “We had, within the next two weeks, 150 [people] on the waiting list and we have since stopped taking people on the waiting list,” he said.
“So within a month, you had signed up either actively or on a waiting list, 250 people in this rural community?” Sanders clarified.
“Yeah,” said Haak, “and there is no one in the community right now that's taking new patients.”
He said a new hub was created in St. Albans because the state identified 250 patients receiving treatment in either the Burlington or Newport hub and could save on transportation by doing so.
Haak said a foundational element of NOTCH’s program is to not just treat the addiction, but to help the patient in all areas of their life. “We don't just treat them with a fish called suboxone,” he said. “We try to help them learn how to fish and work with them on their life and getting their life together.”
“I'm in recovery myself,” said Haak. He said treatment didn’t work for him until he had a solid foundation and changed his way of life completely.
Parsons said NOTCH’s goal is to stabilize the 100 patients and eventually move them onto one of six primary care providers in NOTCH.
Haak said NOTCH is trying to create a mini hub and spoke model at the FQHC level. He said with additional funding, he would like to create a recovery center as well, that both community members and patients can access.
Sanders asked if the community does a good enough job in the schools explaining the addictive nature of opioids to children.
“I don't know,” said Parsons, because NOTCH isn’t, “but yes, that should be a conversation that's happening.”
Perry said children mimic what they see. She said in her opinion, it’s more important to show children healthy habits and ways of life than to give them a lecture on the dangers of drug addiction.
“We can do the work here, but we are very dependent on everything you do because it’s only contributions and left over funds that'll pay for the longevity or the prevention or the summer camps,” said Perry.
“The point being here when you guys take a dollar, you make it go a very, very long way,” said Sanders.
“It's the Vermont way,” chorused a few members of the NOTCH staff at the table.
What would have meant to this FQHC and the others in Vermont and around the country if Medicaid was cut by $800 billion, asked Sanders.
“It would be devastating,” said Parsons. She said NOTCH, which has multiple local offices, most likely would have had to close a location.
Thirty two percent of patients who come to community health centers in Vermont are on Medicaid, said Tess Stack Kuenning, the president of Bi-State Primary Care Association.
“Not to mention nursing homes,” added Sanders. “Not to mention rural hospitals. If the Republican plan had gone through, it would have been absolutely devastating.”
Haak added that more than 90 percent of patients receiving treatment from opioid addiction are on Medicaid.
“Thank god we were able to defeat this disastrous Republican proposal of cutting Medicaid by $800 billion and throwing [millions of] people off health insurance,” said Sanders, on his way out of the Richford Health Center. “That proposal would have been an absolute disaster for this community health center.”
Medicare for all
Arriving in St. Albans, Sanders turned to his own health care proposal: Medicare for All.
Addressing two rooms full of seniors crowded into the Franklin County Senior Center, he began with Republican efforts to repeal and replace the Affordable Care Act (ACA) and proposed cuts to Medicaid.
“The Republicans came out with what I thought was an outrageous proposal,” said Sanders. “We’re going to throw 23 million Americans off of the health insurance they currently have. Can you imagine that?”
“Nobody thinks it’s perfect,” Sanders said about the ACA. But it added more than 20 million people to ranks of the insured and ended the “obscenity” of pre-existing conditions, he said. Prior to the ACA, health insurance companies routinely refused to cover people for conditions they had before purchasing the insurance.
The ACA has not addressed the rising costs of health care, in his view, including high deductibles and co-pays and the “outrageous cost of prescription drugs.”
Sanders has proposed a bill to allow pharmacies, distributors and individuals to purchase prescription drugs from other countries at significantly lower cost. Such a move could save the government billions, he said.
Sanders asked the crowd where health care should go in the future, receiving replies such as “Medicare for all” and “single payer.”
His question led to an exchange with a woman from Canada. “You’re Canadian and you’re still alive,” Sanders observed, pointing out that U.S. critics frequently deride the Canadian system.
“How much do you pay to go to the doctor?” he asked.
“Nothing,” she answered.
He asked what she pays for hospital visits and received the same answer. Prescription drugs are significantly less, so much so that Sanders has in the past taken busloads of area residents to Canada to buy medication.
