Inaugural address of  Howard Dean, M.D.  As it appears in the  Journal  of the  JOINT ASSEMBLY  BIENNIAL SESSION  2001    Thursday, January 4, 2001 Inaugural Address  “Mr.  President, Mr.  Speaker,  members  of  the  General  Assembly,  members  of  the  Vermont  Supreme  Court and fellow Vermonters:  “Governor Robert Stafford -- in a Christmas speech made 40 years ago -- extolled our future: ‘We  are  justified  in  having  great  faith  in  Vermont.  She  will  surely  continue  to  grow  economically  and spiritually. She will continue  to provide us with a place  in which democracy can  flourish,  in which we can  live with comfort and dignity, and in which our children can enjoy an abundant life.’ “Governor Stafford,  it gives me great pride  to  stand before you  today and  say: Your  faith  in our Vermont  is justified.  Forty  years  later,  Vermont  continues  to  provide  us  with  a  place  in  which  democracy  flourishes,  in which we live in relative comfort and dignity, in which our children enjoy a more abundant life.  “It  is  not  the  same  state  you  governed  42  years  ago.  The  population  has  nearly  doubled;  the  General  Fund budget  has  increased  ten-fold.  Interstates  run  border  to  border,  turning  the  drive  from  New  York,  Boston  and Montreal into an easy day trip. Our economy is dependent upon events far beyond our borders. “In  1986,  when  I  went  to  my  first  meeting  of  the  Vermont  Trappers’  Association  in  Tunbridge,  we  talked about  anti-trapping  bills  and  loss  of  habitat.  This  past  summer,  at  the  Trappers’  meeting  in  Barton,  the discussion  was  about  the  price  of  pelts  in  Russia.  Whether  we  approve  or  not,  Vermont  is  integrated  into  a global economy. “What  we  treasure  most  –  our  values  and  our  self  respect  --  have  been  tested,  but  remain  unchanged. Governor  Stafford,  we  are  the  same  Vermonters  you  spoke  of  40  years  ago  when  you  said  our  challenges require great strength, inspired wisdom, fortitude, forbearance, and self discipline. We are the same Vermonters you  spoke  of  this  fall  when  you  reminded  us  that  ‘everyone  in  the  country  is  better  off  living  under  a  society based upon love of each other.’ These remain the guiding principles that continue to shape Vermont’s destiny. “For  a  long  and  wonderful  career  as  Vermont  Attorney  General,  Lieutenant  Governor,  Governor,  United States  Representative,  United  States  Senator,  and  now  Senior  Statesman,   I  ask  Robert  Stafford  and  his  wife Helen to stand and be recognized. “We  walked  into  the  Statehouse  today  after  a  difficult  –  at  times  contentious  –  election.  We  entered  that election after a difficult – at times contentious – legislative session.  “But we need not walk into this Statehouse today a divided Legislature. “We  are  teachers,  farmers,  social workers  and  business  owners.  We  are  employers  and  employees. We  are old and young. We are liberal, conservative and everything in between. We are neighbors; and we are friends. “I  am  a  doctor  who  believes  that  every  Vermonter  deserves  affordable  health  care.  I  am  a  father  with  two children  in  the  public  schools  who  is  dedicated  to  a  better  public  education  for  all  Vermonters.  I  am  a  hiker determined to preserve our most beautiful landscapes and to improve our lakes, streams and rivers. “At this moment we are not divided. We are Vermonters. “At  this moment we  are  united  in  one mission:  To  ensure  that when we  leave  this  Statehouse  in April,  this state  remains  a  place where  democracy  flourishes, where we  can  live with  comfort  and  dignity,  and where  our children can enjoy an abundant life.  “I have observed  in  this building –  in one  capacity or  another  since 1983 –  that  the most  effective  and most wonderful  pieces  of  legislation  happen  when  people  disregard  their  party  affiliation  and  work  together  so  that great  things  may  be  accomplished.  That  is  very  hard  work,  and  we  will  not  always  agree.  But  even  our disagreements are part of this democratic process. Everyone will be heard;  not everyone will get their way.  “I urge us all never  to  take our differences personally, and never  to  lose sight of  the goal  that each one of us share.  “Former Governor Phil Hoff said in 1965: ‘Ours is a time not of triumph but of dedication. We meet here not as exponents of party but as stewards of hope. We share a sacred trust, the future of our great state. Let us draw that future in bold strokes with confidence in our mission.’ “Today  we  are  the  stewards  of  our  future.  Let’s  work  together  in  the  best  tradition  of  Vermont  to  chart  a thoughtful, moderate course -- respectful of all, but as Abraham Lincoln urged, ‘with malice towards none.’  “Over  the  past  25  years,  we  have  crafted  extraordinary  legislation  which  has  brought  us  to  the  forefront  in areas  such  as  equality  of  opportunity  in  education,  stringent  environmental  protection,  nationally  recognized health care programs  for children, working Vermonters and seniors, as well as human  rights. We cannot  retreat from these principles. “Next  week  I  will  give  my  annual  budget  address.  Because  policy  and  budget  are  so  closely  tied,  you  will hear  my  thoughts  on  where  much  of  the  state’s  policy  regarding  education,  economic  development  and environmental  protection  should  go.  We  will  spend  a  lot  of  our  energy  in  this  session  on  reforming  these achievements, such as Act 250 and Act 60, and preparing to move them into the 21st Century. “But  just as Bob Dylan said, ‘Those who are not busy being born are busy dying.’  It  is not enough for us  to spend  this  legislative  session  rehabilitating  and  retooling  past  legislative  achievements.  We  must  have  an achievement to call our own.  “I  propose  that  our  achievement  –  the  achievement  of  this  biennium  –  is  to  design  and  implement  a  better system of health care in Vermont.  “Health care presents us with three problems. The first is that costs are going up at two or three times the rate of inflation. This makes it difficult for Vermonters to buy health insurance, particularly those who either own or work  for  small  businesses.  The  second  is  availability.  Even  those  210,000  Vermonters  with  publicly  financed insurance  –  120,000  on  Medicaid  and  90,000  on  Medicare  –  have  an  access  problem.  This  comes  in  part because  the  state underpays providers  for  their  services and because  in  some areas of  the  state  there  are  simply not enough providers.  “Finally, we have one of the lowest number of uninsured citizens in the country. But if you are one of those 6 percent working hard  to  support your  family, working  for an employer who cannot afford health  insurance,  the fact that you are one of only 6 percent does not pay the doctor’s bill.  “This  biennium  our  goals  for  health  care  are  finding  ways  to  control  costs,  helping  small  businesses  afford private  coverage  for  their  workers,  and  making  government-guaranteed  insurance  for  children,  seniors  and working Vermonters sustainable.  This also means assuring access to health care for every Vermont citizen.  “We will  never  control  costs without  universal  access.  Vermont  deserves  a  health  care  system where  small business  men  and  women  are  not  bankrupted  by  trying  to  treat  their  employees  responsibly,  and   Vermont deserves a system where all Vermonters have access to health insurance and to health care. “First  and  most  importantly,  this  is  what  Vermonters  are  asking  for  --  like  the  141  employees  at  the  firm Tivoly in Derby Line, who wrote me recently saying: ‘The  rising  cost  of  our  health  care  has  gotten  to  the  point we  are  forced  to make  a  decision whether  to  pay these  exorbitant  premiums  or  gamble  our  families  will  remain  healthy.  People  are  scared  and  rightly  so.  The working  class  people  should  never  be  put  in  this  position  of  choosing  between  food  and  medicine.  ...  We  at Tivoly  are  looking  at  an  uncertain  future  at  the  moment.  What  must  we  sacrifice:  food,  fuel  for  heating  our homes, gambling with no health insurance, or just maybe losing everything we’ve worked all our lives for.’ “This the cost of doing nothing: Uncertainty, insecurity and sacrifice. “Secondly,  this  is a balanced  Legislature, a blend of  the political spectrum  that working  together can craft a balanced  and  thoughtful  plan  for  ending  the  uncertainty,  insecurity  and  sacrifice  voiced  by  those  Tivoly employees. “This  need  not  be  a  partisan  issue.  