UVM professor’s new book reveals lobbying’s impact on health costs – Valley News

Report on the Influence of Lobbying on Healthcare Policy and Sustainable Development Goals

Introduction: Healthcare Accessibility and SDG 3

An analysis of the book “Pre-Existing Conditions: How Lobbying Makes American Health Care More Expensive” by University of Vermont professor Alex Garlick reveals significant barriers to achieving Sustainable Development Goal 3 (Good Health and Well-being). The research indicates that industry lobbying inflates healthcare costs, directly undermining the SDG 3 target of universal health coverage. While policies like the Affordable Care Act (ACA) aim to make insurance more accessible through subsidies, they often fail to address the fundamental high cost of care itself, a problem exacerbated by political influence.

Analysis of Systemic Barriers to Sustainable Healthcare

The report identifies two primary mechanisms through which industry influence obstructs progress toward equitable and affordable healthcare, impacting multiple SDGs.

Structural Power and its Conflict with SDG 10 (Reduced Inequalities)

Professor Garlick introduces the concept of “structural power,” where dominant market players disproportionately influence policy. This concentration of power creates systemic challenges to achieving SDG 10 (Reduced Inequalities) by limiting competition and maintaining high costs that disproportionately affect vulnerable populations.

• Case Study: Vermont: The UVM Health Network’s dominance in the state’s small economy exemplifies structural power. When regulators attempted to limit budget growth, the network responded by cutting services, demonstrating its capacity to resist cost-containment measures.
• Impact on Equity: Such power dynamics ensure that healthcare costs continue to rise, making essential services less accessible for lower-income individuals and deepening health-related inequalities.

Informational Bottlenecks and SDG 16 (Peace, Justice and Strong Institutions)

The healthcare industry leverages control over complex information to influence legislation, which compromises the integrity of governance and hinders the development of strong, accountable institutions as outlined in SDG 16.

• Legislative Dependence: Lawmakers with limited capacity or specialized knowledge often become dependent on industry lobbyists for information, leading to policy decisions that favor industry revenues over public health outcomes.
• Quantitative Impact: Research presented in the book suggests a direct correlation between the presence of lobbyists and increased healthcare expenditure, with each lobbyist adding an estimated $7 per capita in additional costs. This highlights a systemic weakness in institutional accountability.
• Regulatory Challenges: Even with transparent bodies like Vermont’s Green Mountain Care Board, the limited duration of legislative sessions creates an “informational bottleneck,” making it difficult to enact comprehensive reforms.

Recommendations for Aligning Healthcare Reform with Sustainable Development

To counteract these challenges and advance the SDGs, a multi-faceted approach is necessary, focusing on strengthening infrastructure, governance, and collaborative action.

1. Enhance Healthcare Infrastructure and Community Resilience (SDG 3 & SDG 11):
   • Increase the supply of hospitals and clinics to mitigate the effects of market concentration and improve access, particularly in rural areas.
   • Leverage federal funding, such as the $50 billion for “rural health transformation,” to build a more robust and decentralized healthcare system.
   • Address related community needs, such as affordable housing for medical staff, to support the long-term sustainability of the healthcare workforce and align with SDG 11 (Sustainable Cities and Communities).
2. Strengthen Governance and Foster Partnerships (SDG 16 & SDG 17):
   • Empower independent regulatory bodies to rein in costs and push back against the structural power of large healthcare networks.
   • Promote the formation of regional state coalitions to develop collective solutions and increase bargaining power against industry interests, embodying the principles of SDG 17 (Partnerships for the Goals).
   • Increase the capacity of state legislatures to analyze complex health data independently, reducing reliance on industry lobbyists and strengthening institutional integrity (SDG 16).

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being:
   • The entire article focuses on the accessibility and affordability of healthcare in the United States, specifically referencing the Affordable Care Act, the high cost of care, and the role of insurance. It directly addresses the challenge of ensuring healthy lives and promoting well-being.
2. SDG 10: Reduced Inequalities:
   • The article discusses policies like the Affordable Care Act’s tax credits, which are designed to make health insurance more affordable for more people. This relates to reducing inequalities in access to essential services like healthcare.
3. SDG 11: Sustainable Cities and Communities:
   • The text explicitly mentions the lack of housing options for hospital workers in Vermont as a key problem affecting the healthcare system. This connects directly to the goal of ensuring access to adequate and affordable housing.
4. SDG 16: Peace, Justice and Strong Institutions:
   • A central theme is the influence of lobbying on health policy, which undermines the development of effective, accountable, and transparent institutions. The article discusses the role of regulators like the Green Mountain Care Board and the capacity limitations of state legislatures, highlighting challenges in institutional governance.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The discussion revolves around the Affordable Care Act, tax credits to make insurance affordable, and the high cost of care itself. The article notes that while subsidies make insurance more affordable, they don’t address the underlying cost of care, which is a key component of achieving universal health coverage and financial risk protection. The mention of a hospital cutting services after a budget dispute also relates to access to quality essential services.
2. Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.
   • The debate over continuing “expanded tax credits for Affordable Care Act marketplace plans” is a direct example of a fiscal and social protection policy aimed at reducing inequality in healthcare access.
3. Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums.
   • The article identifies the inability of medical and hospital employees to find housing as a critical issue that makes it “difficult for (hospitals) to attract and retain staff.” This directly points to the need for adequate and affordable housing to support essential community services.
4. Target 16.6: Develop effective, accountable and transparent institutions at all levels.
   • The article analyzes the “informational bottlenecks” and capacity issues within the Vermont state legislature, which lead to a “dependence on lobbyists.” It also highlights the Green Mountain Care Board as a regulatory institution that collects and publicizes financial data from hospitals, promoting transparency.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For Target 3.8 (Universal Health Coverage):
   • Health care costs: The article repeatedly mentions the high cost of health care as a primary problem. Tracking overall healthcare expenditure per capita would be a direct indicator.
   • Affordability of health insurance: The use of tax credits and subsidies is a measure of efforts to make insurance affordable. The number of people utilizing these subsidies could be an indicator.
   • Availability of services: The article mentions that a hospital “cut services” in response to budget limits, implying that the number and type of available medical services is a measurable indicator of access.
2. For Target 10.4 (Equality through Social Policy):
   • Government spending on social protection: The continuation and value of “expanded tax credits for Affordable Care Act marketplace plans” is a specific, measurable fiscal policy indicator.
3. For Target 11.1 (Affordable Housing):
   • Housing availability and affordability for key workers: The article implies that the ability of hospitals to “attract and retain staff” is linked to housing. Therefore, staff retention rates and housing vacancy/cost data in relevant areas could serve as indicators.
4. For Target 16.6 (Effective Institutions):
   • Influence of lobbying on policy: The article quantifies this by stating that “Each individual lobbyist in a state ends up costing people roughly $7 per capita in additional health care costs.” The number of registered lobbyists and their declared spending are measurable indicators.
   • Transparency of public institutions: The article mentions that the Green Mountain Care Board “collects financial data from hospitals and insurers, which it makes public.” The availability and accessibility of this data is an indicator of institutional transparency.

4. Table of SDGs, Targets, and Indicators

Source: vnews.com