“Every other major country on earth… what they all have said is health care is a right of all people,” said Sanders.
He pointed that the U.S. spends $10,000 per person per year for health care, far more than other countries. Canadians spend less than half of that amount.
Despite spending more, the U.S. often has worse outcomes, ranking behind other developed countries in both infant and maternal mortality. Life expectancy is also lower here than every country in Western Europe, according to the Organization for Economic Cooperation and Development 2016 data.
“Are we getting good value for what we’re spending? The answer is no,” said Sanders.
The reason American health care cost so much, he suggested, is because of the money flowing to corporations, particularly drug and insurance companies.
The five largest pharmaceutical companies made a combined $50 billion last year while one in five Americans can’t afford prescription drugs, said Sanders.
Administrative overhead and the need to fight with insurance companies about coverage also adds to costs, he suggested.
In his view the solution to America’s health care problems lays with Medicare, created in 1965 as part of Pres. Lyndon Johnson’s Great Society. While not perfect, Medicare has accomplished much of its mission, said Sanders.
He will be introducing legislation to create a Medicare-for-all system in the U.S.
“I will be attacked for that,” said Sanders. “We’re threatening all of the corporations that make hundreds of millions of dollars off of the current system.”
Asked by Carol Ostrander about the power of lobbyists and how citizens can help, Sanders said, “I don’t think I will shock anyone in the room if I tell you the system is corrupt.”
Drug and insurance companies “have unbelievable amounts of money,” he said, and they spend it defending their interests. There are more pharmaceutical industry lobbyists in Washington than members of Congress, said Sanders.
Sanders also addressed another concern of seniors: Social Security.
Social Security has $2 trillion in its trust fund. The trust fund was created in the 1980s to save for the retirement of the Baby Boom generation. Previously, Social Security had made payments entirely from the revenues collected each year with a payroll tax.
With the trust fund, Social Security can continue to pay 100 percent of all benefits for the next 17 years. Thereafter, it would have to rely on yearly revenues, which would reduce benefits to 75 percent of those earned, explained Sanders.
Currently, people only pay Social Security taxes on the first $127,000 of income. Thus, someone who makes $5 million a year pays the same Social Security tax as someone who makes $127,000.
Sanders advocated removing the cap and using the additional money to expand benefits. “There are many people in the state of Vermont… who are trying to survive on $12,000, $13,000 per year,” he said.
Republicans have advocated raising the retirement age, instead, and reducing benefits by changing the inflation measurement used to determine benefit increases to chained-CPI, an inflation index lower than the one currently used. Chained-CPI, said Sanders, is just a fancy way of saying reduced benefits.
Terje Anderson of Montgomery asked about cuts to Social Security disability insurance in President Trump’s proposed budget.
“I don’t want to deal with him at great length,” said Sanders. “What really bothers me is the extent to which he has lied to the American people.”
Trump promised to be a champion of working people, but has instead proposed cuts to programs that benefit them such as funding for afterschool programs, nutrition programs, and heating assistance, Sanders explained.
“Think about the programs that help working people and those are cut,” he said. “The Trump budget was an outrage. It was an assault on children, working families and the poor.”
Trump’s tax reform proposals primarily benefit the wealthy, said Sanders, citing the proposed elimination of the estate tax. That tax is paid on inherited property by the top of one-tenth of one percent, said Sanders.
Cutting the estate tax would cost the U.S. Treasury $200 billion over 10 years, said Sanders.
“Don’t think for a moment the majority of the American people agree with his views,” Sanders said of the President. “We just saw in Charlottesville the people who do.”
Asked about the Democratic Party, Sanders said, it is “starting to move in our direction” with support for $15 minimum wage, a $1 trillion investment in infrastructure, increasing support for tuition-free public colleges, and efforts to address climate change.
But it isn’t enough for Democrats to be for progressive policies, he suggested. “You have to have the courage to be against something. You have to have the courage to take on the pharmaceutical companies, the fossil fuel companies and Wall Street.”
“What the fight is about is whether in the wealthiest country in the history of the world we take care of the people in need. Trump is clear about which side he is on,” said Sanders.