On  every  legislator’s  desk  I’ve  distributed  an  article  from  the  October issue  of  the  Atlantic  Monthly  which  talks  of  an  extraordinary  meeting  between  Rep.  Jim  McCrery,  a conservative  Republican  from  Shreveport,  Louisiana,  and  Rep.  Jim  McDermott,  a  liberal  Democrat  from Seattle, Washington. After  listening  to  these  two political opposites voice  a  commitment  to health  care  reform, author Matthew Miller wrote: ‘The  story  of  the  coming  ‘grand  bargain’  on  health  care  is  one  of  Democrats  accepting  the  existence  of  a private insurance industry and Republicans accepting the need to help make sure that everyone can buy a decent policy.  It  is  a  story  of  liberals  agreeing  that  innovation  shouldn’t  be  regulated  out  of  U.S.  health  care  and conservatives agreeing  that  justice has  to be regulated  into it.  It is possible,’ Miller continued, ‘because an old-time  single-payer  liberal  and   a  conservative  Republican  sat  down  with  me  and  proved  that  the  thing  can  be done.’  “We are fortunate in Vermont. We have a strong health care system. The quality of our care is ranked second in  the  nation.  Although  our  insurance  premiums  have  gone  up,  they  still  remain  among  the  lowest  in  New England. “Nonetheless,  in  Vermont  and  in  America  as  a  whole,  we  have  continued  to  postpone  making  the  kind  of changes we  need  to make. We  need  to  address  cost  shift. We  need  to  address  cost  control. We  need  to  address access for all Vermonters.  “This  is  a  particularly  important  time  to  tackle  these  issues.  We  are  beginning  a  period  of  decrease  in  our economic  vitality, when  the  growing  challenge will  be  to  consolidate  our  current  gains  in  health  care  and  help strengthen access for businesses and individuals to viable and affordable health insurance. “As  I  look back over  the decade  I have  served you  as governor,  some of  the best  social  legislation has been signed into law because the frugality of the early 1990s required us to focus on prevention and forward-thinking policy.  Success  by  Six,  the  expansion  of  Dr.  Dynasaur,  and  welfare  reform  were  all  careful  products  of  a Legislature  which  knew  that  it  could  not  solve  problems  by  creating  big-spending  programs.  The  results  of these  efforts  are  extraordinary:  a  nearly  50  percent  decrease  in  child  abuse,  a  43  percent  decrease  in  teen pregnancy, and a 47 percent decrease in the number of Vermonters receiving welfare benefits. “All  of  these  were  done  when  we  knew  we  could  not  spend  a  lot  more  to  meet  our  objectives.  This  is  a Legislature  which  will  not  have  great  recurring  surpluses  to  spend  on  new  programs.  But  this  is  another opportunity to make social progress in a fiscally responsible and sustainable way. “Let me  talk  for  a moment  about what will not work. Vermont  has  a  system  of  community  rating where  all age groups are charged  the same  for  their coverage, despite  the fact  that older people use more health care  than younger people. Some insurance companies left the state because they wanted to avoid insuring older people so they could make plenty of money by only covering low-risk Vermonters. Eliminating community rating will not make  health  insurance  more  affordable  or  more  accessible.  It  will  simply  add  on  another  cost  shift,  causing those  employees  over  50  and  their  employers  to  pay  even  more  money  so  that  costs  can  be  reduced  for  those under 35. I don’t believe Vermonters want this solution. “Our challenge is to find solutions that will work.  Thanks to the hard work of our Congressional delegation, and because we are one of the states which is closest to achieving universal access to health insurance, Vermont has  received  a  $1.3  million  grant  which  will  help  us  chart  a  course  toward  universal  health  insurance  in  our state.  That  report  will  be  due  next  October,  but  we  cannot  wait  until  next  fall  to  deal  with  this  issue.  Small businesses  and Vermont  ratepayers  cannot  afford  another  20  percent  increase;  6  percent  of Vermonters  cannot afford to live with the uncertainty of no health coverage. “I have deliberately avoided laying out the specifics of how I believe our three goals of cost control, reducing the cost shift and universal access should be achieved. I want this to be our plan, not my plan.  “I  can  promise  you my  support, my  hard work  and my  leadership  in  achieving  these  goals. But  I  cannot  do this without your support, your hard work and your leadership.   “Today I will ask the chairs and vice chairs of the House and Senate Health and Welfare Committees to join two of my appointees on  the Governor’s Special Commission on Health Care, which will be chaired by  former Human Services Secretary Cornelius Hogan. This bipartisan group will analyze data and  travel  the state  talking to  employers  and  others  concerned with  rising  health  care  costs  to  find ways we  can  achieve  the  dual  goals  of controlling costs and guaranteeing universal access.  “We  have  this  unique  opportunity  today  precisely  because  the  recent  elections  have  empowered  both Republicans  and Democrats  to  sit  at  the  table. Everybody  has  a  voice  in  this  process. No  one  party  can  dictate the outcome.  “In  addition,  on  February  12  I  will  co-convene  a  small  business  meeting  with  the  Vermont  Chamber  of Commerce  and  employers  from  across  the  state  to  discuss  health  care  costs.  I  invite  the  Speaker  and  the Committee on Committees to send representatives to that meeting, or to attend themselves. “In  the  budget  address  you  will  see  an  additional  $8  million  set  aside  from  our  recurrent  surplus  simply  to cover  the state’s health care obligations. This has nothing  to do with how many health  insurance companies are in  Vermont.  For  example,  our  own  state  employees’  rates  went  up  an  average  of  33  percent  last  year  and  are expected  to  rise  an  average  of  20  percent  this  year. We  are  self-insured. The  insurance market  plays  no  role  in setting our rates. We are simply state employees – and like most Vermonters – are using more health care.  “We  have  increased  reimbursement  for  doctors  in  recent  years  because  of  the  enormous  inflation  in  health care costs, but we cannot afford  to  continue  that unless physicians  and hospitals  agree  to  lower  the growth  rate in  their budgets. Addressing  the cost shift could slow  insurance premium growth, but without fiscal restraint on the  part  of  providers  and  drug  companies  we  will  simply  be  adding  new  revenues  to  a  system  which  already consumes  nearly  15  percent  of  our  gross  national  product.  In  Vermont,  that  means  increases  of  three  or  four times the rate of inflation.  “I am willing to make a good faith effort to address the cost shift. But in return, we must have a guarantee of lower budget growth and better efficiency in our medical system. “The reduction of the cost shift, however, is simply a first step. The real goals must be better cost controls so that  small  business  can  continue  to  offer  health  insurance  as  a  benefit,  and  universal  insurance  for  all Vermonters. “As  Rep.  McCrery  and  Rep.  McDermott  discovered  when  they  sat  down  together  in  Washington,  only  by casting  aside  ideologically  driven  visions  can  we  accomplish  what  our  people  deserve.  This  is  not  a conservative or a liberal issue. This is a Vermont issue. “In 1974, Governor Tom Salmon told the Legislature: ‘Let  us  never  forget  that  Vermont  is  more  than  the  Governorship  and  the  General  Assembly.  It  is  the  sum total  of  the  toil  and  the  hopes  and  aspirations  of  every  human  being  who  resides  within  our  borders.  It  is  the farmer who gets up long before sunrise to tend to his herd; the housewife in the kitchen canning the fruits of the harvest;  the  lineman  who  climbs  poles  covered  with  ice  to  fix  wires  during  the  storm;  the  truck  driver  who drives  while  we  sleep  so  that  we  may  have  food  on  our  table;  the  teacher  and  the  clergyman  who  tend  to  the young and comfort the afflicted.  ‘All  of  these  and  a  thousand  more  are  the  sum  total  of  what  Vermont  is,  and  with  God  helping,  what Vermont will always be.’ “Let  us  sit  down,  Republican  and  Democrat,  independent  and  Progressive,  conservative  and  liberal,  and think of those people we were sent here to serve.  “We are the stewards. This is our future to paint in bold strokes ... and with confidence.  “Thank you.”